Herz

, Volume 36, Issue 8, pp 688–695 | Cite as

Rhythmuschirurgie des Vorhofflimmerns und postoperatives Monitoring

Schwerpunkt/CME
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Zusammenfassung

Vorhofflimmern stellt im klinischen Alltag die häufigste Herzrhythmusstörung dar. Eine chirurgische Wiederherstellung eines Sinusrhythmus ist dann indiziert, wenn der kardiochirurgische Patient symptomatisch ist oder die Ablation bei asymptomatischen Patienten ohne erhöhtes postoperatives Risiko durchgeführt werden kann. Aufgrund der zunehmenden Anzahl an katheterbasierten Ablationsverfahren und der damit einhergehenden Therapiemisserfolge wird zukünftig die chirurgische „Stand-alone-Therapie“ als additive Ablation einen hohen Stellenwert besitzen. Um eine verbesserte Akzeptanz dieses chirurgischen Verfahrens zu erreichen, sollte die Therapie minimal-invasiv und mit einer hohen Erfolgsrate durchgeführt werden. Durch eine enge interdisziplinäre Zusammenarbeit von Elektrophysiologen und Kardiochirurgen kann durch Anwendung beider invasiver Ablationsstrategien ein deutlicher Synergieeffekt zur erfolgreichen und lang anhaltenden Terminierung des Vorhofflimmerns erzielt werden. Zur Dokumentation des Vorhofflimmerns nach Ablation sollten intermittierende Nachsorgestrategien wegen der dadurch möglichen Überschätzung des Therapieerfolgs vermieden werden. Durch Einsatz kleiner, subkutan implantierbarer Aufzeichnungsgeräte („loop recorder“) gelingt eine lückenlose Überwachung des Herzrhythmus und eine genaue Angabe der Vorhofflimmerbelastung des Patienten. Mittels dieser Technik ist eine auf den Patienten abgestimmte individualisierte Therapie möglich.

Schlüsselwörter

Vorhofflimmern Chirurgische Ablation Zusammenarbeit Rhythmusdokumentation Kontinuierliches Monitoring 

Surgical atrial fibrillation ablation therapy and postoperative monitoring

Abstract

Atrial fibrillation represents the most common atrial arrhythmia seen in clinical practice. The surgical treatment of atrial fibrillation is recommended in symptomatic patients as well as in asymptomatic patients at low postoperative risk. As a “stand alone” procedure, surgical ablation therapy is indicated after failed catheter ablation therapy, which occurs increasingly due to the high number of catheter-based ablation techniques. In order to gain acceptance among patients as well as referring cardiologists, the surgical ablation procedure ought to be performed in a minimally invasive fashion and with a very high success rate. When applied in an interdisciplinary approach by cardiologists/electrophysiologists and cardiothoracic surgeons, both ablative techniques have the potential to treat atrial fibrillation effectively and in the long-term. In order to document the true heart rhythm after ablation therapy, intermittent “snapshot” ECG documentation ought to be avoided. Small leadless devices that can be implanted subcutaneously enable full heart rhythm disclosure with documentation of atrial arrhythmias. The modern technique of implantable loop recorders permits individualized treatment for each patient.

Keywords

Atrial fibrillation Surgical ablation Team approach Heart rhythm surveillance Continuous monitoring 

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Copyright information

© Urban & Vogel, Muenchen 2011

Authors and Affiliations

  1. 1.Klinik für Herz- und thorakale GefäßchirurgieUniversitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland

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