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Der Internist

, Volume 49, Issue 12, pp 1437–1445 | Cite as

Die Behandlung von Vorhofflimmern im Alltag

  • T. Meinertz
  • S. Willems
Schwerpunkt: Was ist gesichert in der Therapie?

Zusammenfassung

Vorhofflimmern ist die häufigste Arrhythmie im Erwachsenenalter. Die Therapie hat sich in den letzten Jahren erheblich verändert. Basistherapie sind β-Rezeptorenblocker und – insbesondere bei struktureller Herzkrankheit – ACE-Inhibitoren bzw. AT1-Blocker. Klasse-1C-Antiarrhythmika (Flecainid bzw. Propafenon) sollen nur bei normaler oder leicht eingeschränkter linksventrikulärer Funktion eingesetzt werden. Für therapierefraktäre Patienten und solche mit deutlich eingeschränkter linksventrikulärer Funktion ist Amiodaron die derzeit einzig verbleibende medikamentöse Alternative. Patienten mit symptomatischen, aber seltenen Anfällen von Vorhofflimmern und normaler linksventrikulärer Funktion können mit einer sog. „Pill-in-the-pocket-Therapie“ behandelt werden.

Durch die 2006 publizierten europäischen und US-amerikanischen Leitlinien wurde die Katheterablation bei Vorhofflimmern in die „alltägliche Praxis“ eingeführt. Hochsymptomatische Patienten mit paroxysmalem oder kurz dauerndem anhaltendem Vorhofflimmern können unter folgenden Umständen mit der Katheterablation behandelt werden: Es besteht keine schwerwiegende Herzkrankheit, der linke Vorhof ist nicht wesentlich vergrößert und es besteht Therapierefraktärität oder Intoleranz gegenüber Antiarrhythmika. Bei allen anderen Patienten (z. B. solchen mit Herzinsuffizienz oder Herzklappenfehlern) ist die interventionelle Katheterablation von Vorhofflimmern derzeit experimentell und nur im Einzelfall als Heilversuch indiziert.

Schlüsselwörter

Vorhofflimmern Thromboembolieprophylaxe Antiarrhythmika Kurative Katheterablation 

Treatment of atrial fibrillation in every days practice

Abstract

Atrial fibrillation is the most common arrhythmia in the adult. During recent years the therapeutic strategy has markedly changed. Some of these changes can be summarized as follows: Basis therapy includes betablockers and – in patients with structural heart disease – ACE-inhibitors and AT1-Blockers respectively. Class 1C-antiarrhythmic agents (flecainide or propafenon) should be restricted to patients with no or minimal left ventricular impairment. Amiodaron is the drug of choice in patients refractory to class 1C-agents and in those with already reduced left ventricular function. The “pill-in-the-pocket” regime can be used successfully in patients without structural heart disease and rare episodes of atrial fibrillation.

Catheter ablation for paroxysmal and short lasting chronic atrial fibrillation was introduced into the clinical practice in 2006. The European and US-American guidelines recommend this technique for patients with no or minimal structural heart disease who are highly symptomatic and refractory or intolerant to antiarrhythmic agents. Decisions for curative catheter ablation in patients with long standing atrial fibrillation, heart failure or valvular heart disease should be individualized but are to date not generally recommended.

Keywords

Atrial fibrillation Thromboembolic prophylaxis Antiarrhythmics Curative catheter ablation 

Notes

Interessenkonflikt

Keine Angaben.

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Kardiologie und AngiologieUniversitäres HerzzentrumHamburgDeutschland

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