Der Internist

, Volume 54, Issue 5, pp 583–595 | Cite as

Vorhofflimmern

Aktuelle Empfehlungen zur Diagnostik und Behandlung
CME Zertifizierte Fortbildung
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Zusammenfassung

Vorhofflimmern ist bei Weitem die häufigste anhaltende Rhythmusstörung. Gehäuft tritt sie im hohen Alter auf. Patienten mit Vorhofflimmern benötigen fast immer eine Therapie mit oralen Antikoagulanzien und eine frequenzregulierende Behandlung. Zusätzlich sollten weitere kardiovaskuläre Erkrankungen sorgfältig behandelt werden, um die Gefahr kardiovaskulärer Komplikationen des Vorhofflimmerns zu verringern. Die meisten Patienten profitieren von einer frequenzregulierenden Therapie mit Medikamenten, welche die Reizleitung am AV-Knoten verlangsamen. Ziel ist eine Herzfrequenz in Ruhe von 100–110/min. Leiden Patienten unter Vorhofflimmern, ist eine rhythmuserhaltende Therapie mit Antiarrhythmika, Kardioversion oder Katheterablation indiziert. Die Wahl der rhythmuserhaltenden Maßnahme sollte nach Sicherheitserwägungen erfolgen. Ob der Erhalt des Sinusrhythmus jenseits einer Verbesserung von Symptomen die Prognose bei Vorhofflimmern verbessert, ist Gegenstand laufender Studien.

Schlüsselwörter

Vorhofflimmern Blutungen Schlaganfall Katheterablation Kardioversion Antiarrhythmika 

Atrial fibrillation

Current recommendations for diagnosis and treatment

Abstract

Atrial fibrillation (AF) is by far the most common arrhythmia. It occurs more often with increasing age. Patients with AF almost always require oral anticoagulants and a rate-control treatment. In addition, other cardiovascular diseases must also be carefully treated in order to reduce the risks of cardiovascular complications from AF. Most patients profit from rate-control treatment with drugs that slow the conduction of the electrical impulse through the AV node. The aim is a resting heart rate of 100–110/min. If patients suffer from AF whilst on optimal rate control therapy, rhythm-control treatment with antiarrhythmic drugs, cardioversion or catheter ablation is indicated. The choice of the rhythm-control therapy should be made based on safety considerations. Whether achieving sinus rhythm beyond improvement of symptoms improves the prognosis of AF is tested in ongoing trials.

Keywords

Atrial fibrillation Hemorrhage Stroke Catheter ablation Cardioversion Antiarrhythmic drugs 

Literatur

  1. 1.
    Kirchhof P, Auricchio A, Bax J et al (2007) Outcome parameters for trials in atrial fibrillation: executive summary: recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 28:2803–2817CrossRefGoogle Scholar
  2. 2.
    Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429Google Scholar
  3. 3.
    Samol A, Masin M, Gellner R et al (2012) Prevalence of unknown atrial fibrillation in patients with risk factors. Europace (online publiziert am 20. Dezember 2012)Google Scholar
  4. 4.
    Kaleschke G, Hoffmann B, Drewitz I et al (2009) Prospective, multicentre validation of a simple, patient-operated electrocardiographic system for the detection of arrhythmias and electrocardiographic changes. Europace 11:1362–1368PubMedCrossRefGoogle Scholar
  5. 5.
    Nabauer M, Gerth A, Limbourg T et al (2009) The registry of the German competence NETwork on atrial fibrillation: patient characteristics and initial management. Europace 11:423–434PubMedCrossRefGoogle Scholar
  6. 6.
    Dorian P, Cvitkovic SS, Kerr CR et al (2006) A novel, simple scale for assessing the symptom severity of atrial fibrillation at the bedside: the CCS-SAF scale. Can J Cardiol 22:383–386PubMedCrossRefGoogle Scholar
  7. 7.
    Kirchhof P, Curtis AB, Skanes A et al (2013) Atrial fibrillation guidelines across the Atlantic: a comparison of the current recommendations of the European Society of Cardiology/European Heart Rhythm Association/European Association of Cardiothoracic Surgeons, the American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society, and the Canadian Cardiovascular Society. Eur Heart J (im Druck)Google Scholar
  8. 8.
    Engdahl J, Andersson L, Mirskaya M, Rosenquist M (2013) Stepwise screening for atrial fibrilliation in a 75-year-old population – implications for stroke prevention. Circulation 127:930–937PubMedCrossRefGoogle Scholar
  9. 9.
    Ahmad Y, Kirchhof P (2013) Gone fishing (for silent atrial fibrillation). Circulation 127:870–872 (editorial comment)PubMedCrossRefGoogle Scholar
  10. 10.
    Watson T, Shantsila E, Lip GY (2009) Mechanisms of thrombogenesis in atrial fibrillation: Virchow’s triad revisited. Lancet 373:155–166PubMedCrossRefGoogle Scholar
  11. 11.
    Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992Google Scholar
  12. 12.
    Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891Google Scholar
  13. 13.
    Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151Google Scholar
  14. 14.
    Connolly S, Eikelboom J, Joyner C et al (2011) Apixaban in patients with atrial fibrillation. N Engl J Med 364:806–817Google Scholar
  15. 15.
    Kirchhof P (2012) How do we balance risk and benefit in a population at risk of both stroke and bleeding? Atrial fibrillation: current management. Dialogues Cardiovasc Med 17:197–205Google Scholar
  16. 16.
    Van Gelder IC, Groenveld HF, Crijns HJ et al (2010) Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 362:1363–1373Google Scholar
  17. 17.
    Calkins H, Kuck KH, Cappato R et al (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14:528–606PubMedCrossRefGoogle Scholar
  18. 18.
    Jahangir A, Lee V, Friedman PA et al (2007) Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 115:3050–3056PubMedCrossRefGoogle Scholar
  19. 19.
    Camm AJ, Lip GY, De Caterina R et al (2012) 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747Google Scholar
  20. 20.
    Lown B, Perlroth M, Kaidbey S et al (1963) Cardioversion of atrial fibrillation. A report on the treatment of 65 episodes in 59 patients. N Engl J Med 269:325–331Google Scholar
  21. 21.
    Kirchhof P, Eckardt L, Loh P et al (2002) Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. Lancet 360:1275–1279PubMedCrossRefGoogle Scholar
  22. 22.
    Kirchhof P, Mönnig G, Wasmer K et al (2005) A trial of self-adhesive patch electrodes and hand-held paddle electrodes for external cardioversion of atrial fibrillation (MOBIPAPA). Eur Heart J 26:1292–1297CrossRefGoogle Scholar
  23. 23.
    Schotten U, Verheule S, Kirchhof P, Goette A (2011) Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 91:265–325PubMedCrossRefGoogle Scholar
  24. 24.
    Kirchhof P, Andresen D, Bosch R et al (2012) Short-term versus long-term antiarrhythmic drug treatment after cardioversion of atrial fibrillation (Flec-SL): a prospective, randomised, open-label, blinded endpoint assessment trial. Lancet 380:238–246PubMedCrossRefGoogle Scholar
  25. 25.
    Apostolakis S, Oeff M, Tebbe U et al (2013) Flecainide acetate for the treatment of atrial and ventricular arrhythmias. Expert Opin Pharmacother 14:347–357PubMedCrossRefGoogle Scholar
  26. 26.
    Connolly SJ (1999) Evidence-based analysis of amiodarone efficacy and safety. Circulation 100:2025–2034PubMedCrossRefGoogle Scholar
  27. 27.
    Fabritz L, Kirchhof P (2010) Predictable and less predictable unwanted cardiac drugs effects: individual pre-disposition and transient precipitating factors. Basic Clin Pharmacol Toxicol 106:263–268PubMedCrossRefGoogle Scholar
  28. 28.
    Ahmed S, Rienstra M, Crijns HJ et al (2008) Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation: a randomized trial. JAMA 300:1784–1792PubMedCrossRefGoogle Scholar
  29. 29.
    Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666Google Scholar
  30. 30.
    Engdahl J, Andersson L, Mirskaya M, Rosenqvist M (2013) Stepwise screening of atrial fibrillation in a 75-year-old population: implications for stroke prevention. Circulation 127:930–937PubMedCrossRefGoogle Scholar
  31. 31.
    Ritter MA, Kochhauser S, Duning T et al (2013) Occult atrial fibrillation in cryptogenic stroke: detection by 7-day electrocardiogram versus implantable cardiac monitors. Stroke (im Druck)Google Scholar
  32. 32.
    Healey JS, Connolly SJ, Gold MR et al (2012) Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 366:120–129Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Institute for Biomedical ResearchUniversity of Birmingham Centre for Cardiovascular Sciences and SWBH NHS TrustBirminghamUnited Kingdom
  2. 2.Universitätsklinikum MünsterMünsterDeutschland
  3. 3.Kompetenznetz VorhofflimmernMünsterDeutschland

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