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Der katheterbasierte Vorhofohrverschluss – aktuelle Daten und künftige Entwicklungen

Catheter-based atrial appendage closure—current data and future developments

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Zusammenfassung

In Deutschland sind mehr als 1,6 Mio. Patienten von Vorhofflimmern (VHF) betroffen. Aufgrund der demografischen Entwicklung wird diese Zahl in den nächsten Jahren noch erheblich zunehmen. Patienten mit Vorhofflimmern erleiden unbehandelt 5‑mal häufiger einen Schlaganfall als eine gesunde Population. Eine potente Schlaganfallprävention kann heute insbesondere mit neuen oralen Antikoagulanzien (NOAK) durchgeführt werden, die das Schlaganfallrisiko um etwa 70–80 % senken können. Die Risikobewertungen für Schlaganfall (CHA2DS2-VASc) und Blutungen (HAS-BLED) zeigen überlappende Variablen, sodass Patienten mit dem höchsten Schlaganfallrisiko häufig auch ein hohes Blutungsrisiko aufweisen. Ein relevanter Anteil der Patienten (etwa 20–30 %) kann unter anderem aufgrund eines sehr hohen Blutungsrisikos nicht dauerhaft antikoaguliert werden. Für diese Patientenpopulation besteht ein dringender Bedarf an alternativen Schlaganfallpräventionsstrategien wie dem katheterbasierten Vorhofohrverschluss. Aktuelle Daten zur Effektivität und Sicherheit dieses Therapieverfahrens sowie die Diskussion laufender klinischer Studien sind Gegenstand dieser Arbeit.

Abstract

In Germany more than 1.6 million patients suffer from atrial fibrillation (AF). Within the next decades this number will substantially increase due to current demographic trends with the increasing average age of the population. When untreated, patients with atrial fibrillation have a five times higher risk for stroke as compared with a control cohort. A potent stroke prevention therapy reducing the risk of stroke by approximately 70–80% is primarily treatment with new oral anticoagulants (NOACs). The risk scores for stroke (CHA2DS2-VASc) and major bleeding (HAS-BLED) in patients with atrial fibrillation share common variables, so that patients with the highest stroke risk often carry a very high bleeding risk. A significant number of patients (ca. 20–30%) are, however, not eligible for long-term anticoagulation, e.g. because of a high bleeding risk. For this population there is an urgent need for alternative stroke prevention strategies, such as catheter-based percutaneous left atrial appendage closure. Current data about the efficiency and safety of this treatment as well as a discussion of ongoing recruitment for randomized studies are discussed in this review.

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Author information

Correspondence to Prof. Dr. U. Landmesser.

Ethics declarations

Interessenkonflikt

U. Landmesser hat Vortrags- und Beraterhonorare von Abbott und Boston Scientific erhalten. C. Skurk, J.J. Hartung und D.M. Leistner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

G. Hasenfuß, Göttingen

Caption Electronic Supplementary Material

Video 1: Transseptale Punktion (TEE)

Video 2: Darstellung des LAA mittels Fluoroskopie

Video 3: Implantation eines WatchmanTM-Okkluders

Video 4: Tug-Test

Video 5: Doppler-TEE-Kontrolle der Dichtigkeit nach Device-Implantation

Video 6: 3‑D-TEE zur Kontrolle der richtigen Lage des Devices

Video 1: Transseptale Punktion (TEE)

Video 2: Darstellung des LAA mittels Fluoroskopie

Video 3: Implantation eines WatchmanTM-Okkluders

Video 4: Tug-Test

Video 5: Doppler-TEE-Kontrolle der Dichtigkeit nach Device-Implantation

Video 6: 3‑D-TEE zur Kontrolle der richtigen Lage des Devices

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Cite this article

Skurk, C., Hartung, J.J., Leistner, D.M. et al. Der katheterbasierte Vorhofohrverschluss – aktuelle Daten und künftige Entwicklungen. Internist 59, 1028–1040 (2018). https://doi.org/10.1007/s00108-018-0483-5

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Schlüsselwörter

  • Vorhofflimmern
  • Vitamin-K-Antagonisten
  • Antikoagulanzien
  • Schlaganfallprophylaxe
  • Blutungen

Keywords

  • Atrial fibrillation
  • Vitamin K antagonists
  • Anticoagulants
  • Stroke prevention
  • Hemorrhage