Herzschrittmachertherapie & Elektrophysiologie

, Volume 16, Issue 3, pp 159–164 | Cite as

Asymptomatisches Vorhofflimmern bei systematischem Screening mittels Tele-EKG

—Bedeutung für die Antikoagulation bei paroxysmalem Vorhofflimmern
  • M. Patten
BEITRAG ZUM THEMENSCHWERPUNKT

Zusammenfassung

Die Entwicklung der Telemetrie und ihr vermehrter Einsatz in der Rhythmologie haben in letzter Zeit erheblich dazu beigetragen, das Auftreten von Rhythmusstörungen besser und zeitnaher zu erkennen. In einer kürzlich veröffentlichten Studie wurde ein Tele-EKG-Monitoring an über 1000 Patienten mit symptomatischem paroxysmalen Vorhofflimmern eingesetzt. Hierbei zeigte sich, das sowohl unbehandelt als auch unter antiarrhythmischer Medikation davon ausgegangen werden kann, dass Rezidive von Vorhofflimmern häufiger auftreten als bislang angenommen, da sie in über 50% der Fälle asymptomatisch verlaufen. Somit stellt die subjektive Beschwerdesymptomatik der Patienten kein geeignetes Surrogat zur Erfassung von Vorhofflimmerepisoden dar.

Mit den heute verfügbaren Antiarrhythmika kann keine vollständige Rezidivfreiheit erzielt werden. Hingegen, wird durch eine Absenkung der Herzfrequenz unter antiarrhythmischer Therapie das Auftreten stummer Vorhoffllimmerepisoden eher begünstigt. Unter diesen Gesichtspunkten sollte bei Patienten mit paroxysmalem Vorhofflimmern die Indikation zu einer begleitenden effektiven Antikoagulation auch dann gestellt werden, wenn sie antiarrhythmisch behandelt werden. Die Entscheidung über die Indikation und die Wahl der Antikoagulation sollte letztlich in Abhängigkeit vom Alter, den Begleiterkrankungen sowie dem individuellen Thromboembolierisiko des Patienten getroffen werden.

Schlüsselwörter

Tele-EKG Paroxysmales Vorhofflimmern Antikoagulation 

Asymptomatic atrial fibrillation during systematic screening with a Tele-ECG—Meaning for anticoagulation in paroxysmal atrial fibrillation

Summary

Event recorder monitoring plays an important role in the early detection and diagnosis of rhythm disorders such as atrial fibrillation (AF). In a recent study over 1000 patients with symptomatic paroxysmal AF were followed up by daily and symptom triggered ECG self monitoring. Independent of the presence of antiarrhythmic therapy, the incidence of AF was much higher than expected, since over 50% of AF episodes were asymptomatic. Therefore, patients symptoms are not a reliable surrogate parameter for the detection of AF. Moreover, antiarrhythmic therapy does not totally prevent atrial fibrillation, but raises the risk of silent AF episodes by reducing the mean heart rate. Based on these findings, effective anticoagulation should be taken into consideration in patients with paroxysmal AF independent of antiarrhythmic medication. The decision for anticoagulation with cumarine derivates or aspirin is dependent on the age, underlying diseases, and the individual thrombembolic risk in these patients.

Key words

Tele-ECG paroxysmal atrial fibrillation anticoagulant therapy 

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Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • M. Patten
    • 1
  1. 1.Universitäres Herzzentrum Hamburg, III. Med. Klinik für Kardiologie und AngiologieHamburgGermany

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