Medikamentöse Rhythmuskontrolle bei Vorhofflimmern

Schwerpunkt

Zusammenfassung

Eine medikamentöse Rhythmuskontrolle von Vorhofflimmern wird entweder als Akut-therapie zur Konversion von neu aufgetretenem Vorhofflimmern oder zur Rhythmuskontrolle zum Erhalt des Sinusrhythmus bei paroxysmalem Vorhofflimmern eingesetzt. Die Wahl des jeweils geeigneten Antiarrhythmikums richtet sich nach dem Vorhandensein bzw. Fehlen einer strukturellen Herzerkrankung. Eine leitliniengerechte Antikoagulation muss beachtet werden. Für die Akut-therapie können Flecainid, Propafenon, Vernakalant oder Amiodaron eingesetzt werden. Häufig ist eine Kombination mit einem b-Blocker oder Verapamil zur Frequenzverlangsamung erforderlich. Bei der chronischen medikamentösen Rhythmuskontrolle können, je nach struktureller Herzerkrankung, Klasse-IC-Antiarrhythmika – Sotalol, Dronedaron oder Amiodaron – gegeben werden. Bei Patienten ohne strukturelle Herzerkrankung mit seltenem paroxysmalem Vorhofflimmern kann eine sog. Pill-in-the-pocket-Therapie durchgeführt werden, bei der die Patienten selbst eine Kardioversion durch die Einnahme von Flecainid oder Propafenon durchführen. Trotz der Überlegenheit der Katheterablation zum Erhalt des Sinusrhythmus, behält die medikamentöse Rhythmuskontrolle ihren Stellenwert, da sie schnell und einfach einsetzbar ist. Proarrhythmien müssen bei dieser Therapie immer beachtet und vermieden werden.

Schlüsselwörter

Vorhofflimmern Rhythmuskontrolle Kardioversion „Pill in the pocket” Antiarrhythmika 

Medicinal rhythm control in atrial fibrillation

Abstract

Medicinal antiarrhythmic therapy is either used in the acute setting to convert atrial fibrillation to sinus rhythm or as chronic medication to preserve sinus rhythm if a rhythm control strategy is followed. The choice of the antiarrhythmic agent is based on the presence or absence of structural heart disease. In addition, oral anticoagulation should be established according to current guidelines. In the acute setting the armamentarium comprises flecainide, propafenone, vernakalant and amiodarone. Usually, combination therapy with an atrioventricular (AV) node slowing drug (a beta blocker or verapamil) is used. For chronic rhythm control a class IC drug, such as sotalol, dronedarone and amiodarone is given depending on the comorbidities. In the absence of structural heart disease, rare episodes of paroxysmal atrial fibrillation can be treated by a pill-in-the-pocket strategy, i.e. self-administered pharmacological cardioversion with flecainide or propafenone. Despite recent advances in catheter ablation of atrial fibrillation, medical rhythm control continues to play an important role due to its ubiquitous availability and relatively easy use. The risk for proarrhythmia has to be evaluated in all patients.

Keywords

Atrial fibrillation Rhythm control Cardioversion Pill in the pocket Antiarrhythmic drugs 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.CCB, Cardioangiologisches Centrum BethanienAgaplesion Markus-KrankenhausFrankfurt a. M.Deutschland

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