Herzschrittmachertherapie + Elektrophysiologie

, Volume 25, Issue 4, pp 210–213 | Cite as

Antiarrhythmic therapy of atrial fibrillation: are we treating too late?

Schwerpunkt
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Abstract

Atrial fibrillation (AF) is associated with increased risk for stroke, heart failure and mortality. The causality between worse prognosis and AF is not clear at this time and AF may just be expression of underlying heart disease that by itself is associated with increased morbidity and mortality. AF is characterized by progression from rare paroxysmal episodes to permanent AF. It has been well recognized that maintenance of sinus rhythm with either antiarrhythmic drugs or catheter ablation is easier to achieve if treatment is established early on. In addition to the established indication of symptomatic improvement, the focus of AF management is shifting to earlier intervention to prevent cardiovascular complications. This concept is currently under investigation in the ongoing EAST trial. Early treatment initiation is desirable from a pathophysiologic perspective. This includes consequent prevention and treatment of AF risk factors, efforts for early diagnosis, and stroke prevention according to the CHA2DS2-VASc score. As long as no data support prognostic advantages with “aggressive” rhythm control therapy it remains reserved for symptomatic patients, since both, medication and catheter ablation, convey a significant risk for complications.

Keywords

Atrial fibrillation Progression Early treatment Prevention of cardiovascular complications 

Antiarrhythmische Therapie von Vorhofflimmern – behandeln wir zu spät?

Zusammenfassung

Vorhofflimmern ist mit einem erhöhten Risiko für Schlaganfall, Herzinsuffizienz und Mortalität assoziiert. Die Kausalität zwischen ungünstiger Prognose und Vorhofflimmern ist allerdings zum jetzigen Zeitpunkt nicht gesichert, die Arhythmie ist möglicherweise nur Ausdruck einer fortgeschrittenen Grunderkrankung, die ihrerseits mit erhöhter Morbidität und Mortalität einhergeht. Vorhofflimmern ist durch eine Progression von seltenen Anfällen bis hin zur permanenten Form gekennzeichnet. Dabei ist ein Erhalt des Sinusrhythmus sowohl mit Antiarrhythmika als auch mit der Katheterablation erfolgreicher, wenn die Therapie möglichst früh beginnt. Neben der etablierten Indikation einer rhythmuserhaltenden Therapie mit dem Ziel einer Symptomlinderung rückt deshalb zunehmend eine frühe antiarrhythmische Therapie mit dem Ziel einer Vermeidung kardiovaskulärer Komplikationen in den Mittelpunkt. Diese These wird aktuell u.a. in der EAST Studie untersucht.

Ein möglichst frühzeitiger Therapiebeginn ist aus pathophysiologischer Sicht sinnvoll. Dazu gehört eine konsequente Prävention und Behandlung der Risikofaktoren, das Bemühen um möglichst frühzeitige Diagnosestellung und die Schlaganfallprävention nach CHA2DS2-VASc score. So lange keine Daten einen günstigen Effekt der Vorhofflimmertherapie „mit allen Mitteln“ belegen, bleibt es bei der Empfehlung zur rhythmuserhaltenden Therapie lediglich bei symptomatischen Patienten, denn sowohl Medikamente als auch die Katheterablation sind mit eigenen Risiken behaftet, die es abzuwägen gilt.

Schlüsselwörter

Vorhofflimmern Progression Frühe Therapie Prävention kardiovaskulärer Komplikationen 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Division of Clinical and Experimental Electrophysiology, Department of Cardiology and AngiologyUniversity Hospital MünsterMünsterGermany

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