Typisches Vorhofflattern
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Zusammenfassung
Vorhofflattern ist die häufigste atriale Makro-Reentry-Tachykardie. Die altersabhängige Inzidenz von Vorhofflattern verschiedener Ätiologie steigt von 5/100.000 (< 50 Jahre) bis zu etwa 600/100.000 bei über 80-Jährigen.
Bei Patienten mit Herzinsuffizienz oder Lungenerkrankungen tritt typisches Vorhofflattern gehäuft auf. Mit der Arrhythmie können Symptome wie Palpitationen, Belastungsminderung, Thoraxschmerz und Luftnot auftreten. Das Embolierisiko ist erhöht, so dass wahrscheinlich eine dem Vorhofflimmern analoge Antikoagulation erforderlich ist. Akut können eine Kardioversion oder eine medikamentöse Frequenzkontrolle zur Behandlung erfolgen. Die langfristige Therapie der Wahl ist die Katheterablation des cavotrikuspidalen Isthmus, der einen kritischen Bereich des rechtsatrialen Erregungskreises bildet. Die Ablation weist einen exzellenten akuten Erfolg in > 97 % der Fälle auf. Dabei ist die Komplikationsrate gering (0,5 %).
Dieser Beitrag ist der dritte Teil einer Serie zur gezielten Fortbildung im Bereich „Spezielle Rhythmologie – Invasive Elektrophysiologie“. Grundlagen, Klinik und Therapie des isthmusabhängigen Vorhofflatterns werden mit Fokus auf klinisch relevante Aspekte dargelegt. Vorgehensweise und Befunde der invasiven elektrophysiologischen Diagnostik und die Ablationsbehandlung bilden den Schwerpunkt dieses Artikels.
Schlüsselwörter
Herzrhythmusstörung Supraventrikuläre Tachykardie Cavotrikuspidaler Isthmus Katheterablation AntikoagulationAbkürzungsverzeichnis
- AV
atrio-ventrikulär
- CS
Koronarsinus
- CT
Crista terminalis
- CTI
cavotrikuspidaler Isthmus
- ER
Eustachische Falte
- IVC
Vena cava inferior
- LAO
links anterior oblique
- PPI
Post-pacing-Intervall
- RAO
rechts anterior oblique
- RV
rechtsventrikulär
- SVC
Vena cava superior
- TV
Trikuspidalklappe
- 3D
dreidimensional
Typical atrial flutter
Abstract
Typical, cavotricuspid-dependent atrial flutter is the most common atrial macroreentry tachycardia. The incidence of atrial flutter (typical and atypical forms) is age-dependent with 5/100,000 in patients less than 50 years and approximately 600/100,000 in subjects > 80 years of age. Concomitant heart failure or pulmonary disease further increases the risk of typical atrial flutter.
Patients with atrial flutter may present with symptoms of palpitations, reduced exercise capacity, chest pain, or dyspnea. The risk of thromboembolism is probably similar to atrial fibrillation; therefore, the same antithrombotic prophylaxis is required in atrial flutter patients. Acutely symptomatic cases may be subjected to cardioversion or pharmacologic rate control to relieve symptoms. Catheter ablation of the cavotricuspid isthmus represents the primary choice in long-term therapy, associated with high procedural success (> 97 %) and low complication rates (0.5 %).
This article represents the third part of a manuscript series designed to improve professional education in the field of cardiac electrophysiology. Mechanistic and clinical characteristics as well as management of isthmus-dependent atrial flutter are described in detail. Electrophysiological findings and catheter ablation of the arrhythmia are highlighted.
Keywords
Cardiac arrhythmia Supraventricular tachycardia Cavotricuspid isthmus Catheter ablation AnticoagulationNotes
Einhaltung ethischer Richtlinien
Interessenkonflikt
D. Thomas, L. Eckardt, H.L. Estner, M. Kuniss, C. Meyer, H.R Neuberger, P. Sommer, D. Steven, F. Voss und H. Bonnemeier geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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