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Therapeutisches Management des nichtvalvulären Vorhofflimmerns

Update 2013

Therapeutic management of non-valvular atrial fibrillation

Update 2013

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Zusammenfassung

Jeder Zehnte der über 65-Jährigen in der westlichen Welt wird von Vorhofflimmern betroffen sein. Wichtigstes Ziel bei Patienten mit Vorhofflimmern ist die Verhinderung thrombembolischer Komplikationen durch eine suffiziente und am Risikoprofil (CHA2DS2-Vasc-Score) des Patienten ausgerichtete Antikoagulation sowie die Behandlung zusätzlicher kardiovaskulärer Erkrankungen. Der Leidensdruck bestimmt das weitere Therapiekonzept. Dabei kann der/die behandelnde Arzt/Ärztin eine frequenzkontrollierende Strategie mit einer maximalen Ruheherzfrequenz von 110/min und/oder rhythmuserhaltende Methoden wie Kardioversion, Antiarrhythmika und Katheterablation einsetzen, um die Symptome des Patienten zu mindern. Inwiefern der Erhalt des Sinusrhythmus bei Vorhofflimmerpatienten die Prognose verbessert, wird in laufenden Studien derzeit untersucht.

Abstract

In western countries one in ten of elderly persons (> 65 years old) will develop atrial fibrillation. The main goal in atrial fibrillation therapy is the prophylaxis of thromboembolic complications through anticoagulation according to the individual risk profile (CHA2DS2-Vasc score) of patients and treatment of cardiovascular comorbidities. Symptoms during atrial fibrillation guide the further therapeutic concept. Doctors can deploy a rate control strategy with a heart rate at rest less than 110/min and/or a rhythm control strategy with cardioversion, antiarrhythmic drugs and catheter ablation to alleviate complaints. To what extent maintaining the sinus rhythm improves the prognosis of atrial fibrillation patients is part of ongoing trials.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Bode gibt an, dass kein Interessenkonflikt besteht. P. Sommer ist Referent für St. Jude Medical, Siemens, Bayer, Biotronik, BMS/Pfizer und Boehringer Ingelheim. P. Sommer ist Berater für St. Jude Medical und Boehringer Ingelheim. A. Bollmann erhält Vortragshonorare von St. Jude Medical, Biotronik, Sanofi-Aventis, Boehringer Ingelheim, Bayer, BMS/Pfizer und ist im Advisory Board für BMS/Pfizer tätig. G. Hindricks ist Referent für St. Jude Medical, Biosense Webster. G. Hindricks ist Berater für St. Jude Medical und Stereotaxis. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Rhythmologie, Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    K. Bode, P. Sommer, A. Bollmann & G. Hindricks

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  1. K. Bode
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Bode, K., Sommer, P., Bollmann, A. et al. Therapeutisches Management des nichtvalvulären Vorhofflimmerns. Herz 38, 743–758 (2013). https://doi.org/10.1007/s00059-013-3940-x

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