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Elektrische Isolation des linken Vorhofohrs

Nutzen und Risiko

Electrical isolation of the left atrial appendage

Benefits and risks

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Zusammenfassung

Das linke Vorhofohr (LAA) ist eine Ausstülpung aus dem linken Vorhof (LA), die anatomische und physiologische Abweichungen vom linken Atrium aufweist. Verschiedene LAA-Morphologien werden unterschieden. Das LAA ist nicht nur hauptverantwortlich für intrakardiale Thromben, sondern auch Ursprungsort von Triggern, welche atriale Tachyarrhythmien bzw. Vorhofflimmern initiieren können. Insbesondere bei Patienten mit persistierendem oder lang anhaltend persistierendem Vorhofflimmern kann durch eine elektrische Isolation des LAA zusätzlich zur Pulmonalvenenisolation die klinische Erfolgsrate möglicherweise verbessert werden. Allerdings zeigte sich, dass eine elektrische LAA-Isolation auch unter Therapie mit oralen Antikoagulanzien in Abhängigkeit von der angewandten Ablationsstrategie zu einer erhöhten Rate von LAA-Thromben bzw. Thrombembolien führen kann. Somit sollte nach LAA-Isolation ein Vorhofohrverschluss mit dem Patienten diskutiert werden.

Abstract

The left atrial appendage (LAA) is an extension originating from the body of the left atrium. The LAA is derived from the primary atrium and shows anatomical and physiological deviations from the left atrium. Different LAA morphologies exist. The LAA is not only the most frequent origin of intracardiac thrombi, it also frequently shows triggers responsible for the initiation or maintenance of atrial tachyarrhythmia and atrial fibrillation (AF). Isolation of the LAA using radiofrequency energy in addition to isolation of the pulmonary vein has recently gained importance due to the potential for increasing the clinical success rates, particularly in patients with persistent and long-standing persistent AF; however, after LAA isolation the incidence of LAA thrombi and systemic thromboembolisms might be increased even under treatment with oral anticoagulants, depending on the ablation strategy used. Thus, mechanical occlusion of the LAA should be discussed with patients after electrical isolation of the LAA.

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Authors and Affiliations

  1. Medizinische Klinik für Kardiologie, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    B. Bellmann MD & A. Rillig MD

  2. Universitäres Herzzentrum Lübeck, Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland

    R. R. Tilz MD

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Correspondence to A. Rillig MD.

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Interessenkonflikt

A. Rillig received travel grants from Biosense, Hansen Medical and St. Jude Medical and lecture fees from St. Jude Medical and Boehringer Ingelheim and participated at the Boston scientific EP-fellowship. B. Bellmann participated at the Boston scientific EP-fellowship. R.R. Tilz received research grants from Hansen, Abbot, travel Grants: Abbot, Biosense Webster, Medtronic, Daiichi Sankyo, Sentrheart and speaker’s bureau/proctor honoraria: Biosense Webster, Medtronic, Biotronik, Pfizer, Abbot, Bristol-Myers Squibb; Bayer, Sanofi Aventis, AstraZeneca.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Bellmann, B., Tilz, R.R. & Rillig, A. Elektrische Isolation des linken Vorhofohrs. Herz 42, 364–372 (2017). https://doi.org/10.1007/s00059-017-4559-0

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