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Rhythmologische und metabolische Kontrolle

Rhythm and metabolic control

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Zusammenfassung

Diabetes mellitus und Vorhofflimmern (VHF) zeigen eine stetige Zunahme ihrer Prävalenz. Diabetes stellt einen relevanten, nicht zu unterschätzenden Risikofaktor für die Entstehung und Aufrechterhaltung von VHF dar. Im Rahmen eines Diabetes auftretende Schwankungen des Blutzuckerspiegels, inflammatorische Prozesse und oxidativer Stress führen zu strukturellen, elektromechanischen, elektrischen und autonomen Umbau-, d. h. Remodelling-Prozessen am Herzmuskel, welche VHF begünstigen. Wenn VHF und Diabetes aufeinandertreffen, ist dies häufig mit einer stärker ausgeprägten Symptomatik, einer geringeren Lebensqualität, häufigeren Hospitalisierungen und einer höheren Mortalität vergesellschaftet. Kann die frühe und konsequente euglykämische Blutzuckereinstellung atriale Remodelling-Prozesse, kardiovaskuläre Endpunkte und das Auftreten von VHF effektiv beeinflussen? Gibt es neue gemeinsame, medikamentöse Therapieansätze für die Behandlung von Diabetes und VHF? Welche Ablationsstrategie sollte bei der interventionellen Therapie von Vorhofflimmern bei Diabetespatienten gewählt werden? In diesem Übersichtsartikel wird versucht, Antworten auf diese Fragen zu finden.

Abstract

Diabetes mellitus and atrial fibrillation show a steady increase in their prevalence. Diabetes mellitus is a relevant risk factor for the development and maintenance of atrial fibrillation, which should not be underestimated. Fluctuations in blood glucose levels occurring in diabetes, inflammatory processes and oxidative stress lead to structural, electromechanical, electrical and autonomic remodelling processes in the myocardium that promote atrial fibrillation. When atrial fibrillation and diabetes mellitus coincide, this is often associated with more pronounced symptoms, lower quality of life, more frequent hospitalization and a higher mortality rate. Can early and consistent euglycemic blood glucose monitoring effectively influence atrial remodelling processes, cardiovascular end points and the occurrence of atrial fibrillation? Are there new and combined drug treatment approaches for diabetes mellitus and atrial fibrillation? What ablation strategy should be adopted for the interventional treatment of atrial fibrillation in patients with diabetes mellitus? This review article attempts to find answers to these questions.

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Authors and Affiliations

  1. Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    Denise Guckel,  Christian Sohns &  Philipp Sommer

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  1. Denise Guckel
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  2. Christian Sohns
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  3. Philipp Sommer
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Correspondence to Denise Guckel.

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Interessenkonflikt

D. Guckel, C. Sohns und P. Sommer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Guckel, D., Sohns, C. & Sommer, P. Rhythmologische und metabolische Kontrolle. Herz 47, 410–418 (2022). https://doi.org/10.1007/s00059-022-05128-4

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