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Vorhofflimmern auf der Intensivstation

Eigene Entität – spezielle Behandlung?

Atrial fibrillation in the ICU

Distinct entity—special treatment?

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Zusammenfassung

Vorhofflimmern („atrial fibrillation“, AF) ist mit 44–61 % aller Arrhythmien die häufigste Rhythmusstörung auf der Intensivstation. In der Akutphase ist die Erfolgsrate der elektrischen Kardioversion („direct current cardioversion“, DC-CV) von postoperativem AF mit höchstens 10–35 % sehr niedrig. Sechs Wochen nach der Entlassung wiesen aber 90 % der Patienten mit postoperativem AF wieder einen Sinusrhythmus (SR) auf. In sämtlichen Richtlinien wird die Frequenzkontrolle mit β-Blockern und Kalziumkanalblockern empfohlen. Frequenz und Rhythmuskontrolle sind bezüglich Outcome, Leistungsfähigkeit und Lebensqualität bei ambulanten Patienten nicht unterschiedlich. Die DC-CV wird bei Instabilität und Herzversagen empfohlen. Der Terminus resistentes AF wird für die spezielle Situation des durch eine DC-CV nichtbehebbaren AF ausschließlich in der Akutphase der kritischen Erkrankung empfohlen.

Abstract

Atrial fibrillation (AF) is the single most frequent arrhythmia in the intensive care unit, occurring among 44–61 % of all patients with arrhythmias in the intensive care unit. The success rate of electrical cardioversion (DC-CV) early after surgery is as low as 10–35 % in postoperative AF but 6 weeks after discharge 90 % are in sinus rhythm (SR). Several guidelines recommend rate control in these patients and rate control with β-blockers and calcium channel blockers is not inferior with respect to outcome, 6 min walk test, and quality of life. DC-CV is recommended in unstable and heart failure patients. The term resistant AF is suggested for that distinct situation of AF not amenable to cardioversion solely in the acute phase of critical illness.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. G. Heinz gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Kardiologie, Intensivstation 13H3, Universitätsklinik für Innere Medizin II, Währinger Gürtel 18–20, 1090, Wien, Österreich

    G. Heinz

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Heinz, G. Vorhofflimmern auf der Intensivstation. Med Klin Intensivmed Notfmed 108, 549–554 (2013). https://doi.org/10.1007/s00063-012-0141-y

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