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Was ist gesichert in der Therapie von Vorhofflimmern?

What is confirmed in the treatment of atrial fibrillation?

  • Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Vorhofflimmern ist die häufigste klinisch relevante Herzrhythmusstörung. Wichtige Ziele der Behandlung von Vorhofflimmern sind die Verbesserung der Lebensqualität und Linderung der Symptome sowie die Verhinderung eines Schlaganfalls. Neu in der aktuellen europäischen Leitlinie zum Vorhofflimmern von 2020 ist ein strukturiertes Vorgehen mit Einführung des 4S-AF-Schemas zur besseren Charakterisierung von Vorhofflimmern (4S: Einschätzung von Schlaganfallrisiko, Symptomschwere, Schweregrade der Vorhofflimmerlast sowie Substrat; AF „atrial fibrillation“/Vorhofflimmern) und des ABC-Pfads in der Therapie. Nach entsprechender Risikostratifizierung ist die Entscheidung über den Einsatz einer Antikoagulation zu treffen. Abhängig von Charakterisierung und Symptomatik des Vorhofflimmerns soll die Planung der weiteren Therapie hinsichtlich einer Symptomkontrolle erfolgen. Die rhythmuserhaltende Therapie mit Medikamenten oder Katheterablation gewinnt dabei auf Grundlage neuerer Studien gegenüber einer rein frequenzkontrollierenden Strategie an Bedeutung. Integrale Bestandteile der Therapie sind zudem die Identifizierung und Behandlung von Komorbiditäten und kardiovaskulären Risikofaktoren wie auch die Modifikation eines ungesunden Lebensstils.

Abstract

Atrial fibrillation is the most common clinically relevant cardiac arrhythmia. Important goals in the treatment of atrial fibrillation are improvement of the quality of life, relief of symptoms and the prevention of stroke. New in the current European guidelines on atrial fibrillation from 2020 is a structured approach with the introduction of the 4S-AF scheme (4S estimation of the risk of stroke, severity of symptoms, degree of severity of atrial fibrillation load and substrate, AF atrial fibrillation) for better characterization of atrial fibrillation and the ABC pathway in the treatment. The decision on the use of anticoagulation should be made after appropriate risk stratification. Depending on the characterization and symptoms of atrial fibrillation, the planning of further treatment should be made with respect to symptom control. Based on recent studies, rhythm-maintaining treatment by means of drugs or catheter ablation is gaining in importance over a strategy purely aimed at controlling the frequency. Integral components of treatment are also the identification and treatment of comorbidities and cardiovascular risk factors as well as the modification of an unhealthy lifestyle.

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Authors and Affiliations

  1. I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland

    Volker Liebe, Mathieu Kruska,  Daniel Dürschmied &  Ibrahim Akin

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  1. Volker Liebe
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  2. Mathieu Kruska
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  4. Ibrahim Akin
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Correspondence to Volker Liebe.

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Interessenkonflikt

V. Liebe: Honorar für jeweils einen Vortrag der Firmen Bayer (2021) und Daiichi Sankyo (2019). D. Dürschmied: Forschungsunterstützung von der Deutschen Forschungsgemeinschaft, CytoSorbents, Haemonetic; Beratungs- und Vortragshonorare von Bayer, Daiichi Sankyo, LEO Pharma, AstraZeneca, Boston Scientific und BMS-Pfizer. I. Akin: Vortragshonorare der Firmen Boston Scientific, Daiichi Sankyo und AstraZeneca. M. Kruska gibt 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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Liebe, V., Kruska, M., Dürschmied, D. et al. Was ist gesichert in der Therapie von Vorhofflimmern?. Innere Medizin 63, 1244–1249 (2022). https://doi.org/10.1007/s00108-022-01418-5

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  • DOI: https://doi.org/10.1007/s00108-022-01418-5

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