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Detektion von Vorhofflimmern beim Schlaganfall

Detection of atrial fibrillation after stroke

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Zusammenfassung

Etwa jeder 4. Schlaganfall ist Folge einer kardialen Embolie. Als Emboliequelle spielen Thromben, die sich im Rahmen von Vorhofflimmern besonders im linken Vorhof bilden, eine wesentliche Rolle. Die Detektion von bisher unbekanntem Vorhofflimmern ist eine wichtige klinische Herausforderung, da durch eine systemische Antikoagulation Rezidive von Thrombembolien bei Vorhofflimmern und damit die Häufigkeit erneuter Schlaganfälle signifikant reduziert werden kann. Bei allen Patienten mit kryptogenem Schlaganfall sollte neben einem Oberflächen-EKG ein 24-Stunden-EKG registriert werden, um paroxysmales Vorhofflimmern zu erfassen. Die Langzeitaufzeichnung sollte wegen einer höheren Detektionsrate, wenn möglich, zeitnah nach dem Schlaganfall erfolgen. Zudem ist es sinnvoll, bei dem initialen Bett-EKG-Monitoring auf der Schlaganfallstation sowie in Schrittmacherspeichern auf Vorhofflimmern zu achten. Die Indikation zu einem längeren EKG-Monitoring bis hin zu implantierten Ereignisrekordern muss noch individuell anhand der Vortestwahrscheinlichkeit von Vorhofflimmern (Patientendaten, Schlaganfalllokalisation) gestellt werden. Der Nutzen dieser Systeme wird in laufenden Studien untersucht.

Summary

Approximately every fourth stroke results from cardiac embolism. Atrial fibrillation has been recognized as a common cause for thromboembolic stroke. Detection of unknown atrial fibrillation is an important clinical challenge, as anticoagulation may effectively reduce the risk of recurrent ischemic stroke. In all patients with a cryptogenic stroke 24-h Holter monitoring should be performed in addition to a standard ECG to detect paroxysmal atrial fibrillation. In addition, it is useful to pay attention to atrial fibrillation during continuous bedside ECG monitoring on the stroke unit and in pacemaker interrogation. The indication for longer ECG monitoring by implantable loop recorders may be considered individually based on the expected probability of atrial fibrillation. The potential benefit of these devices is currently being evaluated in clinical trials.

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  1. Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    U.C. Hoppe

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Hoppe, U. Detektion von Vorhofflimmern beim Schlaganfall. Nervenarzt 82, 166–171 (2011). https://doi.org/10.1007/s00115-010-3112-7

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