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Neue Antiarrhythmika in der Therapie des Vorhofflimmerns

I. Ionenkanalblocker

New antiarrhythmic drugs for therapy of atrial fibrillation: I. Ion channel blockers

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Summary

During the last ten years we have made substantial progress in our understanding of the underlying mechanisms of atrial fibrillation. The high rate associated alterations in electrical and structural properties of the atria, referred to as atrial remodeling, promote the progression of atrial fibrillation. The development of new therapeutic approaches addresses three different directions: (i) prevention of atrial remodeling, especially of structural remodeling; (ii) increase of long-term efficacy of currently used drugs and improvement of their side-effect profile; and (iii) design of atria- and pathology-specific antiarrhythmic drugs without concomitant proarrhythmic effects in the ventricles. The current review outlines the pathophysiology of atrial fibrillation and focuses on electrical remodeling. The properties of new antiarrhythmic drugs for atrial fibrillation are discussed in detail.

Zusammenfassung

Die vergangenen zehn Jahre haben einen rasanten Zuwachs in unserem Verständnis von den Mechanismen, die dem Vorhofflimmern zugrunde liegen, gebracht. Nach dem Einsetzen von Vorhofflimmern treten bereits innerhalb kurzer Zeit elektrophysiologische und strukturelle Veränderungen (Remodeling) auf, die die Progredienz dieser Rhythmusstörung maßgeblich verstärken. Die Entwicklung neuer Therapieansätze verfolgt drei Ziele, nämlich 1. Verhinderung von Remodeling, insbesondere von strukturellem Remodeling, 2. Verbesserung von zugelassenen Antiarrhythmika hinsichtlich Wirksamkeit und Nebenwirkungsprofil, und 3. Entwicklung von Vorhof- bzw. Pathologie-selektiven Antiarrhythmika, um ventrikuläre proarrhythmische Effekte zu vermeiden. In der vorliegenden Übersicht werden die Pathophysiologie und das elektrische Remodeling bei Vorhofflimmern erörtert. Nachfolgend werden die Eigenschaften neuer, speziell für die Therapie des Vorhofflimmerns entwickelter antiarrhythmischer Substanzen im Einzelnen diskutiert.

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Authors and Affiliations

  1. Technische Universität Dresden, Institut für Pharmakologie und Toxikologie, Medizinische Fakultät Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany

    U. Ravens, E. Wettwer & D. Dobrev

  2. Department of Physiology, Universität of Maastricht, Maastricht, The Netherlands

    U. Schotten

  3. Klinik für Kardiologie, Medizinische Fakultät der Universität Tübingen, Tübingen, Germany

    R. Weßel

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  1. U. Ravens
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  2. E. Wettwer
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  4. R. Weßel
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Ravens, U., Wettwer, E., Schotten, U. et al. Neue Antiarrhythmika in der Therapie des Vorhofflimmerns. Herzschr. Elektrophys. 17, 64–72 (2006). https://doi.org/10.1007/s00399-006-0512-2

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