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Elektrische und pharmakologische Frühkardioversion von Vorhofflimmern

Electrical and pharmacological strategies for early cardioversion of atrial fibrillation

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Summary

Cardioversion of atrial fibrillation as an element of rhythm control strategy is indicated in patients with first episode of atrial fibrillation, hemodynamic instability, recurrent atrial fibrillation with low probability of spontaneous conversion, or severe symptoms. Early cardioversion is performed within 48 h of onset of atrial fibrillation. The best point in time is still unknown. It can be performed by pharmacological, or, preferentially, by electrical cardioversion. The advantages of electrical cardioversion are higher efficacy and no proarrhythmic risk, however, short time general anaesthesia is needed. Electrical cardioversion is most effective when biphasic shocks are delivered. For pharmacological cardioversion, several antiarrhythmic drugs are available which have to be considered individually. Thrombembolic risk does not differ between the two methods. Early cardioversion and maintenance of sinus rhythm is most effective in atrial fibrillation of short duration, normal left atrial size and no or only mild structural heart disease.

Zusammenfassung

Die Kardioversion als Element der Rhythmuskontrolle ist indiziert bei Patienten mit erstmalig dokumentiertem Vorhofflimmern, ausgeprägter Symptomatik, rekurrierendem Vorhofflimmern ohne Spontankoversion oder hämodynamischer Instabilität. Die Frühkardioversion wird innerhalb von 48 Stunden nach Auftreten des Vorhofflimmerns durchgeführt, wobei der optimale Zeitpunkt hierfür derzeit noch unklar ist. Sie kann durch pharmakologische Kardioversion oder Abgabe von Elektroschocks erfolgen. Das bevorzugte Verfahren ist heutzutage die elektrische Kardioversion aufgrund höherer Effektivität und fehlendem proarrhythmischem Risiko, sie erfordert allerdings eine Kurznarkose. Die elektrische Kardioversion wird am erfolgreichsten unter Verwendung biphasischer Schockabgaben durchgeführt. Für die pharmakologische Kardioversion stehen mehrere Substanzen zur Verfügung, deren Einsatz abgewogen werden muss. Das Thrombembolierisiko unterscheidet sich bei beiden Verfahren nicht. Die größte Wahrscheinlichkeit für die erfolgreiche Wiederherstellung und den Erhalt des Sinusrhythmus besteht bei kurzer Vorhofflimmerdauer, bei normal großem linken Vorhof und bei fehlender oder nur geringgradiger struktureller Herzerkrankung.

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  1. Medizinische Klinik und Poliklinik II, Direktor: Prof. Dr. med. Georg Nickenig, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    M. Linhart &  T. Lewalter

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Correspondence to M. Linhart.

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Linhart, M., Lewalter, T. Elektrische und pharmakologische Frühkardioversion von Vorhofflimmern. Herzschr. Elektrophys. 17, 81–88 (2006). https://doi.org/10.1007/s00399-006-0514-0

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