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Vorhofflimmerablation: Wer kommt in Frage?

Atrial fibrillation ablation: who comes into consideration?

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Zusammenfassung

Die Ablation des Vorhofflimmerns ist seit der Einführung der Leitlinien von 2006 und der Überarbeitung 2007 ein in vielen elektrophysiologischen Zentren inzwischen durchgeführtes Standardverfahren. Bewährt hat sich die Form der Pulmonalvenenisolation, um eine Substratelimination fokaler Trigger zu erzielen. Aus dem pathophysiologischen Ablauf der Entwicklung des Vorhofflimmerns ergibt sich, dass eine frühzeitige Ablation bei Patienten mit paroxysmalem Vorhofflimmern die größten Erfolgschancen hat. Patienten mit persistierendem oder permanentem Vorhofflimmern zeigen demgegenüber eine deutlich geringere Erfolgsrate und bedürfen oft mehrerer invasiver Prozeduren. Eine Fortführung der antiarrhythmischen Pharmakotherapie ist deshalb gerade bei diesen Patientengruppen oft unvermeidlich. Der kurative Ansatz der Vorhofflimmerablation ist mit den bisherigen Techniken nur bei Patienten mit paroxysmalem Vorhofflimmern möglich.

Abstract

Atrial fibrillation ablation is, since the introduction of the guidelines in 2006 and which were updated in 2007, now a standard procedure in many electrophysiological centers. Pulmonary vein isolation has proven itself as a way to eliminate focal triggers. From pathophysiological studies of atrial fibrillation development, it is known that ablation performed early in paroxysmal atrial fibrillation has the highest chance for success. In patients with persistent or permanent atrial fibrillation, success rates are lower and repeat interventions are needed more often. Therefore, continuation of antiarrhythmic drug therapy is often necessary in these patient groups. Thus, the curative use of ablation for atrial fibrillation is only possible with the current techniques for patients with paroxysmal atrial fibrillation.

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  1. Medizinische Klinik 3, St. Vincentius-Kliniken Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Südendstr. 32, 76137 , Karlsruhe, Deutschland

    B.-D. Gonska, H.J. Bauerle & T. Japha

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Gonska, BD., Bauerle, H. & Japha, T. Vorhofflimmerablation: Wer kommt in Frage?. Herzschr. Elektrophys. 20, 76–81 (2009). https://doi.org/10.1007/s00399-009-0043-8

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