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Ablation von persistierendem und lange persistierendem Vorhofflimmern

Optimales Vorgehen und Ergebnisse

Catheter ablation of persistent and long-standing persistent atrial fibrillation

Strategies and results

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die Katheterablation von paroxysmalem Vorhofflimmern ist ein mittlerweile etabliertes Verfahren, bei welchem eine Pulmonalvenenisolation meist unter Verwendung von Hochfrequenzstrom durchgeführt wird. Hier sind Erfolgsraten nach 2 Jahren von 70 % nach einer Prozedur erreichbar. Eine weitaus komplexere Prozedur stellt die Ablation von persistierendem Vorhofflimmern dar. Hierbei werden je nach Zentrum unterschiedliche Ablationsstrategien verfolgt, die von der alleinigen Pulmonalvenenisolation bis zur Terminierung des Vorhofflimmerns mittels Ablation fraktionierter atrialer Elektrogramme reicht. Welches Verfahren hier die besseren Erfolgsaussichten hat, ist noch nicht abschließend geklärt. Nach der Durchführung solch ausgedehnter Ablationsbehandlungen kann es zum Auftreten von geordneten Rezidivarrhythmien kommen, die in der Regel gut zu behandeln sind und einen Fortschritt in Richtung dauerhafter Etablierung des Sinusrhythmus darstellen. Bessere Mappingmethoden und ein detailliertes Verständnis der Mechanismen des persistierenden Vorhofflimmerns können in Zukunft möglicherweise helfen, die Ablationserfolge zu verbessern und die Prozedurzeiten zu verkürzen.

Abstract

Catheter ablation for paroxysmal atrial fibrillation is a meanwhile established therapy option, which is most frequently performed using radiofrequency ablation. Mid-term success rate of 70 % are achievable with a single ablation procedure. However, the mechanistics of persistent atrial fibrillation are less well understood and catheter ablation is a far more challenging procedure. Different ablation approaches are being performed to treat persistent atrial fibrillation ranging from sole pulmonary vein isolation to additional ablation of fractionated electrograms aiming for termination of atrial fibrillation. Thus far, it has not been investigated which strategy is most successful in treating persistent atrial fibrillation. After extended ablation of atrial fibrillation, occurrence of organized atrial arrhythmias is not uncommon and can be successfully ablated. These consecutive arrhythmias can be considered as a next step towards stable sinus rhythm after repeat ablation. Improvement of mapping methods as well as a better understanding of mechanisms of atrial fibrillation may increase success rate of catheter ablation of persistent atrial fibrillation and may also help to improve success rate of these complex procedures.

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Authors and Affiliations

  1. Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Martinistr. 52, 20246, Hamburg, Deutschland

    Daniel Steven, Arian Sultan, Benjamin Schäffer, Helge Servatius, Boris Hoffmann, Jakob Lüker & Stephan Willems

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  1. Daniel Steven
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  2. Arian Sultan
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  3. Benjamin Schäffer
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  4. Helge Servatius
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  5. Boris Hoffmann
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  6. Jakob Lüker
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  7. Stephan Willems
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Correspondence to Daniel Steven.

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Steven, ., Sultan, A., Schäffer, B. et al. Ablation von persistierendem und lange persistierendem Vorhofflimmern. Herzschr Elektrophys 24, 15–18 (2013). https://doi.org/10.1007/s00399-013-0245-y

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  • DOI: https://doi.org/10.1007/s00399-013-0245-y

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