Skip to main content
SpringerLink
Log in

Diagnose Vorhofflimmern

Vom Standard-EKG bis zur Elektrogrammanalyse

Diagnosis of atrial fibrillation

From the standard ECG to analysis of electrograms

  • Schwerpunkt
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Insbesondere wegen der Gefährdung durch eine arterielle Embolie ist die frühe Diagnose von Vorhofflimmern sehr wichtig. Dabei stellt die EKG-Dokumentation den Goldstandard dar. Bei diesem Bemühen ist ein Routine-EKG bei asymptomatischen Patienten jedoch wenig effektiv. In diesem Artikel soll für den Allgemeinarzt bzw. Internisten aufgezeigt werden, wie die Suche nach Vorhofflimmern effizienter gestaltet werden kann. Hier ist zum einen das Schreiben eines EKGs bei über 65-Jährigen mit Pulsunregelmäßigkeiten oder die wiederholte EKG-Registrierung bei über 75-Jährigen mit einer arteriellen Hypertonie zu nennen. Interessant ist hierbei, dass Elemente des CHA2DS2-VASc-Scores, der zur Risikobeurteilung bezüglich arterieller Embolien eingeführt wurde, auch als Risikoparameter für das Auftreten von Vorhofflimmern genutzt werden können. Darüber hinaus wird aufgezeigt, dass bei der Untergruppe von Patienten mit einem Schrittmacher oder ICD, die bislang noch kein Vorhofflimmern hatten, Histogramm- bzw. Elektrogrammspeicher zur Diagnose von Vorhofflimmern genutzt werden können. Hier ist es wichtig, dass die von Kardiologen bei den letztgenannten Patienten gewonnenen Erkenntnisse bei der weiteren Behandlung berücksichtigt werden.

Abstract

The early diagnosis of asymptomatic atrial fibrillation is important because of the associated risk for arterial embolism. Routine ECG recording, however, is not effective in asymptomatic patients. The goal of this article is to show the general practitioner and internist how the search for atrial fibrillation can be made more efficacious. For example, recording an ECG in patients older than 65 years with irregularities in their pulse or repeated ECG recording in patients older than 75 years with hypertension shows improved results in this regard. It is interesting that elements of the CHA2DS2-VASc score, which was developed to predict risk for arterial embolism, are also effective for defining populations to screen for atrial fibrillation. In the subgroup of patients with a pacemaker or implantable converter–defibrillator (ICD), histograms or intracardiac electrograms can be used to identify previously undiagnosed atrial fibrillation. The general practitioner should take these results which are usually obtained by a cardiologist into consideration in the follow-up treatment of his or her patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Ahmad Y, Kirchhof P (2013) Gone fishing (for silent atrial fibrillation). Circulation 127:870–872

    Article  PubMed  Google Scholar 

  2. Andersson T, Magnuson A, Bryngelsson I-L et al (2013) All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case-control study. Eur Heart J 34: 1061–1067

    Google Scholar 

  3. Camm AJ, Lip GY, De Caterina R et al (2012) 2012 focused update of the ESC guidelines for the management of atrial fibrillation. An update of the 2010 ESC guidelines for the management of atrial fibrillation developed with the special contribution of the European Heart Rhythm Association Authors/Task Force Members. Eur Heart J 33:2719–2747

    Article  PubMed  Google Scholar 

  4. Charitos EI, Stierle U, Ziegler PD et al (2012) A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence. Insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions. Circulation 126:806–814

    Article  PubMed  Google Scholar 

  5. Engdahl J, Andersson L, Mirskaya M et al (2013) Stepwise screening of atrial fibrillation in a 75-year-old population. Implications for stroke prevention. Circulation 127:930–937

    Article  PubMed  Google Scholar 

  6. Fetsch T, Bauer P, Engberding R et al (2004) Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. European Heart J 25:1385–1394

    Article  Google Scholar 

  7. Fitzmaurice DA, Hobbs FD, Jowett S et al (2007) Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 335:383–389

    Article  PubMed  Google Scholar 

  8. Glotzer TV, Hellkamp AS, Zimmerman J et al (2003) Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke. Report of the atrial diagnostics ancillary Study of the MOde Selection Trial (MOST). Circulation 107:1614–1619

    Article  PubMed  Google Scholar 

  9. Glotzer TV, Daoud EG, Wyse DG et al (2009) The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk. The TRENDS Study. Circ Arrhythmia Electrophysiol 2:474–480

    Article  Google Scholar 

  10. Healey JS, Connolly SU, Gold MR et al (2012) Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 366:120–129

    Article  PubMed  CAS  Google Scholar 

  11. Hemmer W, Rybak K, Markewitz A et al (2009) Empfehlungen zur Strukturierung der Herzschrittmacher- und Defibrillatortherapie. Kardiologe 2:108–120

    Article  Google Scholar 

  12. Hindricks G, Pokushalov E, Urban L, XPECT Trial Investigators et al (2010) Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation. Results of the XPECT trial. Circ Arrhythm Electrophysiol 3:141–147

    Article  PubMed  Google Scholar 

  13. Hindricks G, Piorkowski C (2012) Atrial fibrillation monitoring. Mathematics meets real life. Circulation 126:791–792

    Article  PubMed  Google Scholar 

  14. Kinlay S, Leitch JW, Neil A, Chapman BL, Hardy DB, Fletcher PJ (1996) Cardiac event recorders yield more diagnoses and are more cost-effective than 48-hour Holter monitoring in patients with palpitations. A controlled clinical trial. Ann Intern Med 124:16–20

    Article  PubMed  CAS  Google Scholar 

  15. Lamas G (2012) How much atrial fibrillation is too much atrial fibrillation? Editorial. N Engl J Med 366:178–180

    Article  PubMed  CAS  Google Scholar 

  16. Morady F, Zipes DP (2012) Atrial fibrillation: clinical features, mechanisms and management. In: Braunwald’s Heart Disease, Elsevier, Philadelphia, S 825

    Google Scholar 

  17. Meesmann M, Holbach B, Koller ML et al (2000) Heart rate variability and nonlinear dynamics. Herzschr Elektrophys 11:151–158

    Article  Google Scholar 

  18. Okin PM, Bang CN, Wachtell K et al (2013) Relationship of sudden cardiac death to new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy. Circ Arrhythm Electrophysiol 6:243–251

    Article  PubMed  CAS  Google Scholar 

  19. Page RL, Tilsch TW, Connolly SJ et al (2003) Asymptomatic or “silent” atrial fibrillation: frequency in untreated patients and patients receiving azimilide. Circulation 107:1141–1145

    Article  PubMed  Google Scholar 

  20. Pollak WM, Simmons JD, Interian A Jr et al (2001) Clinical utility of intraatrial pacemaker stored electrograms to diagnose atrial fibrillation and flutter. Pacing Clin Electrophysiol 24:424–429

    Article  PubMed  CAS  Google Scholar 

  21. Schnabel RS, Sullivan LM, Levy D et al (2009) Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 373:739–745

    Google Scholar 

  22. Seet RCS, Friedman PA, Rabinstein AA (2011) Prolonged rhythm monitoring for the detection of occult paroxysmal atrial fibrillation in ischemic stroke of unknown cause. Circulation 124:477–486

    Article  PubMed  Google Scholar 

  23. Sinha A-ML, Diener H-C, Morillo CA et al (2009) Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL AF): design and rationale. Am Heart J 160:36–41 e1

    Article  Google Scholar 

  24. Swerdlow CD, Schöls W, Dijkman B et al (2000) Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. Circulation 101:878–885

    Article  PubMed  CAS  Google Scholar 

  25. Tayal AH, Tian M, Kelly KM et al (2008) Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology 71:1696–1701

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt.

Der korrespondierende Autor weist auf folgende Beziehungen hin: Vortragshonorare von, Boehringer Ingelheim, Bayer, Pfizer und St. Jude Medical.

Author information

Authors and Affiliations

  1. Medizinische Klinik – Schwerpunkt Kardiologie und Internistische Intensivmedizin, Stiftung Juliusspital Würzburg, Juliuspromenade 19, 97070, Würzburg, Deutschland

    Malte Meesmann

Authors
  1. Malte Meesmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malte Meesmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meesmann, M. Diagnose Vorhofflimmern. Herzschr Elektrophys 24, 97–102 (2013). https://doi.org/10.1007/s00399-013-0269-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-013-0269-3

Schlüsselwörter

Keywords

Search

Navigation