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Metabolisches Syndrom und Vorhofflimmern

Metabolic syndrome and atrial fibrillation

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Zusammenfassung

Das metabolische Syndrom ist durch das gemeinsame Auftreten der kardiovaskulären Risikofaktoren Adipositas, Hypertonie, Diabetes und Fettstoffwechselstörung definiert. Insbesondere Übergewicht nimmt hierbei in vielen Ländern ständig zu. Das metabolische Syndrom ist dabei ein starker Risikofaktor für Vorhofflimmern. Für Antiarrhythmika liegen nur wenige Daten zum Einfluss von Übergewicht vor, hier scheinen insbesondere Natriumkanalblocker eine verminderte Wirksamkeit zu zeigen. Für die Antikoagulation bei Patienten mit Adipositas können direkte orale Antikoagulanzien (DOAK) eingesetzt werden. Bei einem Gewicht > 140 kg wird eine Spiegelbestimmung empfohlen. Starkes Übergewicht vermindert die Erfolgsaussichten einer Ablationsbehandlung und führt zu mehr Komplikationen. Durch eine konsequente Behandlung des metabolischen Syndroms, und insbesondere eine Gewichtsreduktion, können das Risiko und die Häufigkeit von Vorhofflimmern, die assoziierte Symptomatik und die Erfolge einer rhythmuserhaltenden Therapie erheblich verbessert werden.

Abstract

Metabolic syndrome is defined by the simultaneous occurrence of the cardiovascular risk factors obesity, hypertension, diabetes and dyslipidemia. Overweight, in particular, is continuously increasing in many countries. In this respect, metabolic syndrome is a strong risk factor for atrial fibrillation. Only few data are available on the influence of obesity on antiarrhythmic drugs. Sodium channel blockers, in particular, appear to show a reduced effectiveness. Direct oral anticoagulants can be used for anticoagulation in obese patients. With a body weight > 140 kg, a plasma level measurement is recommended. Severe overweight reduces the chances of successful ablation treatment and leads to more complications. Consistent treatment of the metabolic syndrome, and in particular weight reduction, can significantly improve the risk and the frequency of atrial fibrillation, the associated symptoms and the success of treatment for maintaining cardiac rhythm.

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Authors and Affiliations

  1. Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt a.M., Deutschland

    Bernd Nowak, Boris Schmidt, Shaojie Chen, Lukas Urbanek, Stefano Bordignon, David Schaack, Shota Tohoku & Julian Chun

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  1. Bernd Nowak
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Correspondence to Bernd Nowak.

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Interessenkonflikt

B. Nowak, B. Schmidt, S. Chen, L. Urbanek, S. Bordignon, D. Schaack, S. Tohoku und J. Chun geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Nowak, B., Schmidt, B., Chen, S. et al. Metabolisches Syndrom und Vorhofflimmern. Herzschr Elektrophys 33, 367–372 (2022). https://doi.org/10.1007/s00399-022-00898-0

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