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Asymptomatisches Vorhofflimmern

Screening und Therapie

Asymptomatic atrial fibrillation

Screening and therapy

Herzschrittmachertherapie + Elektrophysiologie (2023)Cite this article

Zusammenfassung

Vorhofflimmern (VHF) ist die häufigste anhaltende Herzrhythmusstörung, welche weltweit Millionen von Menschen betrifft und zu einer zunehmenden Belastung des Gesundheitssystems führt. Ein VHF-Screening der Bevölkerung bzw. einer Risikogruppe könnte, neben einer früheren Erkennung, zur Einleitung einer frühzeitigen Therapie und möglicherweise zur Vermeidung von Komplikationen, wie Schlaganfall und Tod, sowie zur Reduktion von Kosten im Gesundheitssystem führen – insbesondere bei Patient:innen mit asymptomatischem VHF. Zur einfachen Durchführung eines Screenings scheinen die rasanten technologischen Entwicklungen der Eventrekorder, einfach zugänglicher Wearables und Smartwatches, innovative Möglichkeiten zu bieten. Da sich die Datenlage bezüglich eines Screenings bisher nicht einheitlich zeigt, wird ein routinemäßiges VHF-Screening von den Fachgesellschaften aktuell nicht empfohlen. Erste Hinweise zeigen, dass es sich lohnen könnte, bereits ein asymptomatisches VHF zu antikoagulieren und einer rhythmuskontrollierenden Therapie zuzuführen, um klinische Endpunkte zu vermeiden. Dieser Artikel berichtet über den aktuellen Stand dieser wissenschaftlichen Erkenntnisse sowie die Lücken der Evidenz und diskutiert die Vor- und Nachteile des Screenings sowie mögliche Therapieoptionen des asymptomatischen VHF.

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide and poses a significant burden to the health care system. AF screening of the general population or of a specific higher-risk population could not only lead to earlier detection of AF but also to a prompt initiation of an adequate therapy to prevent complications such as stroke or death and consecutively to a potential reduction of health care costs, especially in asymptomatic AF patients. To conduct screening programs, accessible new technology devices such as “wearables”, smartwatches, and implantable event recorders provide an innovative solution. However, as data regarding screening are inconclusive, routine AF screening of the population is currently not recommended by the European Society of Cardiology. Recently published studies have indicated that anticoagulation and early rhythm control of asymptomatic AF could avoid occurrence of clinical endpoints. This article reports on the scientific results of the current literature as well as gaps of evidence and discusses possible treatment options of asymptomatic AF.

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  1. Klinik für Kardiologie und internistische Intensivmedizin, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    Melanie Gunawardene, Jens Hartmann & Stephan Willems

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  1. Melanie Gunawardene
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Correspondence to Melanie Gunawardene.

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Interessenkonflikt

M. Gunawardene: Speaker’s honoraria/Travel Grants/Fellowship: Abbott, Biosense Webster, Boston Scientific, Medtronic, Farapulse Inc; J. Hartmann: Speaker’s honoraria/Travel Grants/Fellowship: Abbott, Biosense Webster, Biotronik, Boston Scientific, Medtronic; S. Willems: Consulting fees: Abbott, Biosense Webster, Boston Scientific, Bristol Myers Squibb, Boehringer Ingelheim, Medtronic, Daiichi; Grants: Abbott, Boston Scientific.

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Gunawardene, M., Hartmann, J. & Willems, S. Asymptomatisches Vorhofflimmern. Herzschr Elektrophys (2023). https://doi.org/10.1007/s00399-023-00933-8

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Schlüsselwörter

  • Herzrhythmusstörung
  • Vorhofflimmern
  • Orale Antikoagulation
  • Katheterablation
  • Wearables

Keywords

  • Cardiac arrhythmias
  • Atrial fibrillation
  • Oral anticoagulation
  • Catheter ablation
  • Wearables