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Wiener klinisches Magazin

, Volume 21, Issue 2, pp 56–65 | Cite as

Neu Auftreten von Vorhofflimmern bei Sepsis

Inzidenz, Prognose und mögliche Therapieansätze
  • Marius Keller
  • Rainer Meierhenrich
Intensivmedizin
  • 69 Downloads

Zusammenfassung

Hintergrund

Vorhofflimmern (VHF) ist die häufigste neu auftretende Rhythmusstörung bei Patienten mit Sepsis. Jedoch gibt es keine spezifischen Leitlinien zur Behandlung und die optimalen Therapiestrategien sind derzeit unklar.

Ziel der Arbeit

Zunächst soll der aktuelle Kenntnisstand bezüglich der zugrunde liegenden Mechanismen, der Häufigkeit und der prognostischen Bedeutung von neu aufgetretenem Vorhofflimmern während einer Sepsis dargestellt werden. Anschließend soll im Rahmen der derzeit bestehenden Leitlinien für Vorhofflimmern ein möglicher Therapiealgorithmus für die spezielle Situation der Sepsis abgeleitet werden. Abschließend sollen zukünftige Forschungsaufgaben herausgestellt werden.

Material und Methoden

Eine systematische Literatursuche wurde auf Medline durchgeführt. Alle Publikationen (Übersichtsarbeiten und Studien), die für die Zusammenfassung der derzeitigen Wissensbasis bezüglich neu aufgetretenen VHF bei septischen Patienten relevant waren, wurden eingeschlossen.

Ergebnisse

Zugrunde liegender Pathomechanismus ist in erster Linie die systemische Inflammation. Etwa 8 % aller Patienten mit einer Sepsis und mehr als 20 % aller Patienten mit einem septischen Schock entwickeln neu aufgetretenes VHF. Das Auftreten von VHF ist mit einer erhöhten Morbidität und Mortalität assoziiert. Die Notwendigkeit der Rhythmisierung ist von der hämodynamischen Stabilität abhängig zu machen. Durch die Gabe von Amiodaron kann die Erfolgsrate der elektrischen Kardioversion erhöht werden. Die Notwendigkeit einer systemischen Antikoagulation muss in Abhängigkeit des individuellen thrombembolischen Risikos bestimmt werden.

Diskussion

Weitere Forschungsarbeiten sind nötig, um die optimalen Therapiestrategien bei Patienten mit neu aufgetretenem VHF während einer Sepsis zu entschlüsseln.

Schlüsselwörter

Vorhofflimmern Sepsis Septischer Schock Kardioversion Intensivstation 

Abkürzungen

AATS

American Association for Thoracic Surgery

AHA

American Heart Association

COPD

chronisch obstruktive Lungenerkrankung

CRP

C-reaktives Protein

EKG

Elektrokardiographie

ESC

European Society of Cardiology

IL

Interleukin

KHK

koronare Herzkrankheit

OSAS

Obstruktives Schlafapnoesyndrom

TEE

transösophageale Echokardiographie

TNF-α

Tumor-Nekrose-Faktor-α

VHF

Vorhofflimmern

New onset atrial fibrillation in patients with sepsis

Incidence, prognosis and possible approaches in therapy

Abstract

Background

Atrial fibrillation is the most common new onset arrhythmia in patients hospitalized with sepsis; however, there are no specific treatment guidelines and the ideal therapeutic approaches still remain unclear.

Objectives

To begin with the current state of knowledge concerning the underling mechanisms, the incidence and prognostic impact of new onset atrial fibrillation during sepsis are presented. Then a possible therapeutic algorithm for the special situation of sepsis is derived with respect to the currently existing atrial fibrillation guidelines. Finally necessary future research topics are outlined.

Material ans methods

A systematic literature search was conducted in MEDLINE. All publications (reviews and studies) relevant for the summary of the current knowledge regarding new onset atrial fibrillation in septic patients were included.

Results

The underlying patchomechanism is primarily systemic inflammation. Approximately 8% of patients with sepsis and more than 20% of patients with septic shock develop new onset atrial fibrillation. The occurrence of atrial fibrillation is associated with increased morbidity and mortality. The necessity of rhythm control therapy is dependent on the hemodynamic stability. The success rate of electrical cardioversion can be increased by the administration of amiodarone. The necessity of systemic anticoagulation is based on the individual risk of thromboembolism.

Conclusion

Further research is needed to unveil the optimal therapeutic strategies for patients with new onset atrial fibrillation during sepsis.

Keywords

Atrial fibrillation Sepsis Septic shock Cardioversion Intensive care unit 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Keller und R. Meierhenrich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Anästhesie und IntensivmedizinDiakonie-Klinikum StuttgartStuttgartDeutschland

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