Skip to main content
SpringerLink
Log in

Follow-up nach Katheterablation von Vorhofflimmern

Erfassung der klinischen und elektrokardiographischen Effektivität

Follow-up after catheter ablation of atrial fibrillation

Survey of the clinical and electrocardiographic effectiveness

  • Interventionelle Elektrophysiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die Katheterablation von Vorhofflimmern (VHF) mittels Pulmonalvenenisolation (PVI) hat sich als Therapieverfahren weithin etabliert, und ihre Indikation ist in den aktuellen VHF-Leitlinien entsprechend definiert. Anfänglich ausschließlich auf Patienten mit paroxysmalem VHF ohne strukturelle Herzerkrankung beschränkt, wird eine PVI zwischenzeitlich auch in breiteren Patientenpopulationen eingesetzt. Die PVI ist unverändert einem fließenden methodologischen und technischen Fortschritt unterworfen, gleichzeitig werden unterschiedliche Erfolgsraten der Prozedur berichtet. Der Erfolg der PVI kann klinisch und/oder elektrokardiographisch definiert werden. Bis jetzt fehlen Empfehlungen bezüglich einer einheitlichen Nachbeobachtung. Darüber hinaus variiert die klinische Praxis der Verlaufsbeobachtung nach PVI zwischen spezialisierten Zentren, Kardiologen, Internisten und Allgemeinmedizinern, aber auch innerhalb der entsprechenden Sektoren der Patientenversorgung. Die Erarbeitung diesbezüglicher Empfehlungen ist daher wünschenswert. Um den aktuellen Stand der Nachbeobachtung zu erfassen, hat die Arbeitsgruppe Rhythmologie der DGK eine Umfrage unter niedergelassenen Kardiologen sowie akademischen und/oder universitären Krankenhäusern initiiert, um ihr Vorgehen hinsichtlich Indikationsstellung und Praxis nach PVI zu erfassen. In der vorliegenden Übersicht wird in diesem Kontext der aktuelle Stand der Literatur zusammengefasst.

Abstract

Catheter ablation therapy of atrial fibrillation (AF) by means of pulmonary vein isolation (PVI) has been widely established and its indication has been defined in the current AF guidelines. Initially restricted to patients with paroxysmal AF, PVI has meanwhile been applied to broader patient populations. PVI is subject to ongoing methodological and technical progress, while different success rates of the procedure have been reported. Also, different predictors of long-term success of the procedure were identified, due to variation between study populations, number of patients included in the studies and duration of follow-up. Success of PVI can be defined clinically or electrocardiographically. There are no recommendations with respect to standardized follow-up, particularly with regard to duration and optimal ECG monitoring. Also, follow-up of PVI in clinical practice varies between specialized centres, cardiologists and general practitioners, as well as within these professional groups. Recommendations concerning optimal follow-up are thus warranted. To assess the current practice of follow-up after PVI, the working group on rhythmology of the German Cardiac Society initiated a survey among German cardiologists in private practice and those in academic hospitals to assess their approach to the indication for and follow-up after PVI for AF. The results are discussed in the context of the current literature.

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

Literatur

  1. Arya A, Piorkowski C, Sommer P et al (2007) Clinical implications of various follow-up strategies after catheter ablation of atrial fibrillation. PACE 30:458–462

    PubMed  Google Scholar 

  2. Balk EM, Garlitski AC, Alsheikh-Ali AA et al (2010) Predictors of atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review. J Cardiovasc Electrophysiol 21:1208–1216

    Article  PubMed  Google Scholar 

  3. Berkowitsch A, Greiss H, Vukajlovic D et al (2005) Usefulness of atrial fibrillation burden as a predictor for success of pulmonary vein isolation. PACE 28:1292–1301

    PubMed  Google Scholar 

  4. Calkins H, Reynolds MR, Spector P et al (2009) Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta analyses. Circ Arrhythm Electrophsiol 2:349–361

    Article  CAS  Google Scholar 

  5. Calkins H, Brugada J, Packer DL et al (2007) HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures, and follow-up. Europace 9:335–379

    Article  PubMed  Google Scholar 

  6. Dagres N, Kottkamp H, Piorkowski C et al (2010) Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation. Implications for patient follow-up. Int J Cardiol 139:305–306

    Article  PubMed  Google Scholar 

  7. Dagres N, Hindricks G, Kottkamp H et al (2009) Real-life anticoagulation treatment of atrial fibrillation after catheter ablation: Possible overtreatment of low-risk patients. Thromb Haemost 102:754–758

    PubMed  CAS  Google Scholar 

  8. Darbar D, Roden D (2005) Symptomatic burden as an endpoint to evaluate interventions in patients with atrial fibrillation. Heart Rhythm 2:544–549

    Article  PubMed  Google Scholar 

  9. Eitel C, Husser D, Hindricks G et al (2011) Performance of an implantable automatic atrial fibrillation detection device: impact of software adjustments and relevance of manual episode analysis. Europace 13:480–485

    Article  PubMed  Google Scholar 

  10. ESC Task Force for the Management of Atrial Fibrillation (2010) Guidelines for the management of atrial fibrillation. Eur Heart J 31:2369–2429

    Article  Google Scholar 

  11. Gage BF, Waterman AD, Shannon W et al (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870

    Article  PubMed  CAS  Google Scholar 

  12. Halimi F, Van Erven L (2009) EHRA scientific initiatives committee. Europace 11:1002–1003

    Article  PubMed  Google Scholar 

  13. Hindricks G, Piorkowski C, Tanner H et al (2005) Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence. Circulation 112:307–313

    Article  PubMed  Google Scholar 

  14. Klemm HU, Ventura R, Rostock T et al (2006) Correlation of symptoms to ECG diagnosis following atrial fibrillation ablation. J Cardiovasc Electrophysiol 17:146–150

    Article  PubMed  Google Scholar 

  15. Klingenheben T, Posur W, Butter C et al (2011) Management of atrial fibrillation in the context of catheter ablation in Germany: awareness and clinical decision making among cardiologists in private practice and in teaching hospitals (abstr). Clin Res Cardiol 100(Suppl 1):992

    Google Scholar 

  16. Kottkamp H, Tanner H, Kobza R et al (2004) Time course and quantitative Analysis of atrial fibrillation episode numbers and duration after circular plus linear left atrial lesions: trigger elimination or substrate modification: early or delayed cure? J Am Coll Cardiol 44:869–877

    PubMed  Google Scholar 

  17. Lip GY, Nieuwlaat R, Pisters R et al (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest 137:263–272

    Article  PubMed  Google Scholar 

  18. Medi C, Sparks PB, Morton JB et al (2011) Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up. J Cardiovasc Electrophysiol 22:137–141

    PubMed  CAS  Google Scholar 

  19. Miyazaki S, Kuwahara T, Kobori A et al (2011) Preprocedural predictors of atrial fibrillation recurrence following pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: long-term follow-up results. J Cardiovasc Electrophysiol 22:621–625

    Article  PubMed  Google Scholar 

  20. Nieuwlaat R, Capucci A, Lip GY et al (2006) Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 27:3018–3026

    Article  PubMed  CAS  Google Scholar 

  21. Olesen JB, Lip GY, Hansen ML et al (2011) Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ 342 [Epub ahead of print]

  22. Oral H, Veerareddy S, Good E et al (2004) Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation. J Cardiovasc Electrophysiol 15:920–324

    Article  PubMed  Google Scholar 

  23. Oral H, Knight BP, Tada H et al (2002) Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 105:1077–1081

    Article  PubMed  Google Scholar 

  24. Ouyang F, Tilz R, Chun J et al (2010) Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons form a 5-year follow-up. Circulation 122:2368–2377

    Article  PubMed  Google Scholar 

  25. Pappone C, Oreto G, Rosanio S et al (2001) Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation 104:2539–2544

    Article  PubMed  CAS  Google Scholar 

  26. Patten M, Maas R, Karim A et al (2006) Event-recorder monitoring in the diagnosis of atrial fibrillation in symptomatic patients: subanalysis of the SOPAT trial. J Cardiovasc Electrophysiol 17:1216–1220

    Article  PubMed  Google Scholar 

  27. Piorkowski C, Kottkamp H, Tanner H et al (2005) Value of different follow-up stratiegies to assess the efficacy of circumferential pulmonary vein ablation for the curative treatment of atrial fibrillation. J Cardiovasc Electrophys 16:1286–1292

    Article  Google Scholar 

  28. Rostock T, Steven D, Hoffmann B et al (2008) Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach. Circ Arrhythmia Electrophysiol 1:344–353

    Article  Google Scholar 

  29. Senatore G, Stabile G, Bertaglia E et al (2005) Role of transtelephonic electrocardiographic monitoring in detecting short-term arrhythmia recurrences after radiofrequency ablation in patients with atrial fibrillation. J Am Coll Cardiol 45:873–876

    Article  PubMed  Google Scholar 

  30. Vasamreddy CR, Dalal D, Dong J et al (2006) Symptomatic and asymptomatic atrial fibrillation in patients undergoing radiofrequency catheter ablation. J Cardiovasc Electrophysiol 17:134–139

    Article  PubMed  Google Scholar 

  31. Walker AM, Bennett D (2008) Epidemiology and outcomes in patients with atrial fibrillation in the United States. Heart Rhythm 5:1365–1372

    Article  PubMed  Google Scholar 

  32. Weerasooriya R, Khairy P, Litalien J et al (2011) Catheter ablation for atrial fibrillation: Are results maintained at 5 years of follow-up? J Am Coll Cardiol 57:160–166

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: T. Klingenheben hat in den vergangenen 2 Jahren Referentenhonorare der Firma Sanofi Aventis erhalten. L. Eckardt hat in den vergangenen 5 Jahren Referentenhonorare der Firmen Astra/Zeneca, Biosense Webster, Biotronik, Boehringer Mannheim, Guidant, Medtronic, Sanofi Aventis und St. Jude Medical erhalten. L. Eckardt hat Forschungsstipendien von Biotronik, St. Jude Medical, Sanofi und Osypka erhalten. Er ist Peter Osypka Stiftungsprofessor für experimentelle und klinische Elektrophysiologie der WWU Münster.

Author information

Authors and Affiliations

  1. Praxis für Kardiologie Bonn und Ambulante Herzkatheter-Kooperation Bonn, Im Mühlenbach 2 B, 53177, Bonn, Deutschland

    T. Klingenheben

  2. Medizinische Universitätsklinik Rostock, Rostock, Deutschland

    D. Bänsch

  3. Herzzentrum Brandenburg, Bernau, Deutschland

    C. Butter

  4. SANA Herzchirurgie, Stuttgart, Deutschland

    N. Doll

  5. Zentralklinik Bad Berka, Bad Berka, Deutschland

    J.C. Geller

  6. Evangelisches Krankenhaus Bielefeld, Bielefeld, Deutschland

    C.W. Israel

  7. Isar-Herz-Zentrum, München, Deutschland

    T. Lewalter

  8. Herzzentrum Leipzig, Leipzig, Deutschland

    C. Piorkowski

  9. Kardiol. Praxis, Herne, Deutschland

    W. Posur

  10. Kardiol. Praxis, Dessau, Deutschland

    K. Rybak

  11. Westpfalz-Klinikum, Kaiserslautern, Deutschland

    B. Schumacher

  12. Kardiol. Praxis , Kirchheim unter Teck, Deutschland

    N. Smetak

  13. Universitäres Herzzentrum Hamburg, Hamburg, Deutschland

    S. Willems

  14. Klinikum Ludwigsburg, Ludwigsburg, Deutschland

    C. Wolpert

  15. Department für Kardiologie und Angiologie, Abteilung für Rhythmologie, Universität Münster, Münster, Deutschland

    L. Eckardt

Authors
  1. T. Klingenheben
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Bänsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Butter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Doll
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J.C. Geller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C.W. Israel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Lewalter
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Piorkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. W. Posur
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K. Rybak
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. N. Smetak
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. S. Willems
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. Wolpert
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. L. Eckardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Klingenheben.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Klingenheben, T., Bänsch, D., Butter, C. et al. Follow-up nach Katheterablation von Vorhofflimmern. Kardiologe 5, 270–276 (2011). https://doi.org/10.1007/s12181-011-0327-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-011-0327-1

Schlüsselwörter

Keywords

Search

Navigation