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Kann die Indikation zur Antikoagulation durch die Katheterablation von Vorhofflimmern ersetzt werden?

Can catheter ablation replace the indication for oral anticoagulation?

  • Interventionelle Elektrophysiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die aktuellen Leitlinien empfehlen die Fortführung einer oralen Antikoagulation (OAK) für mindestens 3 Monate nach Katheterablation von Vorhofflimmern. Anschließend wird die Indikation zur langfristigen OAK anhand des individuellen thromboembolischen Risikos festgelegt. Vorhofflimmerrezidive spielen für die Entscheidung einer Fortführung der OAK keine Rolle, da sie gerade nach Katheterablationen schwierig und wenig zuverlässig detektierbar sind. Aktuelle retrospektive Untersuchungen legen die Sicherheit einer Umstellung der OAK auf Acetylsalicylsäure (ASS) nahe, falls Freiheit von Vorhofflimmern besteht und keine Hauptrisikofaktoren für einen Schlaganfall vorliegen (zurückliegender Schlaganfall, Alter >75 Jahre). Weitere prospektive Untersuchungen sind jedoch notwendig, um das optimale Vorgehen zur OAK nach erfolgreicher Katheterablation zu definieren. Insbesondere eine Umstellung auf ASS sollte kritisch geprüft werden, da eine OAK deutlich effektiver das Risiko von Schlaganfällen reduzieren kann, ohne mit einer signifikanten Erhöhung von Blutungen im Vergleich zu ASS einherzugehen.

Abstract

Current guidelines recommend continuation of oral anticoagulation (OAC) for at least 3 months post catheter ablation of atrial fibrillation. Afterwards long-term OAC is determined according to individual thromboembolic risks, regardless whether patients experience arrhythmia recurrences or not. This proceeding arises from difficulties to reliably detect arrhythmia recurrences after catheter ablation. Retrospective studies indicate the safety of switching patients from OAC to aspirin, as long as patients do not have major thromboembolic risk factors (stroke, age >75 years) and experience freedom from atrial fibrillation. Prospective studies are needed to determine the optimal anticoagulation approach in patients following successful catheter ablation. Especially the treatment with aspirin as an alternative to OAC needs to be critically assessed as OAC is much more effective with respect to stroke reduction without being associated with significant differences in bleeding risk.

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Interessenkonflikt

Die korrespondierende Autorin weist für sich und ihre Koautoren auf folgende Beziehungen hin: G. Hindricks ist als Referent für die Firmen St. Jude Medical, Biotronik, Medtronic und Biosense tätig und erhält ein Beraterhonorar von St. Jude Medical und Biosense.

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  1. Abteilung für Rhythmologie, Herzzentrum, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    C. Eitel & G. Hindricks

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  1. C. Eitel
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  2. G. Hindricks
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Correspondence to C. Eitel.

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Eitel, C., Hindricks, G. Kann die Indikation zur Antikoagulation durch die Katheterablation von Vorhofflimmern ersetzt werden?. Kardiologe 6, 226–231 (2012). https://doi.org/10.1007/s12181-012-0411-1

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  • DOI: https://doi.org/10.1007/s12181-012-0411-1

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