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Vorhofflimmern auf der Intensivstation

Die besondere prognostische Bedeutung der Erstmanifestation

Atrial fibrillation on the intensive care unit

The special prognostic importance of the first manifestation

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Zusammenfassung

Vorhofflimmern (VHF) ist die häufigste Rhythmusstörung auf der Intensivstation und mit einer erhöhten Mortalität assoziiert. Es wird in verschiedene Formen unterteilt: erstdiagnostiziertes, paroxysmales, persistierendes, langanhaltend persistierendes und permanentes VHF. Studien konnten belegen, dass die Erstmanifestation von VHF eine besondere Bedeutung bei Intensivpatienten hat. Die Mortalität und Kosten sind deutlich höher als bei Patienten mit chronischem VHF. Dieser wichtige klinische Unterschied der VHF-Muster sollte in der Therapie von Intensivpatienten bedacht werden. Die Behandlung von Komorbiditäten ist wesentlicher Bestandteil des Therapiekonzepts auf der Intensivstation. Bei erhöhtem Risiko für thrombembolische Komplikationen ist eine therapeutische Antikoagulation indiziert, wobei das deutlich erhöhte Blutungsrisiko während der Intensivtherapie im Einzelfall bedacht werden muss. Bei hämodynamischer Instabilität sollte eine unmittelbare elektrische Kardioversion erfolgen. Ansonsten kann auch eine pharmakologische Kardioversion durchgeführt werden. Bei der Wahl des Antiarrhythmikums zur Rhythmuskontrolle kommt aufgrund der jeweiligen Kontraindikationen bis auf wenige Ausnahmen Amiodaron zur Anwendung.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in the intensive care unit (ICU) and is associated with increased mortality. The AF is classified into five different forms, initially diagnosed AF, paroxysmal AF, persistent AF, long-standing persistent AF and permanent AF. Studies could confirm that the first manifestation of AF (new onset AF) is of particular importance in intensive care patients. The mortality and costs are much higher than for patients with chronic AF. This important clinical difference of the AF pattern should be taken into consideration in the treatment of intensive care patients. The treatment of comorbidities is essential in the treatment concept on the ICU. In patients with an increased risk of thromboembolic complications, therapeutic anticoagulation is indicated, although the greatly increased risk of bleeding during intensive care treatment should be considered in individual cases. In cases of hemodynamic instability electrical cardioversion should immediately be carried out. Otherwise, pharmacological cardioversion can also be carried out. Apart from a few exceptions, amiodarone is the antiarrhythmic drug of choice for rhythm control due to the contraindications for other drugs.

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Authors and Affiliations

  1. Medizinische Klinik II: Kardiologie und Intensivmedizin, St. Vincenz-Krankenhaus Paderborn, Am Busdorf 2, 33098, Paderborn, Deutschland

    Andreas Goette

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  1. Andreas Goette
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  2. Sybille Brandner
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Correspondence to Andreas Goette.

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Interessenkonflikt

A. Goette: EU Grant Horizon 2020 MAESTRIA Consortium; grant number 965286. Speaker fees von Abbott, Astra Zeneca, Bayer Health Care, Berlin Chemie, Biotronik, Boehringer Ingelheim, BMS/Pfizer, Boston Scientific, Daiichi-Sankyo, Medtronic, und Omeicos. S. Brandner gibt 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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Goette, A., Brandner, S. Vorhofflimmern auf der Intensivstation. Herzschr Elektrophys 33, 391–397 (2022). https://doi.org/10.1007/s00399-022-00899-z

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