Möglichkeiten und Grenzen der derzeitigen medikamentösen Behandlung von Vorhofflimmern

Zusammenfassung

In den vergangenen Jahrzehnten bestand die Therapie des Vorhofflimmerns (VHF) im Wesentlichen in der medikamentösen Behandlung mit den Zielen der Rhythmuskontrolle oder Frequenzkontrolle. In Zukunft werden diese Strategien durch einige weitere Ansätze ergänzt werden. Große Bedeutung wird hierbei der Verzögerung oder Verhinderung der Bildung eines strukturellen Substrates für VHF (z. B. durch ACE-Hemmer oder AT1-Antagonisten) zukommen. Auch lässt sich von einer „individualisierten” Therapie, die individuelle Charakteristika des Patienten wie das Vorliegen eines bestimmten Substrates für VHF oder genetische Prädispositionen berücksichtigt, eine höhere Erfolgsquote bei der Rhythmuskontrolle erwarten. Eine prognostische Überlegenheit der Rhythmuskontrolle unter Verwendung der bislang verfügbaren klassischen Antiarrhythmika wie Flecainid, Sotalol oder Amiodaron konnte im Vergleich zur reinen frequenzkontrollierenden Therapie nicht nachgewiesen werden. Die ATHENA-Studie war die erste Studie, in der bei VHF die Morbidität und Mortalität nach der Einnahme von Dronedaron als Antiarrhythmikum untersucht wurden.

Abstract

Treatment strategies for atrial fibrillation (AF) encompass restoration and maintenance of sinus rhythm (rhythm control) or rate control. Antiarrhythmic drugs (AADs) currently recognized for this purpose are partially efficacious in maintaining sinus rhythm but are considered to have substantial cardiac or extra-cardiac toxicity. Yet so far, no endpoint trial has shown reduced morbidity or mortality using these agents. However, the ATHENA study was the first AF study conducted where morbidity and mortality were addressed investigating dronedarone as a new ADD therapy. This review summarizes the current pharmacological approaches to AF and briefly reviews the effects of new antiarrhythmic drugs for AF.

Antiarrhythmika - Pathophysiologie - Pharmakologie - Therapie - Vorhofflimmern

antiarrhythmic drugs - atrial fibrillation - pharmacology - pathophysiology - therapy

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