Moderne Diagnostik und Schlaganfallprävention bei Vorhofflimmern

Zusammenfassung

Vorhofflimmern ist die häufigste anhaltende kardiale Rhythmusstörung. Allein in Deutschland wird die Zahl der Betroffenen auf etwa eine Million Menschen geschätzt [1]. Berechnungen zufolge erleidet vermutlich jeder Vierte der heute 40-Jährigen mindestens einmal in seinem Leben eine Episode von Vorhofflimmern [2]. Veränderungen der Altersstruktur in Deutschland lassen vermuten, dass sich die Prävalenz der Erkrankung in den nächsten 30 Jahren verdoppeln oder sogar verdreifachen wird, bedingt durch die Altersstruktur der deutschen Bevölkerung und aufgrund der Zunahme der Vorhofflimmern begünstigenden Grunderkrankungen. Bei einem großen Teil der Betroffenen bleibt die Erkrankung symptomlos, häufig wird hier Vorhofflimmern erst durch Auftreten von Komplikationen wie einem kardioembolischen Schlaganfall oder einer kardialen Dekompensation diagnostiziert. Andere zeigen typische klinische Symptome wie Herzrasen, Palpitationen, Dyspnoe oder thorakale Beschwerden [3]. Vorhofflimmern hat bedeutsame und gefährliche Folgen: Epidemiologische Untersuchungen lassen vermuten, dass sich die Sterberate verdoppelt [4] [5], Ergebnisse die auch in Patientenkollektiven großer Vorhofflimmerstudien bestätigt werden. Ein Viertel aller ischämischen Schlaganfälle werden durch Vorhofflimmern verursacht, somit ist Vorhofflimmern der wichtigste Risikofaktor für das Auftreten von ischämischen Insulten, auch sind durch Vorhofflimmern verursachte Schlaganfälle häufiger mit Tod oder bleibenden Organschäden assoziiert, als Schlaganfälle anderer Ätiologien [6] [7] [8] [9]. Diese Erkenntnisse zeigen einerseits die Notwendigkeit einer verbesserten Früherkennung, insbesondere bei Risikogruppen, andererseits die Notwendigkeit einer leitliniengerechten optimalen antithrombotischen Therapie. Dieser Artikel informiert über neue diagnostische Möglichkeiten bei Vorhofflimmern sowie über die wichtigsten Inhalte der kürzlich erschienenen neuen ESC-Guidelines [10].

Abstract

Atrial fibrillation is the most common sustained cardiac arrhythmia. In Germany, the number of affected subjects is projected at one million people [1]. In pursuance of statistical calculations, approximately every fourth person over 40 years of age will suffer from at least one episode of atrial fibrillation during his or her life [2]. Changes in the age structure of our population allow the assumption that the number of concerned people is going to be doubled, maybe tripled, in the next 30 years due to an increase of atrial fibrillation-favouring diseases. In many cases the occurrence of atrial fibrillation is combined with no or only few symptoms, in these cases the disease is often not diagnosed until complications like stroke appear. Nevertheless, many people show characteristic symptoms like tachycardia, palpitations, dyspnoea or thoracic ailments [3]. In the populations under investigation, atrial fibrillation leads to a significant increase in mortality and morbidity. Large epidemiological investigations provide evidence that the increase in mortality is doubled [4] [5], findings which were confirmed in large atrial fibrillation trials. Between 25 and 33 % of all strokes are caused by atrial fibrillation, therefore, this disease is the most important risk factor for the occurrence of ischaemic strokes. In addition, strokes caused by atrial fibrillation are often more severe with a higher number of deaths or irreversible organic damage than strokes caused by other aetiologies [6] [7] [8] [9]. These findings suggest that both tools for an improved screening, especially in high-risk patients, and guideline-adapted optimal antithrombotic therapies are needed. This article summarises new developments in diagnostics of atrial fibrillation and the key statements of the recently released ESC guidelines [10].

Schlüsselwörter

Vorhofflimmern - kardioembolischer Schlaganfall - orale Antikoagulation - antiarrhythmische Therapie - ESC-Guidelines Vorhofflimmern

Keywords

atrial fibrillation - cardioembolic stroke - oral anticoagulation - antiarrhythmic drugs - ESC guidelines on atrial fibrillation

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