Vorhofflimmern in der Neurologie

Zusammenfassung

Vorhofflimmern (VHF) ist die häufigste Ursache für ischämische Schlaganfälle. Paroxysmales, persistentes und permanentes VHF bedingen dabei ein gleich hohes Schlaganfallrisiko. Da die Prävalenz des VHF mit steigendem Alter zunimmt und die Bevölkerung weiter altert, wird die Bedeutung des VHF und seiner Folgen weiter zunehmen. Entscheidend in der Therapie ist die Prävention thrombembolischer Ereignisse. Liegen weitere vaskuläre Risikofaktoren vor, existiert mit der oralen Antikoagulation eine hocheffektive primär- und sekundärprophylaktische Therapie, die etwa zwei von drei thrombembolischen Komplikationen verhindert. Häufig kommt es bei älteren Patienten zu einer Überbewertung des Blutungsrisikos und zu einem Unterschätzen des Schlaganfallrisikos, weshalb viele Patienten keine Antikoagulation erhalten. Erschwert wird die Behandlung dadurch, dass VHF häufig paroxysmal und asymptomatisch auftritt und somit lange Zeit übersehen wird. In der folgenden Übersicht werden Hintergründe und Behandlungsempfehlungen sowie die Tücken der Detektion des VHF dargestellt.

Summary

Atrial fibrillation (AF) is the leading risk factor for ischemic stroke. Paroxysmal, persistent and permanent AF carry the same risk. Given the projected rising prevalence of AF, its impact will increase further. Since stroke risk in AF changes with comorbidity, individual risk stratification is essential for therapeutic decisions. Oral anticoagulation is highly efficacious for both primary and secondary prevention of stroke in AF. While the age-associated risk of intracerebral bleeding rises with anticoagulation, there generally is an overestimation of the bleeding risk combined with an underestimation of the stroke risk. Therefore many patients fail to receive effective preventive therapy. As AF is often asymptomatic and intermittent, diagnosis – and thus treatment – is frequently missed. This review discusses treatment strategies for atrial fibrillation with risks and benefits and elaborates on the difficulties of detecting AF.

Schlüsselwörter

Vorhofflimmern, - Prävention, - Schlaganfall, - Antikoagulation, - Detektion

Keywords

Atrial fibrillation, - prevention, - stroke, - anticoagulation, - detection

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