Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall

Zusammenfassung

Das vorliegende Positionspapier zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall beinhaltet eine Stellungnahme der Arbeitsgemeinschaft „Herz und Hirn“ der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V. (DGK) und der Deutschen Schlaganfallgesellschaft e. V. (DSG), die in Zusammenarbeit mit der Stroke Unit-Kommission der DSG und dem Kompetenznetz Vorhofflimmern (AFNET) e. V. erstellt wurde.

Vorhofflimmern ist in den Leitlinien der Europäischen Gesellschaft für Kardiologie als eine mindestens 30 Sekunden anhaltende Episode einer Vorhofarrhythmie mit fehlenden P-Wellen definiert. Die 30-Sekundengrenze ist arbiträr gewählt und es ist unbekannt, ob das Schlaganfallrisiko bei Episoden von länger als 30 Sekunden höher ist als bei kürzeren Episoden.

Bei Patienten, die einen Schlaganfall erlitten haben, sollte die Detektion von Vorhofflimmern üblicherweise zu einer Umstellung der medikamentösen Sekundärprävention führen, da eine orale Antikoagulation einer Thrombozytenaggregationshemmung überlegen ist. Die Detektion eines bis dato nicht diagnostizierten Vorhofflimmerns sollte daher bei Patienten mit ischämischem Schlaganfall verbessert werden, um die medikamentöse Sekundärprävention des Schlaganfalls zu optimieren.

In diesem Positionspapier werden interdisziplinär erarbeitete Standards für eine „strukturierte Rhythmusvisite“ auf der Stroke Unit und ein diagnostisches „Stufenschema“ zur Detektion von Vorhofflimmern vorgeschlagen. Das Positionspapier fasst zudem den gegenwärtigen Kenntnisstand zur Detektion von Vorhofflimmern nach ischämischem Schlaganfall zusammen. Das Positionspapier soll den in der Versorgung von Schlaganfallpatienten tätigen Ärzten eine Handhabe geben, auch wenn bisher nicht abschließend geklärt ist, wie lange und mit welcher EKG-Methode Schlaganfallpatienten ohne bisher bekannte Herzrhythmusstörung bestmöglich monitoriert werden sollten. Dem Charakter eines Positionspapiers angemessen, wurde auf die Kennzeichnung von Evidenzgraden verzichtet, da es sich überwiegend um die Meinung von Experten handelt, die auf berichteten Fallserien und klinischer Erfahrung beruht und somit nicht mit einer Leitlinie gleichzusetzen ist und so auch nicht verstanden werden will.

Abstract

This position paper on the detection of atrial fibrillation after ischemic stroke includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. This paper was endorsed by the Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork.

The guidelines of the European Cardiac Society define atrial fibrillation as atrial arrhythmia lasting at least 30 seconds with missing P-waves. The limit of 30 seconds was chosen arbitrarily, and it is unknown whether the risk of ischemic stroke is higher for episodes lasting longer than 30 seconds compared to shorter episodes.

In patients with ischemic stroke, detection of atrial fibrillation should usually lead to a change in secondary stroke prevention since oral anticoagulation is superior to antiplatelet drugs. The detection of previously undiagnosed atrial fibrillation should therefore be improved in patients with ischemic stroke in order to optimize medical stroke prevention.

This position paper summarizes the present knowledge on the detection of atrial fibrillation after ischemic stroke. An interdisciplinary standard for a “structured analysis of ECG monitoring” on the Stroke Unit is proposed as well as a diagnostic “level scheme for the detection of atrial fibrillation”. In light of the fact that the optimal duration and mode of ECG monitoring of patients with so far unknown cardiac arrhythmia has not yet been finally established, this position paper is intended to give advice to physicians who are involved in stroke care. In line with the nature of a position paper, the labeling of classes of recommendations is not provided, since many statements are based on the opinion of experts, reported case series and clinical experience. Therefore, this position paper is not intended as a guideline.

Schlüsselwörter

ischämischer Schlaganfall - Vorhofflimmern - EKG-Monitoring

Keywords

ischemic stroke - atrial fibrillation - ECG monitoring

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