Katheterablation von Vorhofflimmern

Vorhofflimmern ist die häufigste supraventrikuläre Arrhythmie mit einer deutlichen Zunahme im Alter. Die Behandlung richtet sich nach der Dauer, dem klinischen Erscheinungsbild, hämodynamischen Auswirkungen, zugrunde liegenden kardialen Erkrankungen und Risikofaktoren für einen Schlaganfall. Dieser Beitrag gibt einen Überblick über die katheterablativen therapeutischen Optionen bei Vorhofflimmern.

Kernaussagen

• Vorhofflimmern ist eine chronisch-progrediente Erkrankung und die häufigste supraventrikuläre Herzrhythmusstörung. Betroffen sind ca. 2% der Bevölkerung mit einer deutlichen Zunahme im Alter.

• Die Therapie basiert auf der Thrombembolieprophylaxe, der Frequenzkontrolle und, bei bestehender Indikation, der rhythmuserhaltenden Therapie.

• Rhythmuserhalt kann medikamentös oder durch interventionelle Therapie erreicht werden.

• Mit unzweifelhafter Evidenz belegt ist bei der interventionellen Therapie die Isolation der Pulmonalvenen.

• Verschiedene technische Varianten zum Erzielen dieser sind verfügbar. Einen klaren Vorteil weist keines der Verfahren auf.

• Die Katheterablation ist die deutlich effektivste Therapie im Hinblick auf einen Rhythmuserhalt (bei geringer Evidenz für einen Einfluss auf harte klinische Endpunkte).

• Da die Erfolgsaussichten, insbesondere bei persistierendem Vorhofflimmern, unbefriedigend sind, besteht Bedarf an der Entwicklung zusätzlicher Ablationsstrategien.

Schlüsselwörter

Vorhofflimmern - Katheterablation - Indikationsstellung - Ablationsstrategie - Ablationstechnologie

• Literatur

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