Management von Risikofaktoren und Begleiterkrankungen bei Vorhofflimmern

Vorhofflimmern hat als häufigste anhaltende Arrhythmie durch den demografischen Wandel an Bedeutung gewonnen. Aktuelle Studien belegen, dass die Behandlung von Risikofaktoren und Komorbiditäten das Fortschreiten der Erkrankung verhindert und die Ergebnisse einer rhythmuskontrollierenden Therapie verbessert. Dazu empfehlen Leitlinien zum Vorhofflimmern ein ganzheitliches Behandlungskonzept, welches einen interdisziplinären Ansatz umfasst.

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia and has gained increasing importance due to demographic changes. The development of AF is multifactorial, including both non-modifiable risk factors such as age and genetic predisposition, as well as modifiable factors like obesity and alcohol consumption. Common comorbidities include arterial hypertension, heart failure, sleep apnea syndrome, and diabetes mellitus. Current studies show that treatment of these risk factors and comorbidities prevents the progression of AF and improves the results of rhythm control therapy. Preventive measures such as weight reduction, physical activity, abstinence and controlling cardiovascular risk factors are important measures to achieve pre-defined therapy goals. Both the German and European AF-guidelines advocate for a comprehensive treatment approach, incorporating an interdisciplinary strategy that fosters collaboration across multiple specialties to effectively treat risk factors and comorbidities.

Kernaussagen

• Eine gezielte Lifestyle-Modifikation, Gewichtsreduktion und die konsequente Behandlung der Begleiterkrankungen und kardiovaskulären Risikofaktoren stellen fundamentale Bausteine im interdisziplinären Management des Vorhofflimmerns dar.

• Durch diese Maßnahmen können das Auftreten von Vorhofflimmern, ein Fortschreiten des Vorhofflimmerns und niedrigere Raten an Vorhofflimmern-Rezidiven erreicht werden.

• Bei Patient*innen mit Vorhofflimmern und Herzinsuffizienz sollte eine Rhythmuskontrolle mit dem Ziel einer anhaltenden Etablierung des Sinusrhythmus, in Kombination mit einer leitliniengerechten Therapie der Herzinsuffizienz, frühzeitig evaluiert werden.

• Für adipöse Vorhofflimmern-Patient*innen wird eine Gewichtsreduktion von mindestens 10% empfohlen.

• Antidiabetische Medikamente, insbesondere GLP-1-Rezeptor-Agonisten, stehen im Mittelpunkt aktueller wissenschaftlicher Studien.

Schlüsselwörter

Vorhofflimmern - Risikofaktoren - Komorbiditäten - Adipositas

Keywords

atrial fibrillation - risk factors - risk factor management - comorbidities - obesity

Publication History

Article published online:
05 August 2025

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