Ablation von Rotoren bei Vorhofflimmern – eine neue Ära der Ablationstechnik?

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Currently, the hypothesized mechanisms responsible for AF include the trigger hypothesis, the multiple wavelets hypothesis and the rotor hypothesis. Catheter ablation aiming to eliminate tissue critical for maintenance of AF have been established but recurrence rates after current ablation strategies remain high. Recent studies demonstrated that so called ‘AF rotors’ responsible for perpetuating AF can be localized with different invasive and non-invasive mapping systems. Current trials have demonstrated that these rotors can be targeted and eliminated with ablation. This suggests that targeting rotors may pose a new method to potentially increase the success rate of AF ablation. Although initial results are promising the importance of rotors in maintaining AF in the human heart are still controversial. Further trials are needed to confirm the initial data.

Kernsaussagen

• Die Katheterablation ist das effektivste Verfahren zur Rhythmuskontrolle bei Patienten mit paroxysmalem Vorhofflimmern.

• Eine frühzeitige Ablation, insbesondere bei symptomatischem paroxysmalem Vorhofflimmern, führt in einem hohen Prozentsatz dazu, dass kein Vorhofflimmer-Rezidiv mehr auftritt und dass sich die Lebensqualität wesentlich verbessert.

• Die neue Möglichkeit der Rotor-Ablation könnte zu einer optimierten und individualisierten Therapiestrategie der Vorhhofflimmerablation führen.

• Auch wenn die ersten klinischen Studienergebnisse vielversprechend sind, müssen diese Daten noch in unabhängigen multizentrischen Studien belegt werden. Bis zu diesem Zeitpunkt bleibt die rotorgesteuerte Ablation ein primär wissenschaftlicher Ansatz.

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