Dtsch Med Wochenschr 2015; 140(13): 1006-1012
DOI: 10.1055/s-0041-102733
Fachwissen
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Vorhofflimmern: Das richtige Vorgehen in der kardiologischen Rehabilitation

Cardiac rehabilitation in patients with atrial fibrillation
Axel Schlitt
1   Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg und Medizinische Fakultät der Martin Luther-Universität Halle-Wittenberg
,
Wolfram Kamke
2   MediClin Reha-Zentrum Spreewald, Burg
,
Manju Guha
3   Reha-Klinik am Sendesaal, Bremen
,
Olaf Haberecht
4   AMEOS Klinikum Aschersleben
,
Heinz Völler
5   Klinik am See, Rüdersdorf und Humanwissenschaftliche Fakultät der Universität Potsdam
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2015 (online)

Zusammenfassung

Der Verlauf einer kardiologischen Rehabilitation wird nicht selten durch paroxysmales, überwiegend postoperatives Vorhofflimmern beeinflusst. Bei symptomatischen Patienten ist eine Kardioversion – bevorzugt elektrisch – nach vorausgehenden transösophagealer Echokardiografie (TEE) durchzuführen. Bei persistierendem / permanentem Vorhofflimmern werden Kammerfrequenzen in Ruhe bis 110 / min, unter Belastung bis 170 / min toleriert. Das Training sollte daher nicht frequenz-, sondern lastabhängig erfolgen. Eine besondere Herausforderung stellt das antithrombotische Management nach den unterschiedlichen Interventionen / Operationen dar, das nahezu in allen Fällen die orale Antikoagulation beinhaltet. Sozialmedizinische Auswirkungen entstehen aufgrund von Vorhofflimmern selten und sind am ehesten durch die orale Antikoagulation sowie die Grunderkrankung bedingt

Abstract

The course of cardiac rehabilitation is often altered due to episodes of paroxysmal, predominantly postoperative atrial fibrillation. In symptomatic patients, a TEE-guided cardioversion – preferential DC shock – is indicated. In patients with persistent / permanent atrial fibrillation, a heart rate up to 110 / min and 170 / min at rest and during physical activity should, respectively, be tolerated. Therefore, training should not be quitted by heart rate but rather by load. The antithrombotic management is in addition a great task in treating patients with atrial fibrillation. With the exception of patients with a CHA2DS2-VASc-Score < 1, oral anticoagulation is indicated. Atrial fibrillation has little impact on social aspects, whereas the underlying heart disease and drug treatment (oral anticoagulation) has an important impact.

 
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