Pulmonalvenenisolation ist – noch – keine Primärtherapie bei paroxysmalem Vorhofflimmern

Entscheidend für die Reduktion des Schlaganfallrisikos bei Vorhofflimmern ist die Therapie mit oralen Antikoagulanzien. Viele Patienten, die sich zur Katheterablation vorstellen, werden durch den Wunsch motiviert, auf die oralen Gerinnungshemmer zu verzichten. Die aktuellen Leitlinien stellen dazu jedoch fest, dass die Antikoagulation bei erhöhtem CHA2DS-VaSC-Score nicht beendet werden soll.

• Literatur

• 1 Haissaguerre M. Jais P. Shah DC. et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonaty veins. N Engl J Med 1998; 339: 659-666
• 2 Haissaguerre M. Shah DC. Jais P. et al. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation 2000; 102: 2463-2465
• 3 Camm AJ. Kirchhof P. Lip H GY. et al. Guidelines for the management of atrial fibrillation. Eur Heart J 2010; 31: 2369-3429
• 4 Kirchhof P. Benussi S. Zamorano JS. et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eu Heart J 2016; 37: 2893-2962
• 5 Walfridsson H. Walfridsson U. Hansen PS. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial. Europace 2015; 17: 2015-2221
• 6 Wazni OM. Marrouche NF. Brachmann J. et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation. A Randomized Trial. JAMA 2005; 293: 2634-2640
• 7 Camm AJ. Lip GY. De Caterina R. et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719-2747
• 8 Morillo CA. Verma A. Natale A. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2). JAMA 2014; 311: 692-700
• 9 Piccini JP. Lopes RD. Kong MH. et al. Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation. A Meta-Analysis of Randomized, Controlled Trials. Circ Arrhythm Electrophysiol 2009; 2: 626-633
• 10 Kautzner J. Neuzil P. Lambert H. et al. EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation.  Europace 2015; 17: 1229-1235
• 11 Reddy VY. Sediva L. Petru J. et al. Durability of pulmonary vein isolation with cryoballoon ablation. J Cardiovasc Electrophysiol 2015; 26: 493-500
• 12 Kuck KH. Brugada J. Fürnkranz A. et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 2016; 374: 2235-2245
• 13 Marrouche NF. Wilber D. Hindricks G. et al. Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation. The DECAAF Study. JAMA 2014; 311: 498-506
• 14 Narayan SM. Krummen DE. Shivkumar K. et al. Treatment of atrial fibrillation by the ablation of localized sources. J Am Coll Cardiol 2012; 60: 628-636
• 15 Skelly A. Hashimoto R. Al-Khatib S. et al. AHRQ Technology Assessments. Catheter Ablation for Treatment of Atrial Fibrillation. Rockville (MD): Agency for Healthcare Research and Quality; 2015