ESC-Leitlinie 2016 zum Management von Vorhofflimmern

Zusammenfassung

Die neue ESC-Leitlinie zum Management von Patienten mit Vorhofflimmern (VHF) aus 2016 gibt einen Überblick über die aktuelle Datenlage zur Diagnostik und Therapie von Patienten mit VHF. Viele Empfehlungen der Leitlinie beruhen auf Expertenmeinung, und eine Anpassung durch zukünftige Studienergebnisse ist wünschenswert. Insbesondere wird ein multidisziplinärer, kooperativer Ansatz der Prävention, Diagnostik und Therapie von Vorhofflimmern in den Vordergrund gestellt. Ziel ist es, Patienten mit Vorhofflimmern in unterschiedlichen Settings optimal zu behandeln, wobei Lebensqualität und Prognose im Vordergrund stehen. Die Behandlung VHF-begünstigender Faktoren oder Komorbiditäten spielt eine entscheidende Rolle in der Prävention und Therapie von Patienten mit VHF. Neben diesen Empfehlungen zur Prävention und frühzeitigen Erkennung von Vorhofflimmern ist ein großer Teil der Leitlinie auf eine adäquate Schlaganfallprophylaxe und Risikostratifizierung ausgerichtet. Weiterhin wird der klinische CHA₂DS₂-VASc-Score zur Risikoprädiktion und adäquaten Indikation einer oralen Antikoagulation empfohlen. Insgesamt sind die Empfehlungen bei der Antikoagulation auf ein Vermeiden einer Unter- bzw. Überdosierung von Vitamin-K-Antagonisten zugunsten der neuen direkten Thrombininhibitoren verschoben. Die interventionelle Therapie von Vorhofflimmern wird für symptomatische, medikamentös therapierefraktäre Patienten, aber auch als „First-Line“-Therapie bei Wunsch des Patienten empfohlen. Die Einbindung des Patienten in die Prophylaxe und Entscheidungsfindung zur Therapie wird empfohlen und stellt einen zentralen Kernpunkt der Leitlinienempfehlungen dar, wobei kontrollierte Studien zum Nutzen der Einbindung interdisziplinärer Gremien bisher nicht existieren.

Abstract

The new ESC-guideline on the management of patients with atrial fibrillation (AF) published in 2016 gives an overview over current data relevant to the diagnostic and therapeutic options in AF. Many recommendations are based on expert opinion and need to be adopted as soon as future studies on these topics area available. Prevention, diagnosis and treatment of AF is recommended to be evaluated in multidisciplinary teams to optimize management of AF patients in order to increase quality of life and prognosis. Treating AF predisposing factors and comorbidities are important for prevention and therapy. Adequate prevention of thromboembolic complications of AF is a major issue of the current guidelines. Risk stratification using the clinical CHA₂DS₂-VASc-Score and adopted indication for oral anticoagulation is recommended for all AF patients. Principally, all patients without contraindications for novel oral anticoagulants (NOAC) should be initiated on NOACs based on their individual risk score. Oral anticoagulation is recommended for all male patients with CHA₂DS₂-VASc-Score ≥ 2 and female patients with CHA₂DS₂-VASc-Score ≥ 3. Catheter ablation of AF is indicated in symptomatic medically-refractory AF and is superior to antiarrhythmic drug treatment for rhythm stabilization. Therefore catheter ablation may be used as first-line treatment if patientʼs preference. Interdisciplinary teams optimizing treatment options and outcome for the patient are recommended but data on benefit of this strategy is lacking.

Schlüsselwörter

Vorhofflimmern - Katheterablation - Antikoagulation - Leitlinie

Key words

atrial fibrillation - catheter ablation - anticoagulation - guideline

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