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Dtsch Med Wochenschr 2008; 133(49): 2572-2578
DOI: 10.1055/s-0028-1105856
Übersicht | Review article
Kardiologie
© Georg Thieme Verlag KG Stuttgart · New York

Wiederherstellung und Aufrechterhaltung eines Sinusrhythmus bei Patienten mit Vorhofflimmern

Neue medikamentöse TherapieansätzeConversion and maintenance of sinus rhythm in patients with atrial fibrillation – new pharmacological approachesNew pharmacological approachesS. Runge1 , R. Dietz1 , W. Haverkamp1
  • 1Medizinische Klinik Schwerpunkt Kardiologie, Campus Virchow-Klinikum und Campus Berlin-Buch, Berlin
Further Information

Publication History

eingereicht: 16.3.2008

akzeptiert: 1.9.2008

Publication Date:
27 November 2008 (online)

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Wiederherstellung und Aufrechterhaltung eines Sinusrhythmus bei Patienten mit VorhofflimmernDtsch Med Wochenschr 2008; 133(51/52): 2701-2701
DOI: 10.1055/s-0028-1105882

Zusammenfassung

Die Therapie des Vorhofflimmerns, der häufigsten Herzrhythmusstörung im Erwachsenenalter, stellt zusammen mit der altersabhängigen steigenden Prävalenz in einer zunehmend alternden Gesellschaft eine wachsende Herausforderung dar. Aktuelle medikamentöse Therapieansätze zur Wiederherstellung und Erhaltung eines Sinusrhythmus werden durch die begrenzte Effektivität, Tolerabilität und Sicherheit der bisher eingesetzten Antiarrhythmika eingeschränkt. Ein primäres Ziel ist somit die Entwicklung von wirkungsvollen Medikamenten mit möglichst geringem Nebenwirkungsprofil Die folgende Übersicht beschreibt neue vielversprechende medikamentöse Therapieansätze, die die bislang bestehenden Probleme und Grenzen der Antiarrhtmika, zumindest partiell, überwinden.

Summary

Atrial fibrillation is the most frequent cardiac arrthythmia in adults and its prevalence is increasing with age. Therefore, the importance of an adequate therapy is an increasing challenge, in particular considering the demographic shift towards an aging population. Current antiarrhythmic drug therapies for the conversion of atrial fibrillation and the maintenance of sinus rhythm are limited by efficacy, tolerance and safety of the currently available agents. Therefore, a primary goal is to develop effective antiarrhythmic drugs with as little as possible side effects. The following review describes new promising drug therapy approaches to atrial fibrillation that may overcome some of the limitations of current therapies.

Schlüsselwörter

Vorhofflimmern - Antiarrhythmika - neue Therapieansätze - Ionenkanäle - Vorhofspezifische Wirkstoffe - Sinusrhythmus - Torsades de pointes

Keywords

atrial fibrillation - antiarrhythmic drugs - new therapies - ion channels - atrial specific agents - sinus rhythm - torsades de pointes

Literatur

  • 1 Stroke Prevention in Atrial Fibrillation Study. Final results.  Circulation. 1991;  84 (2) 527-539
    Search in Google Scholar
  • 2 Heart Rhythm, 2008, 29th Annual Scientific Sessions. San Francisco; 14. – 17. Mai 2008
    Search in Google Scholar
  • 3 Calo L, Bianconi L, Colivicchi F. et al . N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: a randomized, controlled trial.  J Am Coll Cardiol. 2005;  45 (10) 1723-1728
    Search in Google Scholar
  • 4 Dale K M, White C M. Dronedarone: an amiodarone analog for the treatment of atrial fibrillation and atrial flutter.  Ann Pharmacother. 2007;  41 (4) 599-605
    Search in Google Scholar
  • 5 Deedwania P C, Singh B N, Ellenbogen K. et al . Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). The Department of Veterans Affairs CHF-STAT Investigators.  Circulation. 1998;  98 (23) 2574-2579
    Search in Google Scholar
  • 6 Ehrlich J R, Biliczki P, Hohnloser S H, Nattel S. Atrial-selective approaches for the treatment of atrial fibrillation.  J Am Coll Cardiol. 2008;  51 (8) 787-792
    Search in Google Scholar
  • 7 Ehrlich J R, Hohnloser S H, Nattel S. Role of angiotensin system and effects of its inhibition in atrial fibrillation: clinical and experimental evidence.  Eur Heart J. 2006;  27 (5) 512-518
    Search in Google Scholar
  • 8 Fauchier L, Pierre B, de Labriolle A. et al . Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials.  J Am Coll Cardiol. 2008;  51 (8) 828-835
    Search in Google Scholar
  • 9 Fuster V, Ryden L E, Cannom D S. et al . ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation).  J Am Coll Cardiol. 2006;  48 (4) 854-906
    Search in Google Scholar
  • 10 Gautier P, Guillemare E, Djandjighian L. et al . In vivo and in vitro characterization of the novel antiarrhythmic agent SSR149744C: electrophysiological, anti-adrenergic, and anti-angiotensin II effects.  J Cardiovasc Pharmacol. 2004;  44 (2) 244-257
    Search in Google Scholar
  • 11 Gautier P, Serre M, Cosnier-Pucheu S. et al . In vivo and in vitro antiarrhythmic effects of SSR149744C in animal models of atrial fibrillation and ventricular arrhythmias.  J Cardiovasc Pharmacol. 2005;  45 (2) 125-135
    Search in Google Scholar
  • 12 Gerth A, Höss J, Näbauer M, Steinbeck G. Epidemiologie von Vorhofflimmern. In: Lewalter T, editor Rationale Arrhythmiebehandlung – Ein Paradigmenwechsel. Darmstadt; Steinkopff 2006: 13-22
    Search in Google Scholar
  • 13 Goette N. Neue Aspekte der medikamentösen antiarrhythmischen Therapie. In: Lewalter T, editor Rationale Arrhythmiebehandlung – Ein Paradigmenwechsel. Darmstadt; Steinkopff 2006: 23-9
    Search in Google Scholar
  • 14 Goldschlager N, Epstein A E, Naccarelli G V. et al . A practical guide for clinicians who treat patients with amiodarone: 2007.  Heart Rhythm. 2007;  4 (9) 1250-1259
    Search in Google Scholar
  • 15 Haverkamp W, Haverkamp F, Breithardt G. Medikamentenbedingte QT-Verlängerung und Torsade de pointes.  Deutsches Ärzteblatt. 2002;  99 (28 – 29) A1972-A1979
    Search in Google Scholar
  • 16 Healey J S, Baranchuk A, Crystal E. et al . Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis.  J Am Coll Cardiol. 2005;  45 (11) 1832-1839
    Search in Google Scholar
  • 17 Hohnloser S H, Kuck K H, Lilienthal J. Rhythm or rate control in atrial fibrillation--Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial.  Lancet. 2000;  356 (9244) 1789-1794
    Search in Google Scholar
  • 18 Humphries K H, Lee M, Sheldon R. et al . Statin use and recurrence of atrial fibrillation after successful cardioversion.  Am Heart J. 2007;  154 (5) 908-913
    Search in Google Scholar
  • 19 Kjolbye A L, Haugan K, Hennan J K, Petersen J S. Pharmacological modulation of gap junction function with the novel compound rotigaptide: a promising new principle for prevention of arrhythmias.  Basic Clin Pharmacol Toxicol. 2007;  101 (4) 215-230
    Search in Google Scholar
  • 20 Kowey P R, Aliot E M, Capucci A. et al . Placebo-controlled double-blind dose-ranging study of the efficacy and safety of SSR149744C in patients with recent atrial fibrillation/flutter. (Abstract).  Heart Rhythm. 2007;  4 S72
    Search in Google Scholar
  • 21 Lee K W, Everett T H, Rahmutula D. et al . Pirfenidone prevents the development of a vulnerable substrate for atrial fibrillation in a canine model of heart failure.  Circulation. 2006;  114 (16) 1703-1712
    Search in Google Scholar
  • 22 Lip G Y, Tse H F. Management of atrial fibrillation.  Lancet. 2007;  (9587) 370 604-618
    Search in Google Scholar
  • 23 Maggioni A P, Latini R, Carson P E. et al . Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT).  Am Heart J. 2005;  149 (3) 548-557
    Search in Google Scholar
  • 24 Mathew J P, Fontes M L, Tudor I C. et al . A multicenter risk index for atrial fibrillation after cardiac surgery.  JAMA. 2004;  291 (14) 1720-1729
    Search in Google Scholar
  • 25 Morrow J P, Cannon C P, Reiffel J A. New antiarrhythmic drugs for establishing sinus rhythm in atrial fibrillation: what are our therapies likely to be by 2010 and beyond?.  Am Heart J. 2007;  154 (5) 824-829
    Search in Google Scholar
  • 26 Mozaffarian D. Fish oil and prevention of atrial fibrillation.  J Am Coll Cardiol. 2007;  50 (15) 1513-1514
    Search in Google Scholar
  • 27 Patti G, Chello M, Candura D. et al . Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) study.  Circulation. 2006;  114 (14) 1455-1461
    Search in Google Scholar
  • 28 Pedersen O D, Bagger H, Kober L, Torp-Pedersen C. Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction.  Circulation. 1999;  100 (4) 376-380
    Search in Google Scholar
  • 29 Rahme M M, Cotter B, Leistad E. et al . Electrophysiological and antiarrhythmic effects of the atrial selective 5-HT(4) receptor antagonist RS-100 302 in experimental atrial flutter and fibrillation.  Circulation. 1999;  100 (19) 2010-2017
    Search in Google Scholar
  • 30 Roy D, Pratt C M, Torp-Pedersen C. et al . Vernakalant hydrochloride for rapid conversion of atrial fibrillation: a phase 3, randomized, placebo-controlled trial.  Circulation. 2008;  117 (12) 1518-1525
    Search in Google Scholar
  • 31 Roy D, Rowe B H, Stiell I G. et al . A randomized, controlled trial of RSD1235, a novel anti-arrhythmic agent, in the treatment of recent onset atrial fibrillation.  J Am Coll Cardiol. 2004;  44 (12) 2355-2361
    Search in Google Scholar
  • 32 Ruskin J N. The cardiac arrhythmia suppression trial (CAST).  N Engl J Med. 1989;  321 (6) 386-388
    Search in Google Scholar
  • 33 Sablayrolles S, Le Grand B. Drug evaluation: dronedarone, a novel non-iodinated anti-arrhythmic agent.  Curr Opin Investig Drugs. 2006;  7 (9) 842-849
    Search in Google Scholar
  • 34 Savelieva I, Camm J. Anti-arrhythmic drug therapy for atrial fibrillation: current anti-arrhythmic drugs, investigational agents, and innovative approaches.  Europace. 2008;  10 (6) 647-665
    Search in Google Scholar
  • 35 Singh B N, Aliot E. Newer antiarrhythmic agents for maintaining sinus rhythm in atrial fibrillation: simplicity or complexity?.  European Heart Journal Supplements. 2007;  9 (Supplement G) G17-G25
    Search in Google Scholar
  • 36 Singh B N, Singh S N, Reda D J. et al . Amiodarone versus sotalol for atrial fibrillation.  N Engl J Med. 2005;  352 (18) 1861-1872
    Search in Google Scholar
  • 37 Thrall G, Lip G Y, Carroll D, Lane D. Depression, anxiety, and quality of life in patients with atrial fibrillation.  Chest. 2007;  132 (4) 1259-1264
    Search in Google Scholar
  • 38 Touboul P, Brugada J, Capucci A. et al . Dronedarone for prevention of atrial fibrillation: a dose-ranging study.  Eur Heart J. 2003;  24 (16) 1481-1487
    Search in Google Scholar
  • 39 Van Gelder I C, Hagens V E, Bosker H A. et al . A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.  N Engl J Med. 2002;  347 (23) 1834-1840
    Search in Google Scholar
  • 40 Vassallo P, Trohman R G. Prescribing amiodarone: an evidence-based review of clinical indications.  JAMA. 2007;  298 (11) 1312-1322
    Search in Google Scholar
  • 41 Vermes E, Tardif J C, Bourassa M G. et al . Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials.  Circulation. 2003;  107 (23) 2926-2931
    Search in Google Scholar
  • 42 Schacky C von. Omega-3 fatty acids: antiarrhythmic, proarrhythmic or both?.  Curr Opin Clin Nutr Metab Care. 2008;  11 (2) 94-99
    Search in Google Scholar
  • 43 Waldo A L, Camm A J, deRuyter H. et al . Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators. Survival With Oral d-Sotalol.  Lancet. 1996;  348 (9019) 7-12
    Search in Google Scholar
  • 44 Wyse D G, Waldo A L, DiMarco J P. et al . A comparison of rate control and rhythm control in patients with atrial fibrillation.  N Engl J Med. 2002;  347 (23) 1825-1833
    Search in Google Scholar
  • 45 Yin Y, Dalal D, Liu Z. et al . Prospective randomized study comparing amiodarone vs. amiodarone plus losartan vs. amiodarone plus perindopril for the prevention of atrial fibrillation recurrence in patients with lone paroxysmal atrial fibrillation.  Eur Heart J. 2006;  27 (15) 1841-1846
    Search in Google Scholar

Sarah Runge

Charité-Univeristätsmedizin Berlin, Medizinische Klinik Schwerpunkt Kardiologie, Campus Virchow-Klinikum und Campus Berlin-Buch

Augustenburger Platz 1

13353 Berlin

Email: sarah.runge@charite.de