Atriale Tachykardien nach Vorhofflimmerablation: Fluch oder Segen?

Zusammenfassung

Nach Vorhofflimmerablation kann es neben Vorhofflimmerrezidiven auch zum Auftreten von verschiedenen atrialen Tachykardien kommen. Obwohl bei atrialen Tachykardien eine regelmäßige atriale Aktivierung vorliegt, sind diese Rhythmusstörungen für die Patienten häufig stark symptomatisch und teils kaum medikamentös zu kontrollieren. Für eine individualisierte Therapieplanung können anhand des Oberflächen-EKGs auch bei vielen vor-abladierten Patienten rechts- von links-atrialen Tachykardien recht zuverlässig unterschieden werden. Die Ablationsstrategie richtet sich nach dem Mechanismus der Tachykardie: Auffinden der frühesten elektrischen Aktivierung und lokale Ablation bei fokalen Tachykardien oder lineare Ablation zur Unterbindung des Reentry-Kreislaufs bei Makro-Reentry-Tachykardien. Speziell bei Patienten mit ausgeprägter Vorhoffibrose ist der optimale Therapieansatz aber noch Gegenstand klinischer Studien.

Abstract

Recurrences of atrial tachycardias can occur following ablation for atrial fibrillation. Despite regular atrial activation, atrial tachycardias can be highly symptomatic and difficult to control using antiarrhythmic medications. To guide therapeutic decisions, right- and left-atrial tachycardias can be distinguished with reasonable accuracy using the 12-lead surface ECG. The target of ablation depends on the mechanism of the tachycardia: identifying and ablating the earliest electrical acitivity for focal tachycardias, or linear ablation in macro-reentrant tachycardias. Particularily in patients with extensive fibrotic atrial myopathy, the most promising approach for ablation is still a matter of ongoing research.

Schlüsselwörter

Vorhofflimmern - atriale Tachykardie - Vorhofflattern - Ablation - fibrotische atriale Kardiomyopathie

Keywords

atrial tachycardia - atrial flutter - ablation - fibrotic atrial cardiomyopathy - atrial fibrillation

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