SOP – Kardioversion und Antikoagulationsmanagement

Kardioversionen werden in Arztpraxen und Kliniken in großer Zahl durchgeführt. Die zugrunde liegenden Rhythmusstörungen Vorhofflimmern und Vorhofflattern sind sehr häufig und werden in Zukunft noch mehr Patienten betreffen. Die frühe rhythmuserhaltende Therapie gewinnt aufgrund neuer Daten zusätzlich an Bedeutung. Der vorliegende Artikel soll einen Überblick über die aktuelle Datenlage und erforderliche Maßnahmen rund um die Kardioversion geben.

Schlüsselwörter

Kardioversion - Antikoagulation - Vorhofflimmern - Schlaganfallrisiko - Rezidiv

• Literatur

• 1 Berg JP, Rabe D, Degenhardt MC. et al. Elektrische Kardioversion – Schritt für Schritt. Kardiologie up2date 2022; 18: 19-24
• 2 Eckardt L, Sehner S, Suling A. et al. Attaining sinus rhythm mediates improved outcome with early rhythm control therapy of atrial fibrillation: the EAST-AFNET 4 trial. Eur Heart J 2022; 43: 4127-4144
• 3 Kirchhof P, Camm J, Goette A. et al. Early Rhythm-Control Therapy in patients with atrial fibrillation. N Engl J Med 2020; 383: 1305-1316
• 4 Brugada J, Katritsis DG, Arbelo E. ESC Scientific Document Group. et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41: 655-720
• 5 Steinbeck G, Sinner MF, Lutz M. et al. Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J 2018; 39: 4020-4029
• 6 Hindricks G, Potpara T, Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373-498
• 7 Andrade JG, Mitchell LB. Periprocedural anticoagulation for cardioversion of acute onset atrial fibrillation and flutter: Evidence Base for current guidelines. Can J Cardiol 2019; 35: 1301-1310
• 8 Pluymaekers NAHA, Dudink EAMP, Luermans JGLM. et al. Early or delayed cardioversion in recent onset atrial fibrillation. N Engl J Med 2019; 380: 1499-1508
• 9 Dan GA, Martinez-Rubio A, Agewall S. et al. Antiarrhythmic drugs-clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace 2018; 20: 731-732
• 10 Alboni P, Botto GL, Baldi N. et al. Outpatient treatment of recent-onset atrial fibrillation with the „pill-in-the-pocket“ approach. N Engl J Med 2004; 351: 2384-2391
• 11 Markman TM, Jarrah AA, Tian Y. et al. Safety of Pill-in-the-Pocket Class 1C Antiarrhythmic Drugs for Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8: 1515-1520
• 12 Gunawardene MA, Willems S. Atrial fibrillation progression and the importance of early treatment to improve clinical outcomes. Europace 2022; 24: ii22-ii28
• 13 Andrade JG, Wells GA, Deyell MW. et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med 2021; 384: 305-315
• 14 Wazni OM, Danamundi G, Sood N. et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med 2021; 384: 316-324
• 15 Kuniss M, Pavlovic N, Velagic V. et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace 2021; 23: 1033-1041
• 16 Andrade JG, Deyell MW, Macle L. et al. Progression of Atrial Fibrillation after Cryoablation or Drug Therapy. N Engl J Med 2023; 388: 105-116
• 17 Kuck KH, Lebedev DS, Mikhaylov EN. et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). Europace 2021; 23: 362-369