Katheterablation bei asymptomatischem Vorhofflimmern – Wer profitiert?

Zusammenfassung

Die Katheterablation von paroxysmalem oder persistierendem Vorhofflimmern hat sich in den letzten Jahren als überlegene Therapiebehandlung zur Rhythmusstabilisierung gegenüber Antiarrhythmika etabliert. Allerdings wird diese Behandlung nach den aktuellen Leitlinien nur bei symptomatischen Patienten empfohlen. Ein großer Teil der Vorhofflimmerpatienten bleibt jedoch asymptomatisch. Ältere Studien konnten keinen Vorteil bezüglich der Letalitäts- oder Apoplexreduktion durch Rhythmusstabilisierung nachweisen. Eine aktuelle randomisierte Studie zeigt erstmalig eine Reduktion der kardiovaskulären Ereignisse, aber nicht der Gesamtletalität. Ist nach aktueller Datenlage eine Katheterablation im Falle von asymptomatischen Patienten berechtigt und wer könnte davon profitieren?

Abstract

Catheter ablation of paroxysmal or persistent atrial fibrillation has been established over the last years as a superior treatment compared to antiarrhythmic medication. However, the current guidelines of catheter ablation of atrial fibrillation only include this treatment as indication for symptomatic patients. Nevertheless, a large number of patients with atrial fibrillation remains asymptomatic. The data from older randomised studies concerning mortality or stroke reduction through effective rhythm control could not prove a clear benefit. A new randomised study showed reduction of cardiovascular events but not mortality after effective rhythm control. Is catheter ablation in asymptomatic patients justified and which patient can have a benefit?

Was ist wichtig?

• Ablation von Vorhofflimmern (VHF) hat sich als überlegen gegenüber Antiarrhythmika in der Rhythmusstabilisierung bewiesen.

• VHF ist mit erhöhtem kardiovaskulärem Risiko und Letalität assoziiert.

• Die aktuellen Leitlinien empfehlen eine VHF-Ablation nur bei symptomatischen Patienten.

• Entscheidend ist, die „echten“ asymptomatischen Patienten zu differenzieren.

• Ablation ist effektiver bei Patienten ohne lange persistierendes VHF.

• VHF-Rezidive sind nicht selten und das Absetzen der Antikoagulation nach der Ablation ist bei hohem CHADS-VASc nicht empfohlen.

• Randomisierte Daten zur Reduktion der Letalität und zu kardiovaskulären Ereignissen nach der Ablation sind widersprüchlich.

Schlüsselwörter

invasive Behandlung - Katheterablation - Rhythmusstabilisierung - Pulmonalvenenisolation - asymptomatisches Vorhofflimmern

Keywords

invasive therapy - catheter ablation - rhythm control - pulmonary vein isolation - asymptomatic atrial fibrillation

Publication History

Article published online:
14 June 2021

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