Follow-up nach Pulmonalvenenisolation – Wie wird „Erfolg“ definiert?

Zusammenfassung

Die Katheterablation von Vorhofflimmern ist der medikamentösen Therapie hinsichtlich einer Rhythmuskontrolle überlegen. In der Erfolgskontrolle ist die Durchführung von mehrtägigen EKG-Aufzeichnungen zu empfehlen, wobei der Nachbeobachtungszeitraum mindestens 2 Jahre betragen sollte. Langzeitergebnisse nach einmaliger Ablationstherapie sind hinsichtlich einer vollständigen Freiheit von Vorhofflimmern moderat, können jedoch durch wiederholte Ablationseingriffe dauerhaft verbessert werden. Darüber hinaus kann durch die Ablation eine anhaltende Steigerung der Lebensqualität, unabhängig von einer Rezidivfreiheit, erreicht werden.

Abstract

Catheter ablation of atrial fibrillation is more effective compared to drug therapy. During follow-up time of at least 2 years repeated rhythm monitoring by 4 to 7-days-holter ECG is recommended. Long-term results of treatment of atrial fibrillation by catheter ablation are moderate. However reasonable success rates can be achieved by multiple ablation procedures. Independently of rhythm control catheter ablation can result in a long-term quality of life improvement.

Schlüsselwörter

Vorhofflimmern - Katheterablation - Pulmonalvenenisolation - Langzeitergebnisse - Lebensqualität

Key words

atrial fibrillation - catheter ablation - pulmonary vein isolation - long-term results - quality of life

• Literatur

• 1 Wilber DJ, Pappone C, Neuzil P et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation. JAMA 2010; 303: 333-340
• 2 Calkins H, Reynolds MR, Spector P et al. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation. Two systematic literature reviews and meta-analyses. Circ Arrhythmia Electrophysiol 2009; 2: 349-361
• 3 Calkins H, Kuck KH, Cappato R et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patients management and follow-up, definitions, endpoints, and research trial design. Heart Rhythm 2012; 9: 632-696
• 4 Takahashi A, Iesaka Y, Takahashi Y et al. Electrical connections between pulmonary veins: implications for ostial ablation of pulmonary veins in patients with paroxysmal atrial fibrillation. Circulation 2002; 105: 2998-3003
• 5 Pappone C, Augello G, Sala S et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF study. J Am Coll Cardiol 2006; 48: 2340-2347
• 6 Wazni OM, Marrouche NF, Martin DO et al. Radiofrequency ablation vs. antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation : a randomized trial. JAMA 2005; 293: 2634-2640
• 7 Jais P, Cauchemez B, Macle L et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation 2008; 118: 2498-2505
• 8 Brooks AG, Stiles ML, Laborderie J et al. Outcome of long-standing persistent atrial fibrillation ablation: a systematic review. Heart Rhythm 2010; 7: 835-846
• 9 Ouyang F, Tilz R, Chun J et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation 2010; 122: 2368-2377
• 10 Bertaglia E, Tondo C, de Simone A et al. Does single ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience. Europace 2010; 12: 181-187
• 11 Pontoppidan J, Nielsen JC, Poulsen SH et al. Symptomatic and asymptomatic atrial fibrillation after pulmonary vein ablation and the impact on quality of life. PACE 2009; 32: 717-726
• 12 Mulder A, Wijffels M, Wever E et al. Arrhythmia detection after atrial fibrillation ablation: value of incremental monitoring time. PACE 2012; 35: 164-169
• 13 Ziegler PD, Koehler JL, Mehra R. Comparison of continous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm 2006; 3: 1445-1452
• 14 Edgerton JR, Mahoney C, Mack MJ et al. Long-term monitoring after surgical ablation of atrial fibrillation: how much is enough?. J Thorac Cardiovasc Surg 2011; 142: 162-165
• 15 Pokushalov E, Romanov A, Corbucci G et al. Ablation of paroxysmal and persistent atrial fibrillation: 1-year follow-up through continous subcutanous monitoring. J Cardiovasc Electrophysiol 2011; 22: 369-375
• 16 Eitel C, Husser D, Hindricks G et al. Performance of an implantable automatic atrial fibrillation detection device: impact of software adjustments and relevance of manual episode analysis. Europace 2011; 13: 480-485
• 17 Reynolds MR, Walczak J, White SA et al. Improvements in symptoms and quality of life in patients with paroxysmal atrial fibrillation treated with radiofrequency catheter ablation versus antiarrhythmic drugs. Circ Cardiovasc Qual Outcomes 2010; 3: 615-623
• 18 Weerasooriya R, Jais P, Hocini M et al. Effect of catheter ablation on quality of life of patients with paroxysmal atrial fibrillation. Heart Rhythm 2005; 2: 619-623
• 19 Wokhlu A, Monahan KH, Hodge DO et al. Long-term quality of life after ablation of atrial fibrillation. J Am Coll Cardiol 2010; 55: 2308-2316