Aktuelle Datenlage zur elektrischen Kardioversion bei Vorhofflimmern unter NOAKs

Die Kardioversion von Vorhofflimmern gehört zur klinischen Routine. Obwohl dieses Verfahren in vielen tausend Fällen pro Jahr allein in Deutschland durchgeführt wird, war die wissenschaftliche Datenlage aus prospektiven, randomisierten Studien bislang limitiert. Durch Einführung der nicht- Vitamin-K-Antagonist oralen Antikoagulanzien (NOAK) gibt es nun große prospektiven Studien zur Kardioversion von Vorhofflimmern. In diesen Studien (ENSURE AF, XVeRT) wurden die elektrische und pharamkologische Kardioversion von Vorhofflimmern unter NOAK untersucht und zudem die TEE-gesteuerte Kardioversion mit einem konservativen Ansatz verglichen. Es konnte hierdurch gezeigt werden, dass die Behandlung mit NOAK (Edoxaban und Rivaroxan) effektiv und sicher bei Patienten ist, die wegen Vorhofflimmern kardiovertiert werden müssen. Der vorliegende Artikel fasst die wesentlichen, bisher verfügbaren Daten zur Kardioversion von Vorhofflimmern zusammen.

Cardioversion of atrial fibrillation is of major importance in clinical practice. However, data from prospective and randomized trials were limited. With the introduction of non-vitamin K antogonist oral anticoagulans (NOAC) for therapy of patients with atrial fibrillation, the largest prospective trials ever on cardioversion have been published. The ENSURE AF trial and the XVeRT study could show that cardioversion of atrial fibrillation is safe and effective in patients treated with NOAC. In addition, the two studies helped to examine the impact of transesophageal echocardiography in patients undergoing cardioversion. This review summarizes the most recent and relevant information in this important clinical field.

Key words

Anticoagulation - echocardiography - cardioversion - NOAC - stroke - atrial fibrillation

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