Vorhofflimmern bei Ionenkanal-Erkrankungen und Kardiomyopathien

Patienten mit Kardiomyopathien und kardialen Ionenkanal-Erkrankungen weisen aufgrund der strukturellen und elektrischen Veränderungen des Herzens ein signifikant erhöhtes Risiko für die Entwicklung eines Vorhofflimmerns auf. Dieser Beitrag gibt einen Überblick über die Bedeutung des Vorhofflimmerns bei Kardiomyopathien und Ionenkanal-Erkrankungen und die therapeutischen Ansätze, die von medikamentöser Behandlung bis hin zu invasiven Verfahren reichen.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia among patients with cardiomyopathies and cardiac channelopathies, significantly increasing the risk of thromboembolic events and heart failure. This review aims to provide an overview on the management of AF in these populations, focusing on the integration of the “AF-CARE” concept, introduced in the 2024 ESC guidelines. AF-CARE emphasizes a comprehensive approach involving rhythm and rate control, stroke prevention, and the management of comorbidities. Given the elevated thromboembolic risk, anticoagulation decisions are guided by the specific cardiomyopathy and the CHA2DS2-VA score. Recent evidence supports rhythm control as the preferred strategy over rate control for better clinical outcomes. Continuous monitoring and individualized care are recommended to optimize long-term prognosis and quality of life in these patients.

Kernaussagen

• AF ist die häufigste Arrhythmie bei Patienten mit Kardiomyopathien und kardialen Ionenkanal-Erkrankungen.

• Bei jungen Patienten mit AF sollte an erbliche Kardiomyopathien oder primäre Arrhythmie-Syndrome gedacht und eine weitergehende Diagnostik durchgeführt werden.

• Das neue AF-CARE-Konzept betont eine ganzheitliche Behandlung, einschließlich der Behandlung von Komorbiditäten, einer Rhythmus- und Frequenzkontrolle sowie der Prävention von Schlaganfällen.

• Aufgrund des erhöhten Risikos für thromboembolische Ereignisse ist eine Antikoagulation bei den meisten Patienten notwendig. Die Entscheidung basiert auf der spezifischen Form der Kardiomyopathie und des CHA2DS2-VA-Scores.

• Angesichts neuer Studienergebnisse wird die Rhythmuskontrolle gegenüber der Frequenzkontrolle bevorzugt.

Schlüsselwörter

Vorhofflimmern - Kanalopathien - Kardiomyopathie

Keywords

atrial fibrillation - channelopathies - cardiomyopathy

Publication History

Article published online:
05 August 2025

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