Interventioneller Verschluss des linken Vorhofohrs – Aktueller Stand der Vorhofokkluder

Vorhofflimmern (VHF) ist die häufigste Herzrhythmusstörung und ist mit einem erhöhten thrombembolischen Schlaganfallrisiko kardialen Ursprungs assoziiert. Der interventionelle Verschluss des linken Vorhofohrs (LAA) mittels LAA-Okkluder ist nicht nur sicher und mit hoher Erfolgsrate durchführbar, sondern ist gleichzeitig eine gute Alternative zur oralen Antikoagulation (OAK), insbesondere für Vorhofflimmer-Patienten, bei denen Kontraindikationen für die OAK vorliegen, die ein hohes Risiko für einen Schlaganfall und/oder Blutung haben sowie für Patienten, die unter OAK einen Schlaganfall und/oder eine schwerwiegende Blutungskomplikation erleiden. Diese Übersichtsarbeit schlussfolgert, dass der interventionelle LAA-Verschluss eine gute Alternative zur OAK ist, insbesondere beugt er bei Patienten einen Schlaganfall vor, die Probleme mit der OAK haben. In den nächsten Jahren werden eine Reihe von neuen LAA-Okkludern auf den Markt drängen. Die Frage, ob technische Unterschiede und Unterschiede im technischen Implantationsergebnis wie etwa Okkluder-Undichtigkeit klinische Ereignisse beeinflussen, wird man erst beantworten können, wenn mehr Langzeiterfahrung an größeren Patienten-Kollektiven vorliegt. Ebenso steht der direkte Vergleich zwischen LAA-Okkluder und den neuen OAK aus.

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and is associated with an increased risk of thromboembolic stroke of cardiac origin. The transcatheter occlusion of left atrial appendage (LAA) with a LAA-device cannot only be performed safely and with high success rate, but is simultaneously a good alternative to oral anticoagulation (OAC), in particular for AF-patients with contraindications for OAC, with high stroke risk and/or high bleeding risk, as well as for AF-patients who have a history of stroke and/or severe hemorrhage during OAC. This review concludes that the transcatheter occlusion of LAA is a good alternative to OAC, it prevents stroke in particular in patients who have problems with OAC. In the next years several new LAA occluders will come to the market. To answer the question, if technical differences and differences in technical implantation like leak at the device result in negative clinical outcome, long-term experience in greater number of patients is needed. The direct comparison LAA occlusion versus new OAC is also pending.

Key words

Atrial fibrillation - left atrial appendage - transcatheter occlusion - thromboembolic stroke - severe hemorrhage

• Literatur

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