Neurologische Komplikationen nach linksatrialer Katheterablation bei Vorhofflimmern

Zusammenfassung

Die linksatriale Katheterablation hat sich als therapeutische Option bei symptomatischem paroxysmalem oder persistierendem Vorhofflimmern (VHF) etabliert. Bei der Mehrheit der Patienten kann nach teils mehrfachen Ablationen eine suffiziente Symptomkontrolle erreicht werden. In vielen Fällen kann ein langfristiger Erhalt des Sinusrhythmus erzielt werden, was für die Vermeidung von VHF-assoziierten Komplikationen von Bedeutung sein könnte. Diese Arbeit gibt einen Überblick über mögliche neurologische Komplikationen der linksatrialen Katheterablation. Neurologische Komplikation treten nach linksatrialer Katheterablation bei 0,4 bis 1,2% der Patienten auf und werden vorwiegend durch akute zerebrale Ischämien bedingt. Nicht ischämisch bedingte neurologische Komplikationen sind sehr selten und werden hauptsächlich durch Phrenikusläsionen hervorgerufen. Zudem geht die sporadisch periinterventionell induzierte atrio-ösophageale Fistel in der Mehrzahl der beschriebenen Fälle mit neurologischen Komplikationen einher. In Abhängigkeit vom eingesetzten Ablationssystem können bei Patienten ohne fokal neurologisches Defizit postinterventionell in variierender Häufigkeit akute zerebrale Läsionen nachgewiesen werden. Die klinische Bedeutung dieser mittels MRT detektierten zerebralen Ischämien kann noch nicht beurteilt werden.

Summary

Left atrial catheter ablation has become an established therapy to abolish symptomatic paroxysmal and persistent atrial fibrillation. Most patients undergoing (several) catheter ablation procedures have sufficient symptom relief. In addition, restoring sinus rhythm may help to prevent AF-related complications on the long-term. This review summarizes the current knowledge regarding ablation-related neurological complications. Neurological complications occur in 0.4 to 1.2% of all patients undergoing ablation and are predominantly caused by cerebral ischemia. Nonischemic neurological complications are rare and are generally caused by phrenic nerve paralysis. In addition, neurological complications frequently occur after atrio-oesophageal fistula, a rather seldom complication of left atrial catheter ablation. Moreover, MRI-detected brain lesions without corresponding neurological symptoms can be common after catheter ablation procedures, and may depend on the ablation technology employed. However, the clinical relevance of these ischemic brain lesions is not totally understood so far.

Schlüsselwörter

Vorhofflimmern - Katheterablation - Schlaganfall - Komplikationen

Keywords

Atrial fibrillation - catheter ablation - stroke - complications

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