Antikoagulation bei linksatrialer Katheterablation

ZUSAMMENFASSUNG

Die linksatriale Katheterablation ist eine etablierte rhythmuserhaltenden Behandlung bei Patienten mit Vorhofflimmern und anderen supraventikulären Rhythmusstörungen. Es verdichten sich Hinweise, dass eine rhythmuserhaltende Therapie zusätzlich zur Verbesserung der Lebensqualität und Linderung von vorhofflimmerassozierten Symptomen kardiovaskuläre Ereignisse wie etwa ischämische Schlaganfälle verhindern und zum Erhalt der kognitiven Funktion beitragen kann. Allerdings finden sich bei etwa einem Viertel der Patienten nach linksatrialer Vorhofflimmerablation mittels Kernspintomografie klinisch stumme akute zerebrale Ischämien und etwa 0,2–0,3 % aller abladierten Patienten erleiden periinterventionell eine zerebrale Ischämie mit manifesten neurologischen Defiziten. Eine optimale Antikoagulation zur Prävention thrombembolischer Ereignisse im Zuge einer linksatrialen Katheterablationen ist daher ein zentraler Bestandteil in einem ganzheitlichen Therapiekonzept. Im Rahmen des vorliegenden Artikels soll die Datenlage und insbesondere die Ergebnisse der vom AFNET koordinierten AXAFA-AFNET-5-Studie vorgestellt werden.

ABSTRACT

Left atrial catheter ablation is an established treatment for rhythm maintenance in patients with atrial fibrillation and other supraventricular arrhythmias. There is growing evidence that rhythm-preserving therapy, in addition to improving quality of life and relieving atrial fibrillation-related symptoms, may prevent cardiovascular events such as ischemic stroke and help to preserve cognitive function. However, clinically silent acute cerebral ischemia is found in about a quarter of patients after left atrial fibrillation ablation by MRI and an estimated 0.2–0.3 % of all ablated patients experience cerebral ischemia with manifest neurological deficits peri-intervention. Optimal anticoagulation to prevent thromboembolic events during left atrial catheter ablation is therefore a central element in a holistic therapy concept. In this article, the current evidence and the results of the AFNET-coordinated AXAFA-AFNET 5 study will be discussed.

Schlüsselwörter

Vorhofflimmern - linksatriale Katheterablation - Heparin - MRT - orale Antikoagulation

Key words

Atrial fibrillation - left atrial catheter ablation - oral anticoagulation - heparin - MRI

Publikationsverlauf

Artikel online veröffentlicht:
07. Juni 2022

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