Vorhofflimmern – Zusammenhänge pathophysiologischer und therapeutischer Prinzipien

Zusammenfassung

Vorhofflimmern (VHF) ist die häufigste anhaltende Herzrhythmusstörung, deren Grundlagen und klinische Forschung sich in stetigem Fluss befinden.

Ziel der vorliegenden Übersichtsarbeit ist es, dem nicht primär kardiologisch/elektrophysiologisch orientierten Arzt einen kurzen Überblick über die wichtigsten Konzepte der Pathophysiologie zu geben und über deren Einflüsse auf die Therapieprinzipien von VHF zu informieren. Vorgestellt werden die „Multiple Wavelet”-Theorie nach Moe und Allessie, das Konzept der ektopen Triggerung von paroxysmalem VHF nach Haissaguerre sowie die wichtigsten Mechanismen des atrialen Remodeling („atrial fibrillation begets atrial fibrillation” nach Wijffels) bei länger anhaltendem VHF. Die Bedeutung dieser pathophysiologischen Konzepte wird anschließend im Kontext der medikamentösen, rhythmuschirurgischen sowie katheterinterventionellen Therapieverfahren diskutiert. Gleichzeitig werden die Limitationen dieser Verfahren aufgrund pathophysiologischer Überlegungen skizziert.

Abstract

Atrial fibrillation is the most common supraventricular arrhythmia in humans, basic and clinical sciences are still developing. This present review aims to inform non-cardiologists respectively non-electrophysiologists about the most important pathophysiological concepts and their influence on therapeutical principles of atrial fibrillation. Moe’s and Allessie’s „multiple wavelet” theory is introduced as well as Haissaguerre’s concept of ectopic triggering of paroxysmal atrial fibrillation and the most important aspects of atrial remodeling („atrial fibrillation begets atrial fibrillation” according to Wijffels) during persistence of atrial fibrillation. Impact of these pathophysiological concepts is discussed within the context of medicamentous, surgical and interventional therapy. Concomitantly, limitations of these therapies due to pathophysiological considerations are delineated.

Schlüsselwörter

Vorhofflimmern - atriales Remodeling

Keywords

atrial fibrillation - atrial remodeling

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