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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Dr. Roman Laszlo
Abteilung für Kardiologie und Kreislauferkrankungen, Klinikum
der Eberhard-Karls-Universität Tübingen
Otfried
Müller Str. 10
72076 Tübingen
Telefon: 07071/29-82712
Fax: 07071/29-5040
eMail: roman.laszlo@med.uni-tuebingen.de
