Besser als medikamentöse Rhythmuskontrolle? – Interventionelle Therapie des Vorhofflimmerns

Die interventionelle Therapie des Vorhofflimmerns kann je nach Modalität bei der überwiegenden Mehrzahl der Fälle eine Verbesserung der Symptomatik erreichen. Dabei konkurrieren verschiedene Verfahren. Bei paroxysmalem VHF genügt oft die Pulmonalvenenisolation, bei permanentem VHF kommen meist komplexere Ablationsverfahren zur Anwendung und die Therapieerfolge sind bis dato weniger eindrücklich. Grenzen der Ablationstherapie sind schwer vernarbte Vorhöfe, da sich das Mapping aufgrund der fehlenden Signale erschwert und das Substrat für das Vorhofflimmern nicht mehr nur die Pulmonalvenen umfasst. Das ”Ablate and pace“-Verfahren stellt nach wie vor eine valide risikoarme Therapieoption zur Palliation des Tachy-Bradysyndroms und der schnellen Ventrikelantwort dar. Die Verbesserung der Überlebensrate, Verbesserung von Herzinsuffizienzfolgen, Langzeiterfolg der Pulmonalvenenisolation und vergleichbarer Methoden werden in andauernden Studien evaluiert.

Interventional therapy to treat atrial fibrillation (AF) achieves significant symptom improvement in the majority of patients. Different modalities compete. In paroxysmal AF, isolation of the pulmonary veins is oftentimes sufficient as compared to persistent or permanent AF, where substrate modification and a more complex ablation is often necessary, and results are often less satisfactory, particularly in scarred atria. Mapping is more difficult due to lack of signals and enlarged atria and the substrate initiating and maintaining atrial fibrillation is not confined to the pulmonary veins. When palliation is the main goal, 'ablate and pace' is still a valid low risk option to treat tachy- brady syndrome. Long term outcome of PVI, improvement of survival and amelioration of heart failure symptoms are being evaluated in ongoing clinical trials.

Key words

Atrial fibrillation - Imaging - Ablation

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