Interventioneller Vorhofohrverschluss bei Vorhofflimmer-Patienten mit hohem Blutungsrisiko

Abstract

Atrial fibrillation is the most common sustained cardiac arrhythmia worldwide. The left atrial appendage (LAA) is the main source of thrombi caused by atrial fibrillation because of decreased blood velocity. These thrombi can cause thrombembolic events in leaving the LAA into the systemic circulation. For preventing thromboembolic events a long-term oral anticoagulation therapy is recommended. The interventional LAA closure is a guideline appropriate therapy option for patients with non-valvular atrial fibrillation that cannot be treated with long-term oral anticoagulation. Thereby the LAA is sealed with an implant. This therapy has shown efficient prophylaxis of thrombembolic events with safe performance in several studies.

Kernaussagen

• Der interventionelle Vorhofohrverschluss ist eine leitliniengerechte Therapiemöglichkeit bei Patienten mit nicht valvulärem Vorhofflimmern und Indikation zur oralen Antikoagulation, die nicht mit Langzeit-OAK behandelt werden können.

• In Studien konnte gezeigt werden, dass der interventionelle Eingriff sicher durchführbar ist und einen effizienten Schutz gegen Thrombembolien bietet.

• Aktuell gibt es mit dem Watchman-Device von Boston Scientific und dem Amplatzer Cardiac Plug von St. Jude Medical 2 LAA-Verschluss-Okkluder, die in Deutschland kommerziell erhältlich sind.

• Klassische Komplikationen des interventionellen LAA-Verschlusses sind Perikarderguss/‑tamponade, Schlaganfall durch Luftembolie, Device-Verlust, Device-Thromben und Komplikationen an den Einstichstellen.

• Eine präinterventionelle TEE zur Beurteilung der LAA-Anatomie mit Bestimmung von Eingangsdurchmesser und Tiefenausdehnung sowie der LAA-Konfiguration mit Bestimmung der Lobuli-Anzahl ist notwendig. Zum Zeitpunkt des Verschlusses darf kein LAA-Thrombus vorliegen.

• Postinterventionell muss für 3 – 6 Monate eine Therapie mit Antikoagulanzien verschiedener Art durchgeführt werden, um eine Endothelialisierung des Devices zu ermöglichen. Hierzu gibt es aktuell noch kein abschließend empfehlenswertes Schema.

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