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Nervenheilkunde 2012; 31(11): 791-795
DOI: 10.1055/s-0038-1628223
Kompetenzentz Vorhofflimmern
Schattauer GmbH

Vorhofflimmern und Blutungskomplikationen

Risikofaktoren und -markerAtrial fibrillation and bleeding complicationRisk factors and risk marker
G. Breithardt
1   Kompetenznetz Vorhofflimmern (AFNET)
2   Department für Kardiologie und Angiologie, Universitätsklinikum Münster
,
U. Ravens
3   Institut für Pharmakologie und Toxikologie, Medizinische Fakultät Carl Gustav Carus, Dresden
,
P. Kirchhof
4   Cardiovascular Medicine, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, England, und Department Kardiologie und Angiologie, Universitätsklinikum Münster
,
I. C. van Gelder
5   University of Groningen, University Medical Center Groningen, Niederlande
› Institutsangaben
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Publikationsverlauf

eingegangen am: 29. Mai 2012

angenommen am: 05. Juni 2012

Publikationsdatum:
23. Januar 2018 (online)

    Lizenzen und Reprints

Zusammenfassung

Die Entstehung von Vorhofflimmern (VHF) ist eng verbunden mit Risikofaktoren wie Hyper-tonie und Herzinsuffizienz, ferner mit Diabetes mellitus, Herzinfarkt und Herzklappenerkrankungen. Diese Faktoren überlappen teilweise mit denjenigen, die für das Fort-schreiten des VHF und für Schlaganfälle verantwortlich sind. Für die Vorhersage einer Progression von paroxysmalem zu permanentem VHF ist der HATCH-Score (Herzinsuffizienz, Alter, TIA oder Schlaganfall in der Vorgeschichte, chronisch-obstruktive Lungenerkrankung und Hypertonie) vorgeschlagen worden. Der CHADS2-Score wurde in den Leitlinien der Europäischen Gesellschaft für Kardiologie von 2010 erweitert.

Für die Blutungsbereitschaft spielen teilweise die gleichen Risikofaktoren eine Rolle, die zur Entstehung von VHF führen und das Risiko von Schlaganfällen und TIA bestimmen. Auch wenn die Punktesysteme zur Vorhersage von Ereignissen in größeren Populationen entwickelt worden sind, haben sie zunehmende Bedeutung zur Risikoabschätzung im Einzel-fall erlangt. Auf diese Weise stellen sie eine Hilfe auf dem Weg zu einer besseren Implementierung der oralen Antikoagulation und der Beeinflussung der zum VHF führenden Faktoren in der täglichen Praxis dar.

Summary

The development of atrial fibrillation (AF) is closely linked to risk factors like hypertension and heart failure, diabetes mellitus, myocardial infarction and valvular heart disease. These factors partly overlap with those which determine the progression of atrial fibrillation and the incidence of stroke. For prediction of progression of atrial fibrillation from paroxysmal to permanent AF, the HATCH score (heart failure, age, previous TIA or stroke, chronic obstructive pulmonary disease and hypertension) has been proposed. The CHADS2 score for prediction of stroke has been expanded in the recent guidelines of the European Society of Cardiology by additional factors.

The bleeding risk is partly related to the same risk factors that determine the development of AF and the risk of stroke and TIA. Although these and other score systems have been developed for the prediction of events in larger populations, and thus have some limitations when applied to the individual patient, they have increasingly been used in clinical practice. They help to achieve a better implementation of oral anticoagulation and of preventive measures to influence the development and progression of AF.

Schlüsselwörter

Vorhofflimmern - Prävalenz - Risikofaktoren - Risikomarker - Komplikationen - Schlaganfall - Embolie

Keywords

Atrial fibrillation - prevalence - risk factors - risk markers - complications - stroke - embolism.
 

  • Literatur

  • 1 Wilke T. et al. Incidence and prevalence of atrial fibrillation: An analysis based on 8.3 million patients. Zur Veröffentlichung eingereicht.
    Google Scholar
  • 2 Huxley RR. et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 2011; 123: 1501-8.
    CrossrefGoogle Scholar
  • 3 Kirchhof P. et al. Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options – a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference. Europace 2012; 14: 8-27.
    CrossrefGoogle Scholar
  • 4 Schnabel RB. et al. Validation of an atrial fibrillation risk algorithm in whites and African Americans. Arch Intern Med 2010; 170: 1909-17.
    Google Scholar
  • 5 Rachel R. et al. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors. The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2011; 123: 1501-8.
    CrossrefGoogle Scholar
  • 6 Gammage MD. et al. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med 2007; 167: 928-34.
    CrossrefPubMedGoogle Scholar
  • 7 Sawin CT. et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994; 331: 1249-52.
    CrossrefGoogle Scholar
  • 8 Cappola AR. et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006; 295: 1033-41.
    CrossrefGoogle Scholar
  • 9 Heeringa J. et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med 2008; 168: 2219-24.
    CrossrefGoogle Scholar
  • 10 Gami AS. et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007; 49: 565-71.
    CrossrefGoogle Scholar
  • 11 Ellinor PT. et al. Common variants in KCNN3 are associated with lone atrial fibrillation. Nat Genet 2010; 42: 240-4.
    CrossrefGoogle Scholar
  • 12 Gudbjartsson DF. et al. Variants conferring risk of atrial fibrillation on chromosome 4q25. Nature 2007; 448: 353-7.
    CrossrefGoogle Scholar
  • 13 Lubitz SA. et al. Independent susceptibility markers for atrial fibrillation on chromosome 4q25. Circulation 2010; 122: 976-84.
    CrossrefGoogle Scholar
  • 14 Kaab S. et al. Large scale replication and meta-analysis of variants on chromosome 4q25 associated with atrial fibrillation. Eur Heart J 2009; 30: 813-9.
    Google Scholar
  • 15 Sinner MF. et al. Lack of replication in polymorphisms reported to be associated with atrial fibrillation. Heart Rhythm 2011; 8: 403-9.
    CrossrefGoogle Scholar
  • 16 Breithardt G. Individualisierte Medizin in der Kardiologie: Beispiel Vorhofflimmern. In: Medizin nach Maß. Individualisierte Medizin – Wunsch und Wirklichkeit. V. Schumpelick, B. Vogel. (Hrsg.). Freiburg: Herder Verlag; 2011
    Google Scholar
  • 17 Wallmann D. et al. Frequent atrial premature beats predict paroxysmal atrial fibrillation in stroke patients: an opportunity for a new diagnostic strategy. Stroke 2007; 38: 2292-4.
    CrossrefGoogle Scholar
  • 18 Suissa L, Bertora D, Lachaud S, Mahagne MH. Score for the targeting of atrial fibrillation (STAF): a new approach to the detection of atrial fibrillation in the secondary prevention of ischemic stroke. Stroke 2999 (40) 2866-8.
    Google Scholar
  • 19 Fetsch T. et al. Prevention of atrial fibrillation after cardioversion: results of the PAFAC trial. Eur Heart J 2004; 25: 1385-94.
    CrossrefGoogle Scholar
  • 20 Patten M. et al. Suppression of paroxysmal atrial tachyarrhythmias--results of the SOPAT trial. Eur Heart J 2004; 25: 1395-404.
    CrossrefGoogle Scholar
  • 21 Jeff S. et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120-9.
    CrossrefGoogle Scholar
  • 22 Carsten W. et al. Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device implications for optimal patient care. J Am Coll Cardiol 2004; 43: 47-52.
    CrossrefGoogle Scholar
  • 23 Müssigbrodt A, Eitel C, Hindricks G, Sommer P. EKG-Diagnostik von Vorhofflimmern. Nervenheilkunde 2012; 31: 797-803.
    Artikel in Thieme ConnectGoogle Scholar
  • 24 Kirchhof P. et al. Outcome parameters for trials in atrial fibrillation: recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork and the European Heart Rhythm Association. Europace 2007; 9: 1006-23.
    CrossrefGoogle Scholar
  • 25 Jahangir A. et al. Longterm progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study. Circulation 2007; 115: 3050-6.
    CrossrefGoogle Scholar
  • 26 Näbauer M. et al. The registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 2009; 11: 423-34.
    CrossrefPubMedGoogle Scholar
  • 27 de Vos CB. et al. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol 2010; 55: 725-31.
    CrossrefGoogle Scholar
  • 28 Camm AJ. et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Europace 2010; 12: 1360-420.
    CrossrefPubMedGoogle Scholar
  • 29 Fuster V. et al. Guidelines for the management of patients with atrial fibrillation. Europace 2006; 8: 651-745.
    CrossrefGoogle Scholar
  • 30 Lewalter T. et al. Kommentar zu „ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation – executive summary“. Kardiologe 2008; 2: 181-205.
    CrossrefGoogle Scholar
  • 31 Gerth A. et al. Risk factors for thromboembolic events and impact of the CHA2DS2-VASc risk score on risk stratification in atrial fibrillation: Results from the German AFNET Registry. Eur Heart J. 2011 ; Abstract.
    Google Scholar
  • 32 Verdecchia P. et al. Atrial fibrillation in hypertension: predictors and outcome. Hypertension 2003; 41: 218-23.
    CrossrefGoogle Scholar
  • 33 Gallego P. et al. Relation of the HAS-BLED bleeding risk score to major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2012; 5: 312-8.
    CrossrefPubMedGoogle Scholar