Antiarrhythmische Pharmakotherapie

Zusammenfassung

Es werden die Ergebnisse von Studien sowie die Protokolle laufender „Megastudien“ mit Bezug zum Vorhofflimmer-Netzwerk dargestellt. Bei den abgeschlossenen Studien handelt es sich um die Flecainide Short-Long trial (Flec-SL) und die Angiotensin-II-Rezeptorblocker in Paroxysmal Atrial FibrillationStudie (ANTIPAF). Bei den „Megastudien“ um Studien mit den Kürzeln EAST (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), CABANA (Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial) und CASTLE-AF (Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation). Die Ergebnisse der Studien: Eine präventive Kurzzeittherapie nach Kardio-version ist sinnvoller als der Verzicht auf jegliche Antiarrhythmika-Nachbehandlung. Noch effektiver scheint eine antiarrhythmische Langzeit-Nachbehandlung über sechs Monate zu sein. In der ANTIPAF-Studie zeigte sich, dass bei Patienten mit paroxysmalem Vorhofflimmern (VHF) ohne strukturelle Herzkrankheit der Angiotensinrezeptorblocker Olmesartan nicht in der Lage ist, die Häufigkeit der Anfälle zu reduzieren. Wichtigstes therapeutisches Ziel ist die Verhinderung der Progression von VHF. In der EAST-Studie wird geprüft, ob eine frühzeitig eingeleitete, „aggressive“ Therapie zur Kontrolle des Herzrhythmus eher in der Lage ist, Morbidität und Mortalität von VHF zu senken als die Standardtherapie.

Summary

There are exiting new developments in several areas of atrial fibrillation (AF) management. This paper summarizes the results of two studies carried out within the atrial fibrillation network (AFNET) and provides some information about ongoing “Mega-Studies” dealing with optimized management of AF. The Flecainide Short-Long trial (Flec SL) was embedded within the AFNET and was designed to compare short- and long-term therapy with flecainide following successful cardioversion. Although sufficiently powered, the trial failed to demonstrate non inferiority of short-term as compared to long term antiarrhythmic therapy for prevention of recurrent AF after cardioversion. However, in a post-hoc Landmark analysis beginning at the time point of withdrawel of short-term therapy, long-term drug therapy was superior to short-term therapy. The “Angiotensin II-Antagonist in paroxysmal atrial fibrillation (ANTIPAF)-Trial was a prospective, randomized double-blind placebo controlled trial, which was also conducted by the German AFNET. The ANTIPAF-study enrolled patients with paroxysmal atrial fibrillation without significant heart disease. Compared to placebo Olmesartan had no effect on the cumulative incidence of AF recurrence or AF burden. In the same way Olmesartan did not influence the cumulative incidence of persistent AF. It is likely that a “comprehensive approach for rhythm control therapy of AF” can help to improve outcome in patients with AF. This concept of “early and comprehensive rhythm control therapy” for reducing relevant outcomes in AF patients will be tested in future controlled trials, including the EAST trial (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial).

Schlüsselwörter

Vorhofflimmern - antiarrhythmische Pharmakotherapie - elektrisches Remodeling - Therapie

Keywords

Atrial fibrillation - antiarrhythmic drug therapy - electrical remodeling - comprehensive therapy

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