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Dtsch Med Wochenschr 2022; 147(13): 858-873
DOI: 10.1055/a-1477-4020
CME-Fortbildung

Katheterablation von Vorhofflimmern – aktuelle Versorgungsstandards und Zukunftstrends

Catheter ablation for atrial fibrillation – standard of care and future perspectives
Moritz Huttelmaier
,
Thomas Fischer
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Vorhofflimmern ist die häufigste anhaltende Herzrhythmusstörung. Zur Behandlung symptomatischen Vorhofflimmerns stellt die Katheterablation eine effektive und sichere Therapie dar. In jüngster Zeit gibt es zunehmend Evidenz, dass eine frühe Rhythmuskontrolle und Katheterablation von prognostischem Nutzen sein kann. Ferner ermöglichen technologische Neuerungen eine weitere Verbesserung von Ablationseffektivität und -sicherheit. Diese Arbeit bietet einen Überblick über aktuelle Versorgungsstandards sowie Zukunftstrends der Katheterablation von Vorhofflimmern.

Abstract

Atrial fibrillation is the most frequent cardiac arrhythmia in adults. For symptomatic atrial fibrillation, catheter ablation has proven to be an effective and safe treatment that is superior to antiarrhythmic drug treatment regarding quality of life and maintenance of normal sinus rhythm. Moreover, there is increasing evidence that early rhythm control and catheter ablation can be of prognostic benefit. Especially heart failure patients with impaired left ventricular systolic function seem to benefit from rhythm control therapy by catheter ablation. Furthermore, technological innovations such as novel single-shot devices, contact force mapping, the concept of high-power-short-duration (HPSD) ablation and implementation of electroporation (pulsed field ablation) offer the prospect of further improving ablation efficiency and safety. This review provides an overview of current standards of care as well as future trends in atrial fibrillation catheter ablation techniques.

Schlüsselwörter

Vorhofflimmern - Therapiestrategien - Katheterablation - innovative Ablationstechnologien

Key words

atrial fibrillation - treatment strategies - catheter ablation - innovative ablation technologies


Publication History

Article published online:
04 July 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 Hindricks G, Potpara T, Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373-498
    Search in Google Scholar
  • 2 Haïssaguerre M, Jaïs P, Shah DC. et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659-666
    CrossrefPubMedSearch in Google Scholar
  • 3 Goette A, Kalman JM, Aguinaga L. et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Heart Rhythm 2017; 14: e3-e40
    CrossrefPubMedSearch in Google Scholar
  • 4 Van Gelder IC, Groenveld HF, Crijns HJ. et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363-1373
    CrossrefPubMedSearch in Google Scholar
  • 5 Fischer TH. Is There Still a Need for Medical Antiarrhythmic Therapy?. Dtsch Med Wochenschr 2020; 145: 526-535
    PubMedSearch in Google Scholar
  • 6 Kirchhof P, Camm AJ, Goette A. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med 2020; 383: 1305-1316
    Search in Google Scholar
  • 7 Packer DL, Mark DB, Robb RA. et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA 2019; 321: 1261-1274
    CrossrefPubMedSearch in Google Scholar
  • 8 Andrade JG, Wells GA, Deyell MW. et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. N Engl J Med 2021; 384: 305-315
    CrossrefPubMedSearch in Google Scholar
  • 9 Wazni OM, Dandamudi G, Sood N. et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. N Engl J Med 2021; 384: 316-324
    CrossrefPubMedSearch in Google Scholar
  • 10 Calkins H, Hindricks G, Cappato R. et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm 2017; 14: e445-e494
    CrossrefPubMedSearch in Google Scholar
  • 11 Tose Costa Paiva B, Fischer TH, Brachmann J. et al. Catheter ablation of atrial fibrillation – A key role in heart failure therapy?. Clin Cardiol 2019; 42: 400-405
    CrossrefPubMedSearch in Google Scholar
  • 12 Marrouche NF, Kheirkhahan M, Brachmann J. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 379: 492
    PubMedSearch in Google Scholar
  • 13 Packer DL, Piccini JP, Monahan KH. et al. Ablation Versus Drug Therapy for Atrial Fibrillation in Heart Failure: Results From the CABANA Trial. Circulation 2021; 143: 1377-1390
    CrossrefPubMedSearch in Google Scholar
  • 14 Kuck KH, Merkely B, Zahn R. et al. Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure: The Randomized AMICA Trial. Circ Arrhythm Electrophysiol 2019; 12: e007731
    CrossrefPubMedSearch in Google Scholar
  • 15 Sohns C, Zintl K, Zhao Y. et al. Impact of Left Ventricular Function and Heart Failure Symptoms on Outcomes Post Ablation of Atrial Fibrillation in Heart Failure: CASTLE-AF Trial. Circ Arrhythm Electrophysiol 2020; 13: e008461
    CrossrefPubMedSearch in Google Scholar
  • 16 Di Biase L, Burkhardt JD, Santangeli P. et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation 2014; 129: 2638-2644
    CrossrefPubMedSearch in Google Scholar
  • 17 Kuck K, Brugada J, Albenque J. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation. N Engl J Med 2016; 375: 1100-1101
    PubMedSearch in Google Scholar
  • 18 Leshem E, Zilberman I, Tschabrunn CM. et al. High-Power and Short-Duration Ablation for Pulmonary Vein Isolation: Biophysical Characterization. JACC Clin Electrophysiol 2018; 4: 467-479
    CrossrefPubMedSearch in Google Scholar
  • 19 Richard Tilz R, Sano M, Vogler J. et al. Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious – AF study. Int J Cardiol Heart Vasc 2021; 35: 100847
    PubMedSearch in Google Scholar
  • 20 Kewcharoen J, Techorueangwiwat C, Kanitsoraphan C. et al. High-power short duration and low-power long duration in atrial fibrillation ablation: A meta-analysis. J Cardiovasc Electrophysiol 2021; 32: 71-82
    CrossrefPubMedSearch in Google Scholar
  • 21 Bradley CJ, Haines DE. Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31: 2136-2147
    CrossrefPubMedSearch in Google Scholar
  • 22 Reddy VY, Dukkipati SR, Neuzil P. et al. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol 2021; 7: 614-627
    CrossrefPubMedSearch in Google Scholar
  • 23 Reddy VY, Neuzil P, Koruth JS. et al. Pulsed Field Ablation for Pulmonary Vein Isolation in Atrial Fibrillation. J Am Coll Cardiol 2019; 74: 315-326
    CrossrefPubMedSearch in Google Scholar
  • 24 Santangeli P, Zado ES, Hutchinson MD. et al. Prevalence and distribution of focal triggers in persistent and long-standing persistent atrial fibrillation. Heart Rhythm 2016; 13: 374-382
    CrossrefPubMedSearch in Google Scholar
  • 25 Verma A, Jiang CY, Betts TR. et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 2015; 372: 1812-1822
    CrossrefPubMedSearch in Google Scholar