Herzinsuffizienz und Vorhofflimmern – eine Zwillingsepidemie

Zusammenfassung

Vorhofflimmern (VHF) und eine Herzinsuffizienz begünstigen sich gegenseitig und treten häufig in Kombination auf. Eine effektive Therapie des VHF inklusive der möglicherweise notwendigen Antikoagulation sollte zentraler Baustein bei Patienten mit eingeschränkter systolischer Funktion und VHF sein. Medikamentöse Therapieoptionen sind in der Regel wenig effektiv, sodass zunehmend Katheterablationsverfahren zur Behandlung dieser Patienten in den Vordergrund gestellt werden. Randomisierte Studien bei selektierten Patienten zeigen nicht nur einen symptomatischen Effekt auf die Herzinsuffizienz, sondern neben Verbesserung der LV-Funktion auch einen Letalitätsbenefit der effektiven Ablation von VHF. In der Zukunft gilt es, Patienten sinnvoll für die Katheterablation zu identifizieren. Ob das reine Vorhandensein von VHF oder eher die VHF-Last bei Patienten mit Herzinsuffizienz entscheidend für die Prognose ist, wird aktuell in weiteren Studien untersucht.

Abstract

Atrial fibrillation (AF) and heart failure are mutually beneficial and often occur in combination. Effective therapy of AF, including potentially necessary anticoagulation, should be a central component in patients with impaired systolic function and AF. Drug therapy options are generally ineffective, so catheter ablation procedures are increasingly being emphasized to treat these patients. Randomized trials in selected patients show not only a symptomatic effect on heart failure but also a mortality benefit of effective ablation of AF in addition to improvement in LV function. In the future, it will be important to identify patients for catheter ablation in a meaningful way. Whether the presence of AF or rather the AF burden is crucial for prognosis in patients with heart failure is currently being investigated in further studies.

Schlüsselwörter

Vorhofflimmern - Herzinsuffizienz - Katheterablation - HFrEF - Letalität

Keywords

atrial fibrillation - heart failure - catheter ablation - HFrEF - mortality

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