Behandlung rezidivierender Vorhofarrhythmien nach Pulmonalvenenisolation

Vorhofflimmern ist die häufigste anhaltende Herzrhythmusstörung weltweit. Trotz erfolgreicher initialer Pulmonalvenenisolation (PVI) kommt es bei einem Teil der Patienten zu Rezidiven des Vorhofflimmerns und atrialen Tachykardien. Die therapeutischen Optionen reichen dann von einer medikamentösen rhythmuserhaltenden Therapie über eine erneute Ablation, einer medikamentösen Frequenzkontrolle bis hin zur Ultima Ratio einer AV-Knotenablation.

Schlüsselwörter

Vorhofflimmern - Ablation - Pulmonalvenenisolation - atriale Tachykardie

• Literatur

• 1 Linz D, Gawalko M, Betz K. et al. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur 2024; 37: 100786
• 2 Benjamin EJ, Wolf PA, D’Agostino RB. et al. Impact of Atrial Fibrillation on the Risk of Death. Circulation 1998; 98: 946-952
• 3 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 for 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
• 4 Haissaguerre M, Jais 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
• 5 Rillig A, Magnussen C, Ozga AK. et al. Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure. Circulation 2021; 144: 845-858
• 6 Kuck K-H, Brugada J, Fürnkranz A. et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 2016; 374: 2235-2245
• 7 Ekanem E, Reddy VY, Schmidt B. et al. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace 2022; 24: 1256-1266
• 8 Tilz RR, Schmidt V, Pürerfellner H. et al. A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. Eur Heart J 2023; 44: 2458-2469
• 9 Tzeis S, Gerstenfeld EP, Kalman J. et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024; 21: e31-e149
• 10 Jaïs P, Matsuo S, Knecht S. et al. A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry. J Cardiovasc Electrophysiol 2009; 20: 480-491
• 11 Shah AJ, Jadidi A, Liu X. et al. Atrial Tachycardias Arising from Ablation of Atrial Fibrillation: A Proarrhythmic Bump or an Antiarrhythmic Turn?. Cardiol Res Pract 2010; 2010: 950763
• 12 Urbanek L, Bordignon S, Schaack D. et al. Pulsed Field Versus Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation: Efficacy, Safety, and Long-Term Follow-Up in a 400-Patient Cohort. Circ Arrhythm Electrophysiol 2023; 16: 389-398
• 13 Chen G, Li G, Zhang D. et al. Blanking period antiarrhythmic drugs after catheter ablation for atrial fibrillation: a meta-analysis of randomized controlled trials. Front Cardiovasc Med 2023; 10: 1071950
• 14 Kistler PM, Chieng D, Sugumar H. et al. Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation. JAMA 2023; 329: 127-135
• 15 Heeger C-H. Vorhofflimmern trotz dauerhaft isolierter Pulmonalvenen: Was tun?. 2024 Zugriff am 06. Oktober 2024 unter: https://herzmedizin.de/fuer-aerzte-und-fachpersonal/herzerkrankungen/rhythmologie/ehra-kongress-2024-astro-studio-vorhofflimmern-ablation.html
• 16 Heeger C-H, Rillig A, Geisler D. et al. Left Atrial Appendage Isolation in Patients Not Responding to Pulmonary Vein Isolation: Benefit and Risks. Circulation 2019; 139: 712-715
• 17 Nademanee K, McKenzie J, Kosar E. et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol 2004; 43: 2044-2053
• 18 Vogler J, Willems S, Sultan A. et al. Pulmonary Vein Isolation Versus Defragmentation: The CHASE-AF Clinical Trial. J Am Coll Cardiol 2015; 66: 2743-2752
• 19 Verma A, Jiang C, Betts TR. et al. Approaches to Catheter Ablation for Persistent Atrial Fibrillation. N Engl J Med 2015; 372: 1812-1822
• 20 Huo Y, Gaspar T, Schönbauer R. et al. Low-Voltage Myocardium-Guided Ablation Trial of Persistent Atrial Fibrillation. NEJM Evid 2022; 1: EVIDoa2200141
• 21 Marrouche NF, Wazni O, McGann C. et al. Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial. JAMA 2022; 327: 2296-2305