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Der Klinikarzt 2011; 40(S 01): 13-17
DOI: 10.1055/s-0031-1292572
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Neue evidenzbasierte Leitlinien – Diagnostik und Therapie des Vorhofflimmerns

New evidence based guidelines to manage atrial fibrillation
Michael Block
1   Klinik für Kardiologie, Klinik Augustinum, München
,
Thomas Budde
2   Klinik für Innere Medizin 1, Alfried Krupp Krankenhaus, Essen
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Publication History

Publication Date:
04 October 2011 (online)

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Eine große Anzahl von kontrollierten und randomisierten Studien erlaubt es, für die Diagnostik und Therapie von Vorhofflimmern weitestgehend evidenzbasierte Leitlinien herauszugeben. Vor allem die therapeutischen Fortschritte der letzten Jahre hatten zur Folge, dass die Europäische Gesellschaft für Kardiologie (ESC) nach 5 Jahren 2010 ihre Leitlinien überarbeitete. Wesentliche Neuerungen sind weniger strikte Forderungen zur Frequenzkontrolle, eine mehr Patienten betreffende Antikoagulation, beruhend auf dem neuen CHA2DS2-VASc Score, erste Empfehlungen zu neuen fix dosierbaren Antikoagulantien, klare Empfehlungen zur Kombination von Antikoagulantien und Thrombozytenaggregationshemmern bei Koronarstents, die Aufnahme von Dronedaron in die Empfehlungen zur Rhythmusstabilisierung und eine weniger restriktive Empfehlung zur Katheterablation von Vorhofflimmern.

Many controlled and randomized studies allow to write guidelines on the management of patients with atrial fibrillation which are based on solid evidence. Progress made in therapy of atrial fibrillation forced the European Society of Cardiology to update the guidelines after 5 years in 2010. Important changes are less reluctant control of ventricular rate during atrial fibrillation, anticoagulation in more patients based on the CHA2DS2-VASc score, a first mentioning of new antithrombotic agents without need of INR-control, recommendations how to combine anticoagulation with antithrombotic agents in case of coronary stents, incorporation of dronedarone in the recommendations for preventing recurrent atrial fibrillation and a less restrictive recommendation for catheter ablation.

Key words

atrial fibrillation - guidelines - anticoagulation - antiarrhythmic drugs - catheter ablation
 

  • Literatur

  • 1 Camm AJ, Kirchhof P, Lip GY 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). Eur Heart J 2010; 31: 2369-2429
    CrossrefPubMedGoogle Scholar
  • 2 Bruckenberger E. Herzbericht 2009. Hannover: Selbstverlag; 2010: 9-19
    Google Scholar
  • 3 Lip GY, Nieuwlaat R, Pisters R et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137: 263-272
    CrossrefPubMedGoogle Scholar
  • 4 Pisters R, Lane DA, Nieuwlaat R et al. A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in atrial fibrillation patients: the Euro Heart Survey. Chest 2010; 138: 1093-1100
    CrossrefPubMedGoogle Scholar
  • 5 Connolly SJ, Ezekowitz MD, Yusuf S et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151
    CrossrefPubMedGoogle Scholar
  • 6 Connolly SJ, Eikelboom J, Joyner C et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364
    PubMedGoogle Scholar
  • 7 Holmes DR, Reddy VY, Turi ZG et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 2009; 374
    PubMedGoogle Scholar
  • 8 Reddy VY, Holmes D, Doshi SK et al. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation 2011; 123: 417-424
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Hohnloser SH, Crijns HJ, Van Eickels M et al. Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 2009; 360: 668-678
    CrossrefPubMedGoogle Scholar
  • 11 Le Heuzey J, De Ferrari G, Radzik D et al. A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study. J Cardiovasc Electrophysiol 2010; 21: 597-605
    CrossrefPubMedGoogle Scholar
  • 12 Piccini JP, Lopes RD, Kong MH et al. Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: a meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol 2009; 2: 626-633
    CrossrefPubMedGoogle Scholar
  • 13 Wann LS, Curtis AB, January CT et al. 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm 2011; 8: 157-176
    CrossrefPubMedGoogle Scholar
  • 14 Cappato R, Calkins H, Chen SA et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 2010; 53: 1798-1803
    PubMedGoogle Scholar