Schwerpunkte der Nachsorge und Langzeiterfolg nach der Katheterablation des Vorhofflimmerns

Übersicht

Abstract

During the last twenty years catheter ablation of atrial fibrillation has evolved from an experimental method to a standard rhythm control strategy for patients suffering from drug refractory atrial fibrillation. Continuous enhancements and simplification of technologies lead to ready availability of this treatment option. Despite promising short and mid-term results data on long term efficacy are lacking. Beside documentation of arrhythmia recurrences an adequate follow up serves as key position for relevant clinical decisions. In the first weeks after the ablation procedure, follow up focused on detection of sub-acute procedural complications. During the next months statements on rhythm outcome are possible, additionally, adaptation of medical therapy, e. g. regarding antiarrhythmic or anticoagulation are made. Finally long term follow up provides additional information on rhythm outcome and durable success of the ablation procedure.

Kernaussagen

• Die Katheterablation von Vorhofflimmern ist ein komplexer Eingriff, der ein hohes Maß an Spezialisierung und Ausbildung erfordert.

• Die Betreuung dieser Patienten endet nicht mit dem Verlassen der Katheterlabore, sondern sollte eine intensive und gezielte Nachsorge umfassen. Diese lässt sich nur in enger Kooperation mit dem die Ablation durchführenden Zentrum und den niedergelassenen Ärzten verwirklichen.

• Für eine abschließende Beurteilung der Langzeiteffektivität reichen die vorliegenden Daten nicht aus. Die permanente Weiterentwicklung der Technik und die hiermit verbundene Verbesserung der Ergebnisse, aber auch die ernüchternden Erfolgsraten der medikamentösen Therapie, unterstreichen jedoch die Wertigkeit dieser möglicherweise kurativen Therapieform.

• Aus der Patienteninformation muss jedoch hervorgehen, dass die aktuell publizierten und durchaus vorzeigbaren Ergebnisse in vielen Fällen erst nach wiederholten Eingriffen zu erreichen sind bzw. dass diese Daten im Rahmen von Studien durchgeführt und von sehr erfahrenen Untersuchern gewonnen wurden, weshalb sie nicht in allen Zentren reproduzierbar sein werden.

• Ein wichtiges Qualitätskriterium für ein anspruchsvolles Zentrum ist das Maß der Nachbeobachtung und somit der Selbstreflexion.

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