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Der Klinikarzt 2008; 37(2): 73-79
DOI: 10.1055/s-2008-1062693
In diesem Monat

© Georg Thieme Verlag Stuttgart · New York

Verhinderung von Vorhofflimmern - Rhythmuskontrolle

Prevention of atrial fibrillation - Rhythm controlRené P. Andrié1 , Andreas Götte2 , Thorsten Lewalter1
  • 1Kardiologie/Pneumologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn(Direktor: Prof. Dr. G. Nicening)
  • 2Klinik für Kardiologie, Angiologie und Pneumologie, Zentrum für Innere Medizin, Universitätsklinikum Magdeburg(Kommissarischer Direktor: PD Dr. A. Götte)
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Publication History

Publication Date:
29 February 2008 (online)

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Bei der Therapie des Vorhofflimmerns stehen prinzipiell zwei Behandlungsstrategien zur Verfügung: die Frequenz- und die Rhythmuskontrolle. Welche Strategie eingesetzt wird, muss bei jedem Patienten individuell festgelegt werden. Allerdings konnte bislang kein wesentlicher Vorteil für eine der beiden Strategien nachgewiesen werden, insbesondere auch kein Überlebensvorteil für die Patienten, bei denen der Sinusrhythmus erhalten wurde. Zur medikamentösen Rhythmuskontrolle nach Kardioversion werden Betablocker, Klasse-I- und Klasse-III-Antiarrhythmika eingesetzt. Grundlagen der Therapieentscheidung sind in diesem Fall die vorliegende kardiale Grunderkrankung und das Ausmaß der linksventrikulären Pumpfunktionseinschränkung. Bei der ablativen linksatrialen Therapie des Vorhofflimmerns wählt man zwischen einer Pulmonalvenenablation, einer Substratmodifikation des Vorhofs und kombinierten Therapieansätzen. Heute wird die Katheterablation bei immer mehr symptomatischen Patienten als zweite oder dritte Therapiealternative nach einer medikamentösen Basisbehandlung durchgeführt und wird in Zukunft vermutlich weiter an Bedeutung gewinnen.

Atrial fibrillation is the most frequent sustained cardiac arrhythmia affecting humans. There are two different management strategies for treatment of atrial fibrillation: rate control, and rhythm control. Several clinical trials have shown no significant differences between the two strategies with respect to mortality, bleeding, and thromboembolic events. For stable maintenance of sinus rhythm after cardioversion, drug treatment is needed. β-blockers, class-I- and class-III-antiarrhythmics are used to suppress atrial fibrillation. The choice of drug depends on the underlying comorbidities or the extent of the reduction of left-ventricular function. Based on the success of surgical approaches, catheter ablation strategies to treat atrial fibrillation aim at eliminating the triggers and/or to modify the atrial substrate. Currently, ablation therapy should be considered in symptomatic patients resistant or intolerant to pharmacological treatment. In the future, ablation could become a first-line treatment in an increasing number of patients if proven to be safer and more effective than pharmacological treatment.

Key words

atrial fibrillation - rhythm control - antiarrhythmic drugs - pulmonary vein ablation

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1 Atrial Fibrillation Follow-up Investigation of Rhythm Management

2 RAte Control versus Electrical cardioversion for persistent atrial fibrillation

3 Pharmacological Intervention in Atrial Fibrillation

4 Strategies of Treatment of Atrial Fibrillation

5 HOw to Treat Chronic Atrial Fibrillation6 Danisch Investigations of Arrhythmia and Mortality ON Dofetilide in Congestive Heart Failure

6 Danisch Investigations of Arrhythmia and Mortality ON Dofetilide in Congestive Heart Failure

7 EURopean trial In atrial fibrillation or flutter patients receiving Dronedarone for the maIntenance of Sinus rhythm

8 American-Australian-African trial with DronedarONe In atrial fibrillation patients for the maintenance of Sinus rhythm

9 A Trial with dronedarone to prevent Hospitalization or death in patiENts with Atrial fibrillation

10 Catheter ABlation versus ANtiarrhythmic drug therapy for Atrial fibrillation

Korrespondenz

Prof. Dr. Thorsten Lewalter

Medizinische Klinik und Poliklinik II Universitätsklinikum Bonn

Sigmund-Freud-Straße 25

53105 Bonn

Email: th.lewalter@uni-bonn.de