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Langzeiterfolg nach Vorhofflimmerablation

Long-term success after catheter ablation of atrial fibrillation

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Zusammenfassung

Die aktuelle Datenlage zur langfristigen Effektivität der Vorhofflimmerablation ist umfangreich und limitiert zugleich. Die Pulmonalvenenisolation (PVI) ist dabei der einzige etablierte Endpunkt mit reproduzierbarer Wirksamkeit. Definierte und in ihrer Effektivität reproduzierbare Therapiestrategien für Patienten mit fortgeschrittenen Formen von Vorhofflimmern fehlen bislang. Für Patienten mit persistierendem Vorhofflimmern und fortgeschrittenem Substrat müssen mehrere Eingriffe mit z. T. komplexeren Ablationsstrategien in Betracht gezogen werden, um die Wahrscheinlichkeit von stabilem Sinusrhythmus zu erhöhen. Die Langzeiterfolgsraten nach einem einzelnen Eingriff werden für Patienten mit paroxysmalem Vorhofflimmern mit 60–70 % und nach wiederholten Eingriffen mit bis zu 80 % angegeben. Die Erfolgsraten bei persistierendem oder langanhaltend persistierendem Vorhofflimmern sind weniger überzeugend (Primäreingriff: 40–50 %, multiple Eingriffe: ca. 70 %). Daher ist eine frühzeitige Katheterablation von Vorhofflimmern zu empfehlen, um den Progress der Erkrankung und des atrialen Substrats aufzuhalten. Darüber hinaus ist sie der medikamentösen Therapie hinsichtlich der Effektivität überlegen.

Abstract

Ablation is an established treatment option for atrial fibrillation (AF) and is associated with convincing success rates and a reasonable safety profile. Ablation strategies going beyond pulmonary vein isolation in patients with chronic forms of AF are less well established and reproducible. Especially in patients with progressed AF forms multiple ablation procedures might be mandatory to achieve reasonable clinical success. An early ablation strategy might stop or prolong the progress from paroxysmal to persistent AF. In addition, ablation is more effective than drug-based treatment and comparably safe. Long-term success rates after a single and after multiple ablation procedures in paroxysmal AF are reported with 60–70% and up to 80%, while success rates in persistent or long-standing persistent AF are less favorable (single procedure 40–50%, multiple procedures 70%). However, currently non-recurrence of AF is the most established but potentially not the best endpoint. The burden of AF after ablation as assessed by novel monitoring modalities might gain further clinical importance.

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Authors and Affiliations

  1. Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Laura Rottner &  Andreas Metzner

  2. Universitäres Herz- und Gefäßzentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland

    Andreas Metzner

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Correspondence to Andreas Metzner.

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Interessenkonflikt

L. Rottner und A. Metzner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rottner, L., Metzner, A. Langzeiterfolg nach Vorhofflimmerablation. Herzschr Elektrophys 34, 286–290 (2023). https://doi.org/10.1007/s00399-023-00972-1

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