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Nervenheilkunde 2022; 41(06): 417-425
DOI: 10.1055/a-1814-2536
Schwerpunkt

Perkutaner Vorhofohrverschluss nach Schlaganfall

Zusammenfassung der Datenlage unter besonderer Berücksichtigung der CLOSURE-AF-StudiePercutaneous left atrial appendage closure for stroke preventionPresent evidence and future directions
Carsten Skurk
1   Klinik für Kardiologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
2   Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Standort Berlin
,
Karl Georg Häusler
3   Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg
4   AFNET e. V., Münster
,
Matthias Endres
2   Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Standort Berlin
5   Klinik und Hochschulambulanz für Neurologie mit Experimentelle Neurologie, Campus Mitte, Charite Universitätsmedizin Berlin
7   Berliner Institut für Gesundheitsforschung (BIG), Berlin
,
Thorsten Lewalter
4   AFNET e. V., Münster
6   Klinik für Kardiologie und Internistische Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd, München
,
Ulf Landmesser
1   Klinik für Kardiologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin
2   Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Standort Berlin
7   Berliner Institut für Gesundheitsforschung (BIG), Berlin
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ZUSAMMENFASSUNG

Der katheterbasierte Verschluss des linken Vorhofohrs stellt bei Patienten mit Vorhofflimmern, welche nicht für eine Langzeittherapie mit oralen Antikoagulanzien geeignet sind, eine potenzielle Therapieoption zur Reduktion des Schlaganfallrisikos dar. Die Weiterentwicklung der Device- und Implantationstechnik führte in den letzten Jahren zu einer Verbesserung des Sicherheitsprofils der Behandlungsmethode. Das Therapieprinzip wird durch neue Daten unterstützt, die die Wirksamkeit des operativen Verschlusses des linken Vorhofohrs zusätzlich zur Antikoagulation im Rahmen von kardiochirurgischen Eingriffen zeigen. Aktuell wird der katheterbasierte Verschluss des linken Vorhofohres in verschiedenen Patientenpopulationen in randomisierten Studien evaluiert. Die Datenlage, die Einsatzgebiete und randomisierte Studien unter besonderer Berücksichtigung der CLOSURE-AF-Studie sollen in der vorliegenden Übersichtsarbeit diskutiert werden.

ABSTRACT

Left atrial appendage closure (LAAC) is a potential treatment option for stroke prevention in patients not suitable for long-term oral anticoagulation. Due to advances in LAA closure devices and implantation techniques, the safety profile of LAAC has significantly improved over the last years. Recent data about the efficacy and safety of surgical closure of the left atrial appendage in conjunction with oral anticoagulation during open-heart surgery support the therapeutic concept of left atrial appendage closure. Presently, several randomized trials are underway to provide further data for LAAC in different patient populations. Recent data, potential indications for the procedure and ongoing randomized clinical trials with a special focus on the Closure-AF study will be summarized and discussed in this review.

Schlüsselwörter

Vorhofflimmern - linksatrialer Vorhofohrverschluss - orale Antikoagulation - Schlaganfallprävention

Key words

Atrial fibrillation left atrial appendage closure - oral anticoagulation - stroke prevention


Publication History

Article published online:
07 June 2022

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