Perkutaner Vorhofohrverschluss

Abstract

Atrial fibrillation is a common condition with a lifetime incidence approaching 25 % and an ever-increasing prevalence in an aging society. The two principal goals of therapy in atrial fibrillation are to alleviate symptomes and to reduce the rate of systemic embolism. Oral anticoagulation is nescessary in the majority of patients with atrial fibrillation. Many atrial fibrillation patients are not treated by oral anticoagulation due to a history of bleeding or other contraindications. Among patients with nonvalvular atrial fibrillation the majority of thrombi ist located within or involves the left atrial appendage. Percutaneous left atrial appendage closure is considered an alternative to anticoagulation in patients with atrial fibrillation. The most widely used occlusion systems (WATCHMAN, Amplatzer Cardiac Plug) has a high implantation success rate and a low procedure risk. The available data records indicate the closure oft he left atrial appendage is a equally or more effective as oral anticoagulation.

Kernaussagen

• Vorhofflimmern ist eine Herzrhythmusstörung, die mit zunehmendem Alter häufiger auftritt.

• Vorhofflimmern wird in den nächsten Jahrzehnten aufgrund der Überalterung weiter an Bedeutung gewinnen.

• Bei nicht valvulärem Vorhofflimmern sind über 90 % aller Thromben im linken Vorhofohr lokalisiert.

• Aufgrund der unerwünschten, teilweise fatalen Nebenwirkungen der oralen Antikoagulation und deren sonstigen Limitationen gewinnt die Methode des Vorhofohrverschlusses zunehmend an Bedeutung.

• Die bisherigen Studien zum Vorhofohrverschluss haben eine gleich gute bis höhere Effizienz mit erhöhter Sicherheit im Vergleich zur oralen Dauerantikoagulation mit Vitamin-K-Antagonisten gezeigt.

• Für Patienten, die keine orale Antikoagulation erhalten können, ist der perkutane Vorhofohrverschluss eine geeignete Therapiealternative.

• Literatur

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