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Klinische Neurophysiologie 2018; 49(02): 97-104
DOI: 10.1055/s-0043-118513
Review
© Georg Thieme Verlag KG Stuttgart · New York

Vorhofflimmern: Diagnostik und was ein Neurologe darüber wissen sollte.

Atrial Fibrillation: Diagnostics and what Neurologists should know
Timolaos Rizos
1   Klinik und Poliklinik für Neurologie, Universität Heidelberg, Heidelberg
,
Christina Rasch
1   Klinik und Poliklinik für Neurologie, Universität Heidelberg, Heidelberg
,
Solveig Horstmann
1   Klinik und Poliklinik für Neurologie, Universität Heidelberg, Heidelberg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
16. Oktober 2017 (online)

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Zusammenfassung

Vorhofflimmern (VHF) ist ein wichtiger Risikofaktor für Schlaganfälle. Eine orale Antikoagulation kann das Auftreten von Schlaganfällen hocheffektiv verhindern, daher ist die Detektion von VHF besonders wichtig. Insbesondere paroxysmales VHF entgeht den üblichen diagnostischen Methoden häufig. Ein „Goldstandard“ zur VHF Detektion ist nach wie vor nicht etabliert. Grundsätzlich gilt: Je länger die EKG-Ableitung desto höher die zu erreichende Detektionsrate. Neben direkten Nachweisverfahren, existieren indirekte Verfahren wie die Analyse der Herzratenvariabilität und Modelle zur Vorhersage von VHF und zur Selektion von Patienten für erweiterte Detektionsmethoden. Diese sind allerdings bislang noch unzureichend untersucht und werden im Alltag kaum eingesetzt. Konnte VHF nach einem Schlaganfall bzw. einer TIA nachgewiesen werden, besteht eine Indikation für eine orale Antikoagulation. Im Falle positiver Studienergebnisse könnte das Indikationsspektrum einer oralen Antikoagulation in Zukunft auf Patienten mit „embolic stroke of undetermined source“ (ESUS) erweitert werden. Eine mögliche Alternative zur medikamentösen Schlaganfallprävention bei VHF stellt der interventionelle Vorhofohrverschluss dar.

Abstract

Atrial fibrillation (AF) represents a major risk factor for stroke. Oral anticoagulation permits highly effective prevention of strokes in AF. Therefore, the detection of AF is highly important. In particular, detection of paroxysmal AF is frequently challenging. A "gold standard" for AF detection has still not been established, but the longer the ECG monitoring time, the higher are detection rates. In addition to direct detection methods, there are indirect methods such as analysis of heart rate variability and models to predict AF and to select patients for advanced detection methods. However, these are still poorly examined and only rarely applied in daily clinical routine. If AF is detected after stroke, there is an indication for oral anticoagulation. In case of positive study results, the indication range of oral anticoagulants could be further extended to patients with “embolic stroke of undetermined source“ (ESUS). Moreover, left atrial appendage occlusion represents a possible alternative to drug-based secondary measures in selected AF patients.

Schlüsselwörter

Vorhofflimmern - Echokardiografie - ischämischer Schlaganfall - TIA

Key words

Atrial fibrillation - echocardiography - ischemic stroke - TIA
 

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