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Innovative Verfahren der Vorhofflimmertherapie

Innovative techniques in atrial fibrillation therapy

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Zusammenfassung

Die Pulmonalvenenisolation (PVI) ist der etablierte Endpunkt und integraler Bestandteil der meisten ablativen Therapiestrategien bei Vorhofflimmern (VHF). Die Anlage kontinuierlicher, transmuraler und dauerhafter Läsionen mittels hochfrequenzstrombasierter Katheter in Kombination mit einem 3-dimensionalen Mappingsystem stellt jedoch weiterhin eine große Herausforderung dar. Um diesen Limitationen zu begegnen, sind innovative zirkuläre Mapping- und Ablationskatheter sowie ballonbasierte Ablationssysteme mit integrierten alternativen Energiequellen (Kryo, Laser) eingeführt und evaluiert worden und konnten ihr Potenzial zur sicheren und effektiven PVI unter Beweis stellen. Zudem sind unser aktuelles Spektrum erweiternde Ablationsstrategien wie die Identifizierung von VHF auslösenden Foci bzw. VHF aufrechterhaltenden Rotoren mittels endo- und epikardialer Mapping-Systeme und deren Ablation entwickelt worden und befinden sich derzeit in der klinischen Evaluierungsphase. Gleiches gilt für die Identifizierung und Modulation von atrialen Ganglien und somit des autonomen Nervensystems als weiterer potenzieller, additiver Therapieansatz in der ablativen Therapie von VHF.

Abstract

Pulmonary vein isolation (PVI) is the established cornerstone in most catheter-based ablation treatment strategies for atrial fibrillation (AF); however, it is still a challenge to create contiguous, transmural and permanent ablation lesions using radiofrequency current in combination with three-dimensional mapping systems. To overcome these limitations, innovative spiral mapping and ablation catheters as well as balloon-based ablation catheters incorporating alternative energy sources, such as cryoenergy and laser were developed and evaluated and have proved their potential for safe and clinically effective PVI. In addition, novel ablation strategies, such as identification and ablation of AF-inducing foci and/or AF-perpetuating rotors using either endocardial or epicardial mapping systems were introduced and are currently under clinical evaluation. The identification and modulation of atrial ganglionic plexi (GP) and, therefore, of the autonomous nervous system is another additive ablation approach which requires further clinical evaluation.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.Metzner: Beraterhonorare, Reisekostenunterstützung und Vortragshonorare von Medtronic, Cardiofocus, Biosense Webster. E. Wißner: Beraterhonorare, Reisekostenunterstützung und Vortragshonorare von Medtronic, Cardiofocus, EP Solutions, Biosense Webster. K.H. Kuck: Beraterhonorare, Reisekostenunterstützung und Vortragshonorare von Medtronic, Cardiofocus, EP Solutions, Biosense Webster. T. Finck und F.Ouyang geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    A. Metzner, E. Wissner, T. Fink, F. Ouyang & K.-H. Kuck

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  1. A. Metzner
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  2. E. Wissner
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  3. T. Fink
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Correspondence to A. Metzner.

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Metzner, A., Wissner, E., Fink, T. et al. Innovative Verfahren der Vorhofflimmertherapie. Herz 40, 37–44 (2015). https://doi.org/10.1007/s00059-014-4194-y

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