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Der Klinikarzt 2008; 37(2): 66-70
DOI: 10.1055/s-2008-1062692
In diesem Monat

© Georg Thieme Verlag Stuttgart · New York

Vorhofflimmern - eine Standortbestimmung - Vorkommen, Mechanismen und klinische Präsentation

Atrial fibrillation: occurrence, mechanisms, clinical presentation - Determination of medical status and approachPaulus Kirchhof1 , Günter Breithardt1
  • 1Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Universitätsklinikum Münster(Direktor: Univ.-Prof. Dr. Dr. h.c. G. Breithardt)
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Publication History

Publication Date:
29 February 2008 (online)

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Vorhofflimmern ist bei Weitem die häufigste Rhythmusstörung des Herzens. Derzeit sind in Deutschland etwa eine Million Menschen betroffen - eine Zahl, die sich in den kommenden 30 Jahren vermutlich noch verdoppeln wird. Vorhofflimmern verdoppelt die Sterberate, verursacht etwa jeden fünften Schlaganfall und kann mit schwerwiegenden Symptomen assoziiert sein. Die Ursachen sind vielfältig: Ektope elektrische „Trigger”, eine Verkürzung des Vorhofaktionspotenzials („elektrisches Remodeling”), ein Verlust der Vorhofkontraktion, Veränderungen der Extrazellulärmatrix und eine erhöhte

Fibrose der Vorhöfe sowie die Aktivierung von gewebsständiger Gerinnung und Entzündung tragen zur Auslösung und zum Erhalt des Vorhofflimmerns bei. Die klinische Präsentation der Erkrankung ist sehr unterschiedlich: Bei einigen asymptomatischen Patienten ist Vorhofflimmern ein Zufallsbefund, bei anderen wird die Rhythmusstörung beim Auftreten von Komplikationen (z.B. Schlaganfällen) erstdiagnostiziert, wieder andere bemerken typische Symptome wie Herzrasen, Atemnot und Brustschmerz. Es kann aber auch zur kardialen Dekompensation, zum Lungenödem oder zu Synkopen kommen.

Summary

Atrial fibrillation is by far the most frequent rhythmic disorder. At present approximately one million persons are affected in Germany alone, and this number is likely to increase to two million within the next 30 years. Atrial fibrillation increases the death rate to twice the normal level and is responsible for about every fifth stroke and may be associated with severe symptoms. Causes are manifold: ectopia electric „triggers”, a shorter atrial action potential („electrical remodeling”), loss of atrial contraction, changes of the extracellular matrix and enhanced fibrosis of the atria as well as activation of tissue coagulation and inflammation - all these factors contribute to triggering and sustaining atrial fibrillation. Clinical presentation may differ widely: in some asymptotic patients atrial fibrillation may be detected by chance; in other patients the rhythmic disorder may be diagnosed for the first time only if there are complications, such as stroke; whereas in other patients there may be typical symptoms such as a „racing” heartbeat, labored breathing, chest pain. However, cardiac decompensation, lung edema or syncopes may also occur.

Key words

atrial fibrillation - prevalence - clinical presentation - paroxysmal - persistent - permanent - frequency regulation - rhythm preservation therapy - anticoagulation

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1 Congestive heart failure, Hypertension, Age, Diabetes mellitus, Stroke (x 2)

2 Dies wird häufig fälschlicherweise direkt aus dem englischen als „Rhythmuskontrolle” („rhythm control”) übersetzt. Im Englischen beinhaltet das Wort „control” jedoch eine aktive Beeinflussung bzw. Regulierung, während im Deutschen in der Regel mit „Kontrolle” nur eine Messung bzw. Überprüfung (in diesem Falle des Herzrhythmus) gemeint ist.

Korrespondenz

Prof. Dr. Paulus Kirchhof

Medizinische Klinik und Poliklinik C Kardiologie und Angiologie Universitätsklinikum Münster

Albert-Schweitzer-Straße 33

48149 Münster

Email: kirchhp@uni-muenster.de

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