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Vorhofflimmern bei nichtkardialen Infektionen und Sepsis

Atrial fibrillation in patients with sepsis and non-cardiac infections

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Zusammenfassung

Vorhofflimmern (VHF) ist die mit Abstand häufigste mit Infektionen bzw. Sepsis assoziierte Herzrhythmusstörung. Neu aufgetretenes VHF im Rahmen einer Infektion ist mit einer Verschlechterung der Prognose sowohl für das Akutereignis als auch für die langfristige Prognose der Patienten assoziiert. Das Risiko, VHF im Rahmen einer Infektion zu entwickeln, hängt sowohl von allgemeinen (z. B. Alter, strukturelle Herzerkrankung) als auch von infektionsspezifischen Faktoren (z. B. Schwere der Sepsis, Katecholamintherapie) ab. Für die Therapie von infektassoziiertem VHF gibt es bisher keine Leitlinienempfehlungen bzw. kaum prospektive Daten. Die Verwendung von β‑Blockern scheint sowohl zur Prophylaxe als auch zur Frequenzkontrolle selbst bei katecholaminpflichtigen Patienten vertretbar zu sein. Zur spezifischen antiarrhythmischen Therapie ist neben dem bisher überwiegend verwendeten Amiodaron auch der Einsatz von Klasse-I-Antiarrhythmika denkbar. Neu aufgetretenes VHF im Rahmen von Infektionen wurde lange als spezifische Entität mit niedrigem Rezidivrisiko betrachtet, sodass nur ein geringer Teil der Patienten im Verlauf eine effektive Antikoagulation erhalten hat. Daten aus größeren, retrospektiven Studien legen allerdings deutlich höhere Rezidivraten nahe, sodass die Frage, inwieweit dieses Patientenkollektiv von einer langfristigen effektiven Antikoagulation bzw. einem erweiterten Arrhythmie-Monitoring profitiert, Gegenstand zukünftiger Untersuchungen sein sollte.

Abstract

Atrial fibrillation (AF) is by far the most frequent cardiac arrhythmia associated with sepsis and infections. Newly occurring AF due to infections is associated with a deterioration of the prognosis for acute events and also for the long-term prognosis of patients. The risk of developing AF during an infection depends on general (e.g. age, structural heart disease) as well as infection-specific risk factors (e.g. sepsis severity, vasopressor treatment). Current guidelines do not make specific recommendations on the treatment of infection-associated AF and very few prospective data are available. The use of beta blockers appears to be safe for both prevention and frequency control of AF even in patients requiring catecholamines. For specific antiarrhythmic treatment, the use of class I antiarrhythmic agents is conceivable as an alternative to the predominantly used amiodarone. Newly occurring AF within infections has long been considered a specific entity with a low risk of recurrence, so that only a small proportion of patients received long-term effective anticoagulation; however, data from large retrospective studies suggest significantly higher recurrence rates. Therefore, the question of whether this group of patients benefits from long-term effective anticoagulation and extended monitoring of arrhythmia should be the subject of future research.

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Abbreviations

AHA:

American Heart Association

CRP:

C-reaktives Protein

ESC:

European Society of Cardiology

IL:

Interleukin

i.v.:

Intravenös

VHF:

Vorhofflimmern

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Authors and Affiliations

  1. Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland

    Benjamin Rath, Philipp Niehues, Patrick Leitz & Lars Eckardt

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  1. Benjamin Rath
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Correspondence to Benjamin Rath.

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B. Rath, P. Niehues, P. Leitz und L. Eckardt geben an, dass kein Interessenkonflikt im Hinblick auf diese Arbeit besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rath, B., Niehues, P., Leitz, P. et al. Vorhofflimmern bei nichtkardialen Infektionen und Sepsis. Herzschr Elektrophys 30, 256–261 (2019). https://doi.org/10.1007/s00399-019-0633-z

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  • DOI: https://doi.org/10.1007/s00399-019-0633-z

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