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Hochfrequenzstrom oder Cryoballon für die Ablation von Vorhofflimmern?

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Radiofrequency current or cryoballoon for ablation of atrial fibrillation?

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Zusammenfassung

Vorhofflimmern (VHF) ist die häufigste Herzrhythmusstörung. Therapieziel symptomatischer Patienten ist die Etablierung des stabilen Sinusrhythmus (SR). Die effektivste Behandlung bietet die Katheterablation mit Isolation der Pulmonalvenen als essenzieller Bestandteil aller Ablationsstrategien. Die beiden am häufigsten verwendeten Technologien zur Pulmonalvenenisolation (PVI) sind die Hochfrequenzstrom(HF)-basierte und die Cryoballon(CB)-geführte Ablation. Ungeachtet der Vereinfachung der PVI mit kürzerer Lernkurve und Prozedurzeit, ist der CB der HF-Ablation nicht unterlegen bezüglich Effektivität und Sicherheit bei der Behandlung von Patienten mit paroxysmalem VHF. In der Therapie von Patienten mit persistierendem VHF ist die Effektivität der alleinigen PVI zur Stabilisierung des SR häufig unzureichend. In der Durchführung zusätzlicher Ablationsstrategien mit dem Bestreben, die Rezidivfreiheit dieser Patienten zu verbessern, ist die differenzierte HF-Ablation der Goldstandard.

Abstract

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. The aim of therapy in symptomatic patients is the establishment of a stable sinus rhythm (SR). Catheter ablation with isolation of the pulmonary veins is the essential component of all forms of ablation therapy and provides the most effective treatment option. The most frequently used technologies for pulmonary vein isolation (PVI) are radiofrequency current (RFC)-based and cryoballoon (CB)-guided ablation. Irrespective of the simplification of PVI, CB ablation is characterized by a short learning curve and short procedural times and demonstrated non-inferiority with respect to safety and efficacy when directly compared to RFC ablation for the treatment of patients with paroxysmal AF; however, the clinical outcome in patients with persistent AF is often insufficient when performing pulmonary vein isolation (PVI) alone for stabilization of SR. Differentiated RFC ablation is the treatment of choice when performing additional ablation strategies beyond PVI in order to improve clinical results with freedom from arrhythmia recurrence.

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

    B. Reissmann,  K.-H. Kuck &  A. Metzner

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  1. B. Reissmann
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Correspondence to B. Reissmann.

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B. Reissmann, K.-H. Kuck und A. Metzner geben an, dass kein Interessenkonflikt besteht.

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Reissmann, B., Kuck, KH. & Metzner, A. Hochfrequenzstrom oder Cryoballon für die Ablation von Vorhofflimmern?. Herz 42, 352–356 (2017). https://doi.org/10.1007/s00059-017-4567-0

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