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Techniken zum Verschluss des linken Herzohres

Chancen und Risiken

Techniques for occlusion of the left atrial appendage

Chances and risks

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Zusammenfassung

Vorhofflimmern ist die häufigste Ursache für thrombembolische Komplikationen. Das Risiko, während eines Vorhofflimmerns eine thrombembolische Komplikation zu erleiden, ist vor allen Dingen abhängig von begleitenden kardiovaskulären Risikofaktoren sowie dem Patientenalter. Bei einigen Patienten kann eine orale Antikoagulation trotz zwingender Indikation wegen gesteigerter Blutungsneigungen nicht erfolgen. Für diese selektive Gruppe von Patienten wurde u. a. ein interventioneller Verschluss des linken Herzohres als therapeutische Option postuliert. Initiale Daten hierzu wurden von herzchirurgischen Untersuchungen gewonnen, wobei der interventionelle Vorhofsohrverschluss in transseptaler Technik eine Weiterentwicklung darstellt. Nach initialen eher enttäuschenden Daten erscheinen die aktuell verfügbaren Vorhofsohrverschlusssysteme eine suffiziente Prophylaxe von thrombembolischen Komplikationen in ausgewählten Patienten zu gewährleisten.

Summary

Atrial fibrillation causes 15–20% of ischemic strokes and the overall risk of stroke in patients with non-valvular atrial fibrillation is about 5% per year globally. Warfarin has long been the cornerstone for decreasing risks of stroke in patients with atrial fibrillation and its efficacy has been well established. However, 14–44% of patients with atrial fibrillation who are at risk of stroke are ineligible for anticoagulation therapy, mostly owing to the risks of major bleeding and falls. Occlusion of the left atrial appendage (LAA) appears to be an interesting new tool to prevent thromboembolic events in selected cases. In addition to surgical techniques, percutaneous transcatheter approaches have been introduced to occlude the LAA. Recent results indicate non-inferiority of mechanical occlusion of the LAA in comparison to warfarin therapy.

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  1. Medizinische Klinik II, St. Vincenz-Krankenhaus GmbH, Am Busdorf 2, 33098, Paderborn, Deutschland

    A. Goette

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Goette, A. Techniken zum Verschluss des linken Herzohres. Nervenarzt 82, 172–179 (2011). https://doi.org/10.1007/s00115-010-3113-6

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