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Linksatrialer Vorhofohrverschluss

Aktuelle Daten und zukünftige Entwicklungen

Left atrial appendage closure

Current data and future developments

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Zusammenfassung

Der katheterbasierte Verschluss des linken Vorhofohrs („left atrial appendage closure“, LAAC) stellt bei Patienten mit Vorhofflimmern und hohem Schlaganfall- sowie hohem Blutungsrisiko eine potenzielle Therapieoption zur Reduktion des Schlaganfallrisikos dar. Aufgrund der Weiterentwicklung der Implantationstechnik sowie der Einführung neuer bzw. optimierter Devices hat sich das Sicherheitsprofil der perkutanen LAAC in den letzten Jahren verbessert. Diese Beobachtungen sind auch der Ausgangspunkt für eine aktuell umfangreiche weitere Prüfung der Behandlungsmethode für neue Einsatzgebiete, wie beispielsweise bei Vorhofflimmerpatienten mit niedrigem Blutungsrisiko bzw. nach Pulmonalvenenisolation (PVI) oder bei Patienten nach elektrischer Isolation des linken Vorhofohrs. Das Therapieprinzip des Herzohrverschlusses wird durch neuere Daten unterstützt, die die Wirksamkeit des operativen Verschlusses des linken Vorhofohrs bezüglich einer Reduktion des Schlaganfallrisikos z. T. auch zusätzlich zur Antikoagulation im Rahmen von kardiochirurgischen Eingriffen zeigen. Aktuell wird die Anwendung in der klinischen Praxis durch eine hohe Studienaktivität begleitet. Diese randomisierten Studien werden den Einsatz des LAAC in neuen Indikationsfeldern prüfen und sollen zusammen mit neuen Entwicklungen bei der Implantationstechnik den optimalen zukünftigen Einsatz der Methode für die klinische Praxis weiter definieren. Die aktuell möglichen Indikationen zum LAAC, laufende randomisierte Studien sowie Fortschritte bei der Device-Entwicklung, der Implantationsplanung- und -technik sowie zukünftige Entwicklungen auf dem Gebiet der LAA-Verschluss-Therapie sollen in der vorliegenden Übersichtsarbeit zusammengefasst und diskutiert werden.

Abstract

Catheter-based left atrial appendage closure (LAAC) is currently a potential treatment option for stroke prevention in patients with atrial fibrillation and high risk for stroke/embolism as well as high bleeding risk. Due to improvements in LAAC devices, advances in implantation techniques and growing experience of the interventional teams, the safety profile of LAAC has significantly improved in recent years. These developments have led to a currently comprehensive exploration of novel indications for LAAC, such as patients with atrial fibrillation and a low risk of hemorrhage, patients with atrial fibrillation after pulmonary vein ablation or patients after electrical isolation of the left atrial appendage. The treatment principle of closure of the left atrial appendage is supported by new data, which show the effectiveness of surgical closure of the left atrial appendage with respect to a reduction of the risk of stroke, at least partly in conjunction with oral anticoagulation during cardiological surgical interventions. Currently, the application in the clinical practice is reflected by a high degree of active studies. These randomized studies are testing the use of LAAC in new fields of application and together with the new developments in implantation techniques should define the optimal future use of the methods for the clinical practice. The current potential indications for the LAAC procedure, ongoing randomized clinical trials and advances in device development, implantation planning and technique as well as future developments in the field of LAAC treatment are summarized and discussed in this review article.

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Authors and Affiliations

  1. Klinik für Kardiologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    Carsten Skurk MD, Claudio Seppelt, Denitsa Meteeva, Markus Rheinthaler & Ulf Landmesser MD

  2. DZHK Partner Site Berlin, Berlin, Deutschland

    Carsten Skurk MD, Claudio Seppelt, Denitsa Meteeva, Markus Rheinthaler & Ulf Landmesser MD

  3. Berlin Institutes of Health (BIH), Berlin, Deutschland

    Ulf Landmesser MD

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  1. Carsten Skurk MD
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  2. Claudio Seppelt
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  3. Denitsa Meteeva
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  4. Markus Rheinthaler
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  5. Ulf Landmesser MD
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Correspondence to Carsten Skurk MD or Ulf Landmesser MD.

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Interessenkonflikt

C. Skurk, C. Seppelt, D. Meteeva, M. Rheinthaler und U. Landmesser geben an, dass kein Interessenkonflikt 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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Skurk, C., Seppelt, C., Meteeva, D. et al. Linksatrialer Vorhofohrverschluss. Herz 46, 452–466 (2021). https://doi.org/10.1007/s00059-021-05065-8

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