Publication: Beneficio del ecocardiograma intracardiaco en pacientes sometidos a la ablación de las venas pulmonares por fibrilación auricular
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2017-10-04
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Universidad Complutense de Madrid
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Abstract
La cateterización transeptal a través de la punción del septo interauricular es un procedimiento fundamental para el tratamiento de ciertas arritmias, como la Fibrilación Auricular y otras patologías cardiacas. Para ello es preciso atravesar el septo interauricular en la región de la fosa oval (FO), usualmente utilizando una aguja conocida como aguja “de Brockenbrough”. Para la localización de la FO se utilizan referencias anatómicas identificables bajo visión radioscópica. El avance y la mejora en el tratamiento de ciertas patologías cardiacas que requieren la punción del septo, han convertido a la punción transeptal (PT) en un procedimiento cada vez más frecuente en los laboratorios de electrofisiología y hemodinámica, extendiéndose esta técnica a casos cada vez más complejos. Esto a su vez supone un incremento de la posibilidad de enfrentarnos a una anatomía cardiaca menos predecible por marcas anatómicas fluoroscópicas y, por tanto, un incremento del riesgo de sufrir complicaciones. Algunas de estas complicaciones ocurren como consecuencia de referencias anatómicas insuficientes o variaciones interindividuales de la anatomía cardiaca que pueden suponer atravesar el septo interauricular por zonas erróneas, con incremento del riesgo de perforación y taponamiento cardiaco. Hoy en día disponemos de una técnica de imagen, la ecocardiografía intracardiaca (EIC), que proporciona una excelente información anatómica y en tiempo real. Desde la aurícula derecha nos permite visualizar las cuatro cavidades cardiacas además de otras estructuras extracardiacas. Se trata de una técnica de imagen que podría facilitar la PT, disminuir el riesgo de complicaciones y además acortar su curva de aprendizaje...
Transseptal catheterization through the atrial septal puncture is fundamental to treat certain arrhythmias, such as atrial fibrillation (AF) and other cardiac pathologies. This requires crossing the atrial septum in the region of the oval fossa (OF), usually using a needle called "Brockenbrough". Locating the OF an identifiable anatomical landmarks is done using fluoroscopy. The progress in the treatment of certain cardiac pathologies requires puncturing the septum. Transseptal puncture (TP) in an increasingly frequent in electrophysiology and hemodynamic laboratories procedures, extending this technique to cases that are more complex. This in turn means an increase of the possibility of facing a less predictable fluoroscopic cardiac anatomy and anatomical landmarks; therefore, an increases risk of complications. Some of these complications occur as a result of insufficient anatomical landmarks or interindividual variations of cardiac anatomy, which my result in crossing the atrial septum into the wrong areas, and increase the risk of perforation and cardiac tamponade. Today, we have an imaging technique intracardiac echocardiography (ICE), which provides excellent anatomic information in real time. From the right atrium, it allows us to visualize the four heart chambers as well as other extracardiac structures. This is an imaging technique that could facilitate the TP, by reducing the risk of complications and also shortening the learning curve. Additionally, using ICE would potentially reduce the risk of puncture, as well as providing security in complex cases such as failed punctures due to complex anatomy, presence of prosthetic material, or congenital heart disease patients on anticoagulantes...
Transseptal catheterization through the atrial septal puncture is fundamental to treat certain arrhythmias, such as atrial fibrillation (AF) and other cardiac pathologies. This requires crossing the atrial septum in the region of the oval fossa (OF), usually using a needle called "Brockenbrough". Locating the OF an identifiable anatomical landmarks is done using fluoroscopy. The progress in the treatment of certain cardiac pathologies requires puncturing the septum. Transseptal puncture (TP) in an increasingly frequent in electrophysiology and hemodynamic laboratories procedures, extending this technique to cases that are more complex. This in turn means an increase of the possibility of facing a less predictable fluoroscopic cardiac anatomy and anatomical landmarks; therefore, an increases risk of complications. Some of these complications occur as a result of insufficient anatomical landmarks or interindividual variations of cardiac anatomy, which my result in crossing the atrial septum into the wrong areas, and increase the risk of perforation and cardiac tamponade. Today, we have an imaging technique intracardiac echocardiography (ICE), which provides excellent anatomic information in real time. From the right atrium, it allows us to visualize the four heart chambers as well as other extracardiac structures. This is an imaging technique that could facilitate the TP, by reducing the risk of complications and also shortening the learning curve. Additionally, using ICE would potentially reduce the risk of puncture, as well as providing security in complex cases such as failed punctures due to complex anatomy, presence of prosthetic material, or congenital heart disease patients on anticoagulantes...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 17/12/2015