Медицинская литература. Новинки

 

 

 

 

 

 

Оценка анатомии и функции левого предсердия по данным мультиспиральной компьютерной томографии при подготовке к радиочастотной катетерной абляции у пациентов с фибрилляцией предсердий

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Фибрилляция предсердий (ФП) является наиболее распространенным нарушением ритма в клинической практике. Оптимальной терапией ФП, рефрактерной к противоаритмическим препаратам, на настоящий момент признана катетерная абляция (КА) аритмогенных очагов. Визуализация перед проведением процедуры необходима для детальной оценки левого предсердия, легочных вен и прилежащих анатомических структур, что позволяет оптимально спланировать вмешательство, а также спрогнозировать и предотвратить возможные осложнения. Цель исследования: определить роль мультиспиральной компьютерной томографии (МСКТ) с контрастным усилением в обследовании пациентов с ФП, а также оценить перспективы развития данной мето дики на основании систематического обзора мировой литературы. Материал и методы. Проанализированы 140 статей, находящихся в свободном доступе в системе PubMed за период с 01.2009 по 01.2017 по запросам “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial appendage”, а также ряд русскоязычных публикаций в системе eLibrary. Результаты. В обзоре литературы представлены и систематизированы имеющиеся данные по эпидемиологии и механизмам развития ФП, приведена актуальная классификация. Рассмотрены преимущества МСКТ-диагностики перед другими методами визуализации как в рамках подготовки к процедуре КА, так и последующего ведения пациентов. Заключение. МСКТ является точным, эффективным и доступным методом, отвечающим требованиям визуализации в рамках подготовки к КА. Кроме того, МСКТ в совокупности с навигационной системой электроанатомического картирования увеличивает безопасность и эффективность процедуры. В послеоперационном периоде МСКТ может быть использована для диагностики осложнений и оценки результата.

Ключевые слова:
фибрилляция предсердий, катетерная абляция, МСКТ, объем левого предсердия, легочные вены, ушко левого предсердия, осложнения катетерной абляции, atrial fibrillation, catheter ablation, MDCT left atrial volume, pulmonary veins, left atrial appendage, complications of catheter ablation

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Evaluation of Left Atrial Anatomy and Function using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Catheter ablation (CA) of arrhythmogenic foci is supposed to be an established treatment option for symptomatic patients with AF, refractory to antiarrhythmic therapy. Pre-procedural imaging is indispensable for the assessment of left atrium, pulmonary veins and adjacent anatomy, and facilitates selection of the ablation strategy to achieve an optimal result and minimize the risk of complications. Purpose: to evaluate the role of contrast-enhanced MDCT in patients with AF; also to present the prospects for further development of this method according to the systemic review of world research data. Materials and methods. 140 free access articles requested as “MDCT left atrium”, “MDCT pulmonary veins”, “MDCT atrial appendage” from 01.2009 until 01.2017 were analyzed in PubMed, as well as a number of Russianlanguage articles in eLibrary. Results. This literature review reports and systematizes available data on epidemiology and mechanisms of AF, represents current classification. In addition were analyzed advantages of MDCT over other methods of visualization while planning the CA and follow-up. Conclusion. MDCT is precise, effective and accessible option, which satisfies visualization requirements during the preparation for CA. Moreover, using MDCT in combination with electro-mapping systems increases safety and effectiveness of the procedure. In postoperative period MDCT can be used for complications diagnostic and results assessment.

Keywords:
фибрилляция предсердий, катетерная абляция, МСКТ, объем левого предсердия, легочные вены, ушко левого предсердия, осложнения катетерной абляции, atrial fibrillation, catheter ablation, MDCT left atrial volume, pulmonary veins, left atrial appendage, complications of catheter ablation