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Методики томографической визуализации ушка левого предсердия при планировании интервенционного лечения фибрилляции предсердий

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Изменение внутрисердечной гемодинамики на фоне неправильного ритма фибрилляции предсердий создает условия для формирования тромбов в полости ушка левого предсердия. Наличие тромба в ушке является неблагоприятным прогностическим фактором последующих кардиоваскулярных событий, являясь источником до 64% случаев ишемических инсультов, а сопутствующая антикоагулянтная терапия приводит к большой частоте геморрагической транcформации. Симптомная и рефрактерная к медикаментозному лечению фибрилляция предсердий требует хирургической коррекции ритма или электрической кардиоверсии. Во время вмешательства существует высокий риск кардиоэмболического инсульта, поэтому на дооперационном этапе для его профилактики необходимо исключить тромбоз ушка левого предсердия. Основной метод визуализации ушка - чреспищеводная эхокардиография, но на сегодняшний день определенный вклад вносит компьютерная томография и, в меньшей степени, магнитно-резонансная томография. Целью данного научного обзора было изучение возможностей каждой методики и их роли в диагностическом алгоритме при обследовании пациентов перед катетерной абляцией источников фибрилляции предсердий.

Ключевые слова:
МСКТ, фибрилляция предсердий, радиочастотная абляция, тромбоз ушка левого предсердия, MDCT, atrial fibrillation, radiofrequency ablation, left atrial appendage trombosis

Литература:
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Techniques of left atrial appendage tomography for planning intervention treatment of atrial fibrillation

Due to intracardiac circulatory changes atrial fibrillation creates conditions for thrombus formation in the left atrial appendage (LAA). The presence of thrombus in LAA is poor prognostic factor of subsequent cardiovascular events. It is the source of up to 64% of ischemic stroke cases, and concomitant anticoagulant therapy leads to a high frequency of hemorrhagic conversion. For patient with symptomatic and drug-refractory arrhythmia is recommended surgical rhythm correction or electrical cardioversion. There is a high risk of cardioembolic stroke during the intervention, so it is necessary to exclude LAA thrombosis at pre-operation stage. The main method of LAA visualization is transesophageal echocardiography, but today computed tomography and, less, magnetic resonance tomography become important. The purpose of this review is to analyze the possibilities of each visualisation technique and their role in the diagnostic algorithm when examining patients before catheter ablation of atrial fibrillation sources.

Keywords:
МСКТ, фибрилляция предсердий, радиочастотная абляция, тромбоз ушка левого предсердия, MDCT, atrial fibrillation, radiofrequency ablation, left atrial appendage trombosis