Задняя Стенка Левого Предсердия Как Мишень При Катетерной Аблации Фибрилляции Предсердий

Козлов, Александр Владимирович; Дурманов, С. С.; Базылев, В.В.

doi:10.24022/1997-3187-2020-14-4-368-376

Cited by 2 publications

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“…КА ФП в последние годы стала эффективной альтернативой лекарственной терапии и сложным хирургическим операциям на открытом сердце [1][2][3][8][9][10]. Все пациенты с ФП во время пароксизма имеют определенные риски ТЭ осложнений [11,12].…”

Section: обсуждение полученных результатовunclassified

“…Рядом исследователей было замечено, что несмотря на предоперационную антикоагулянтную терапию, тромбы могут образовываться на межпредсердной перегородке и/или катетере почти сразу после ТСП и что раннее введение гепарина существенно снижает этот риск. Поэтому рекомендуется вводить гепарин до или сразу после ТСП во время процедур абляции ФП и корректировать его для достижения и поддержания целевых показателей АСТ более 300 секунд [7][8][9]. Мета-анализ исследований более 7000 пациентов также показал снижение риска ТЭ осложнений без увеличения риска кровотечений при достижении целевого АСТ более 300 секунд во время аблации ФП [32].…”

Section: рис 2 максимальные значения активированного тромбоцитарного ...unclassified

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Warfarin versus non-vitamin k antagonist oral anticoagulants: how the degree of coagulation diﬀers during catheter ablation of atrial ﬁbrillation

Popylkova

Дурманов

Patel

et al. 2022

Vestnik aritmologii

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Aim. To evaluate intraoperative doses of administered heparin to achieve the target value of activated clotting time (ACT) in patients receiving preoperative anticoagulant therapy with warfarin or one of the non-vitamin K antagonists oral anticoagulants (NOAC).Materials and methods. The study was of a retrospective. Inclusion criteria: patients with atrial ﬁbrillation (AF) who have indications for catheter ablation in accordance with national clinical guidelines; age 18-75 years; absence of thrombus and the eﬀect of echocontrasting 3-4 stage in the left atrium cavity according to transesophageal echocardiography or computed tomography with contrast enhancement; regular intake of anticoagulants prescribed at least 3 weeks before hospitalization. Exclusion criteria: additional intake of antiplatelet drugs; contraindications to the anticoagulant therapy, including intolerance to the components of drugs; weight more than 100 kg. According to the criteria for inclusion in the study 279 patients were included (211 of them received warfarin and 68 received one of the NOAC). The mean age of the patients was 59.2±8.9 years, the body mass index was 59.2±8.9 kg/m2. Among them, men accounted for 155 (55,6%), diabetes mellitus was diagnosed in 28 (10%), arterial hypertension - in 224 (80.3%), coronary heart disease - in 103 (36.9%). Paroxysmal AF was observed in 185 (66.3%) of patients, persistent AF - in 77 (27.6%), and long-standing persistent AF - in 17 (6.1%). To ensure maximum comparability of the groups pseudorandomization was performed with the formation of 67 pairs of patients.Results. A group of patients taking warfarin for preoperative preparation required lower doses of heparin to achieve the target AСT and amounted to 14.8±5.1 thousand ME compared to 17.9±4.4 thousand ME in the NOAC group (p=0.0001). Despite the lower dose of heparin the ACT level in the warfarin group was signiﬁcantly higher than in patients taking NOAC (441.5±203.4 sec. and 345.4±148.8 sec. accordingly, p=0.0001).Conclusions. A signiﬁcantly lower dose of heparin was required in the warfarin group to achieve the target ACT (>300) than in the group of NOAC, while the maximum ACT value was higher. Thus, with the standard starting dose of heparin, the target anticoagulation was achieved faster in patients receiving warfarin.

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Section: обсуждение полученных результатовunclassified

Section: рис 2 максимальные значения активированного тромбоцитарного ...unclassified

Warfarin versus non-vitamin k antagonist oral anticoagulants: how the degree of coagulation diﬀers during catheter ablation of atrial ﬁbrillation

Popylkova

Дурманов

Patel

et al. 2022

Vestnik aritmologii

View full text Add to dashboard Cite

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The change in the position of the esophagus during radiofrequency ablation of the pulmonary veins is minimal according to esophagography

Bazylev,

Kozlov,

Durmanov

2024

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Aim. To study the change in the position of the esophagus during radiofrequency ablation of the pulmonary veins (RFA PV) using esophagographyMethods. The period of the study is from August 2022 to January 2023 inclusive. The study is a single-center observational non-randomized study. The study included 191 patients. RFA PV were performed under conscious sedation with dexmedetomidine and fentanyl. The patients were available for verbal contact throughout the operation. After performing a transeptal puncture, esophagography was performed in the LAO 30° projection using 10 ml of Omnipac water-soluble contrast agent (GE Healthcare Ireland). At the end of the operation, esophagography was performed repeatedly. The position of the esophagus was determined relative to the shadow of the spine. Measurements were carried out at three levels: the upper one at the intersection of the esophagus and the roof of the left atrium, the lower one at the intersection with the ring of the mitral valve; the middle level at the middle of the distance between the upper and lower measurements. The width of the contrasted lumen of the esophagus was measured at the same levels. Lateral displacement of the esophagus was defined as the difference in the values of measurements of the position of the lateral and medial boundaries of the esophageal shadow on esophagograms obtained at the beginning and end of the operation.Results. The average lateral displacement of the esophagus was 2.0 ±1.9 mm at the upper level, 3.4±1.6 mm at the middle level and 1.4±1.2 mm at the lower level of the left atrium. There was no significant statistically difference in the change in the position of the esophagus at the beginning and end of the operation (p=0.251, p=0.558, p=0.824, respectively, for the upper, middle and lower measurement levels). The most significant displacement of the esophageal shadow was 5.3 mm. The maximum change in the width of the contrasted lumen of the esophagus was 5.5 mm.Conclusions. According to esophagography with water-soluble contrast, the position of the esophagus during RFA PV does not experience clinically significant changes.

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Задняя Стенка Левого Предсердия Как Мишень При Катетерной Аблации Фибрилляции Предсердий

Cited by 2 publications

References 0 publications

Warfarin versus non-vitamin k antagonist oral anticoagulants: how the degree of coagulation diﬀers during catheter ablation of atrial ﬁbrillation

Warfarin versus non-vitamin k antagonist oral anticoagulants: how the degree of coagulation diﬀers during catheter ablation of atrial ﬁbrillation

The change in the position of the esophagus during radiofrequency ablation of the pulmonary veins is minimal according to esophagography

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