Radiofrekventna ablacija anteroseptalnog aksesornog puta – izazov za elektrofiziologa

  • Mihailo Čedomir Vukmirović Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Lazar Angelkov Department of Cardiology, Dedinje Cardiovascular Institute, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Filip Vukmirović Department of Pathology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Irena Tomašević Vukmirović Department of Radiology, Clinical Center of Montenegro, Podgorica, Montenegro
DOI: https://doi.org/10.2298/4462
Ključne reči: heart conduction system||, ||srce, provodni sistem, arrhythmias, cardiac||, ||aritmija, catheter ablation||, ||ablacija preko katetera, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Anteroseptalni aksesorni put nalazi se u vrhu Koch-ovog trougla i spaja pretkomorski i komorski septum u predelu Hisovog snopa. Ablacija u ovoj regiji predstavlja izazov za elektrofiziologa zbog visokog rizika od privremenog ili stalnog atrioventrikularnog (AV) bloka. Prikaz bolesnika. Bolesnik star 18 godina, hospitalizovan je zbog radiofrekventne (RF) ablacije aksesornog puta. Aktivno se bavio fudbalom. Žalio se na povremene palpitacije u toku napora, praćene osećajem kratkoga daha i omaglicama, ali bez sinkope. U elektrokardiogramu na prijemu registrovana je povremena preekscitacija. Intrakardijalni maping pokazao je najraniju komorsku aktivaciju u anteroseptalnoj regiji, neposredno uz AV čvor, odnosno Hisov snop. Upotrebom dugog vaskularnog uvodnika isporučena je RF energija niske snage i zbog odsustva produženja PR intervala odnosno nodalnog ritma tokom 15 sekundi, snaga je postepeno pojačana na 40 W, nakon čega nije registrovana preekscitacija. Zaključak. Uprkos blizine Hisovog snopa i visokog rizika privremenog ili trajnog AV bloka, ablacija anteroseptalnog aksesornog puta može biti uspešno urađena, ali zahteva veliku opreznost u toku procedure.

Biografija autora

Mihailo Čedomir Vukmirović, Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro

internista kardiolog

magistar kardiologije

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Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 4 (2015)
Rubrika
Prikaz bolesnika