Izolacija plućnih vena kod bolesnika sa fibrilacijom pretkomora i naglašenim vagalnim odgovorom: Da li je to dovoljno?
Sažetak
Uvod. Izolacija plućnih vena (PVI) antrumskom cirkumferentnom ablacijom je standardna metoda za bolesnike sa simptomatskom i na lekove refraktornom atrijalnom fibrilacijom (AF). Kod pojedinih bolesnika dopunska modifikacija anatomskih lokacija autonomnih gangliona ganglionated plexi (GP) dovodi do značajno boljeg ishoda od onih kojima je učinjena samo PVI. Prikaz bolesnika. Prikazali smo bolesnika sa paroksizmalnom AF i epizodama teške bradikardije koje je imao u poslednjih mesec dana. Bolesnik je lečen antiaritmijskom terapijom bez značajnijeg uspeha. Zbog teške bradikardije bolesniku je implantiran privremeni vodič srčanog ritma dva dana pre elektrofiziološkog ispitivanja i radiofrekventne ablacije. Tokom radiofrekventne ablacije zbog izraženog vagalnog odgovora odlučeno je da se učini i modifikacija anatomskih lokacija GP sa leve strane. Tri meseca kasnije bolesnik je bio u stabilnom sinusnom ritmu i bez simptoma. Zaključak. Kod pojedinih bolesnika sa paroksizmalnom AF i naglašenim vagalnim odgovorom, PVI cirkumferentnom antrumskom ablacijom udruženom sa modifikacijom GP, može imati veći uspeh od PVI ili modifikacije GP samostalno.
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