Información del artículo
Resumen
La ablación de venas pulmonares por radiofrecuencia es un procedimiento habitual utilizado para tratar la fibrilación auricular persistente. Aunque es una técnica eficaz y segura, puede asociarse con complicaciones de diversa entidad y gravedad (relacionadas con el acceso vascular como hematomas en el punto de punción, con las propias venas pulmonares como la estenosis o trombosis, y con los órganos adyacentes como el desarrollo de fístula atrioesofágica, entre otras). La tomografía computarizada multidetector (TCMD) es la técnica de elección para valorar estas complicaciones, así como los hallazgos anatómicos de interés a tener en cuenta en los estudios de planificación previos al procedimiento.
Palabras clave:
Fibrilación auricular
Ablación por radiofrecuencia
Venas pulmonares
Estenosis
Fístula atrioesofágica
Tomografía computarizada multidetector
Abstract
Radiofrequency ablation (RFA) of the pulmonary veins is a common procedure used to treat persistent atrial fibrillation. Although it is generally safe and effective, it can be associated with complications of varying nature and severity. These include vascular access-related issues such as puncture site haematomas, complications involving the pulmonary veins themselves such as stenosis or thrombosis, and injuries to adjacent organs, including the development of atrio-oesophageal fistula, among others. Multidetector computed tomography (MDCT) is the technique of choice to assess these complications, as well as for identifying key anatomical features that should be considered during pre-procedural planning.
Keywords:
Atrial fibrillation
Radiofrequency ablation
Pulmonary veins
Stenosis
Atrio-oesophageal fistula
Multidetector computed tomography
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Bibliografía
[1]
D.C. Shah, M. Haissaguerre, P. Jais, M. Hocini, T. Yamane, I. Deisenhofer, et al.
Electro physiologically guided ablation of the pulmonary veins for the curative treatment of atrial fibrillation.
Ann Med., 32 (2000), pp. 408-416
[2]
F. Pelosi, F. Morady.
Evaluation and management of atrial fibrillation.
Med Clin North Am., 85 (2001), pp. 225-244
[3]
C. Pappone, S. Rosanio, G. Oreto, M. Tocchi, F. Gugliotta, G. Vicedomini, et al.
Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.
Circulation., 102 (2000), pp. 2619-2628
[4]
A. Gupta, T. Perera, A. Ganesan, T. Sullivan, D.H. Lau, K.C. Roberts-Thomson, et al.
Complications of catheter ablation of atrial fibrillation: A systematic review.
Circ Arrhythm Electrophysiol., 6 (2013), pp. 1082-1088
[5]
P. Cronin, M.B. Sneider, E.A. Kazerooni, A.M. Kelly, C. Scharf, H. Oral, et al.
MDCT of the left atrium and pulmonary veins in planning radiofrequency ablation for atrial fibrillation: A how-to guide.
AJR Am J Roentgenol., 183 (2004), pp. 767-778
[6]
J.M. Madrid Pérez, P.M. García Barquín, A.J. Villanueva Marcos, I. García Bolao, G. Bastarrika Alemañ.
Complicaciones asociadas a la ablación mediante radiofrecuencia de venas pulmonares.
Radiología., 58 (2016), pp. 444-453
[7]
H. Saad, D.T. Myers, T.K. Song, J. Nadig.
Radiologic manifestations of pulmonary vein ablation complications: A pictorial review.
J Thorac Imaging., 36 (2021), pp. W89-W95
[8]
S.Y. Ho, J.A. Cabrera, V.H. Tran, J. Farre, R.H. Anderson, D. Sanchez-Quintana.
Architecture of the pulmonary veins: Relevance to radiofrequency ablation.
Heart., 86 (2001), pp. 265-270
[9]
S. Tzeis, E.P. Gerstenfeld, J. Kalman, E.B. Saad, A.S. Shamloo, J.G. Andrade, et al.
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.
Europace., 26 (2024), pp. 1-107
[10]
C. Scharf, M. Sneider, I. Case, A. Chugh, S.W.K. Lai, F. Pelosi Jr., et al.
Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography.
J Cardiovasc Electrophysiol., 14 (2003), pp. 150-155
[11]
J.M. Lacomis, W. Wigginton, C. Fuhrman, D. Schwartzman, D.R. Amrfield, K.M. Pealer.
Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation.
Radiographics., 23 (2003), pp. 35-48
[12]
N.E. Budorick, V. McDonald, M.E. Flisak, R.M. Moncada.
The pulmonary veins.
Semin Roentgenol., 24 (1989), pp. 127-140
[13]
Y. Ishidoya, E. Kwan, D.J. Dosdall, R.S. Macleod, L. Navaravong, B.A. Steinberg, et al.
Shorter distance between the esophagus and the left atrium is associated with higher rates of esophageal thermal injury after radiofrequency ablation.
J Cardiovasc Electrophysiol., 33 (2022), pp. 1460-1471
[14]
C. Teunissen, J. Habets, B.K. Velthuis, M.J. Cramer, P. Loh.
Double-contrast, single-phase computed tomography angiography for ruling out left atrial appendage thrombus prior to atrial fibrillation ablation.
Int J Cardiovasc Imaging., 33 (2017), pp. 121-128
[15]
C. Teunissen, B.K. Velthuis, R.J. Hassink, J.F. van der Heijden, P.A. Vonken, N. Clappers, et al.
Incidence of pulmonary vein stenosis after radiofrequency catheter ablation of atrial fibrillation.
JACC Clin Electrophysiol., 3 (2017), pp. 589-598
[16]
H. Oral, B.P. Knight, H. Tada, M. Ozaydin, A. Chugh, S. Hassan, et al.
Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation.
Circulation., 105 (2002), pp. 1077-1081
[17]
D.R. Holmes, K.H. Monahan, D. Packer.
Pulmonary vein stenosis complicating ablation for atrial fibrillation: Clinical spectrum and interventional considerations.
JACC Cardiovasc Interv., 2 (2009), pp. 267-276
[18]
S.Y. Ahsan, J.C. Moon, M.P. Hayward, A.W. Chow, P.D. Lambiase.
Constrictive pericarditis after catheter ablation for atrial fibrillation.
Circulation., 118 (2008), pp. 834-835
[19]
R.K. Thakur, G.J. Klein, R. Yee, M. Zardini.
Embolic complications after radiofrequency catheter ablation.
Am J Cardiol., 74 (1994), pp. 278-279
[20]
M. Kwon, H.Y. Lee, J.H. Cho, S. Um.
lung infarction due to pulmonary vein stenosis after ablation therapy for atrial fibrillation misdiagnosed as organizing pneumonia: Sequential changes on CT in two cases.
Korean J Radiol., 16 (2015), pp. 942-946
[21]
J. Yataco, J.K. Stoller.
Pulmonary venous thrombosis and infarction complicating pulmonary venous stenosis following radiofrequency ablation.
Respir Care., 49 (2004), pp. 1525-1527
[22]
K. Koranne, I. Basu-Ray, V. Parikh, M. Pollet, S. Wang, N. Mathuria, et al.
Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation: A meta-analysis.
J Atr Fibrillation., 9 (2016), pp. 1452
[23]
C. Pappone, H. Oral, V. Santinelli, G. Vicedomini, C.C. Lang, F. Manguso, et al.
Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
Circulation., 109 (2004), pp. 2724-2726
[24]
D. Sanchez-Quintana, J.A. Cabrera, V. Climent, J. Farre, A. Weiglein, S.Y. Ho.
How close are the phrenic nerves to cardiac structures? Implications for cardiac interventionalists.
J Cardiovasc Electr., 16 (2005), pp. 309-313
[25]
A. Boussuges, S. Rives, J. Finance, F. Brégeon.
Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives.
World J Clin Cases., 8 (2020), pp. 2408-2424
[26]
A. Corrado, D. Patel, L. Riedlbauchova, T.S. Fahmy, S. Themistoclakis, A. Bonso, et al.
Eficacy, safety, and outcome of atrial fibrillation ablation in septuagenarians.
J Cardiovasc Electrophysiol., 19 (2008), pp. 807-811
[27]
J. Martí-Almor, M.E. Jauregui-Abularach, B. Benito, E. Vallès, V. Bazan, A. Sánchez-Font, et al.
Pulmonary hemorrhage after cryoablation for pulmonary vein isolation in the treatment of atrial fibrillation.
Chest., 145 (2014), pp. 156-157
[28]
L.A. Prudente, J.R. Moorman, D. Lake, Y. Xiao, H. Greebaum, J.M. Mangrum, et al.
Femoral vascular complications following catheter ablation of atrial fibrillation.
J Interv Card Electrophysiol., 26 (2009), pp. 59-64
[29]
S.B. González, J.C.V. Busquets, R.G. Figueiras, C.V. Martín, C.S. Pose, A.M. de Alegría, et al.
Imaging arteriovenous fistulas.
AJR Am J Roentgenol., 193 (2009), pp. 1425-1433
[30]
N.E. Saad, W.E. Saad, M.G. Davies, D.L. Waldman, P.J. Fultz, D.J. Rubens.
Pseudoaneurysms and the role of minimally invasive techniques in their management.
Radiographics., 25 (2005), pp. 173-189
