{"id":78238,"date":"2017-10-03T15:42:31","date_gmt":"2017-10-03T15:42:31","guid":{"rendered":"http:\/\/humanitasnet-new.local\/cure\/ablatia-fibrilatiei-arteriale-2\/"},"modified":"2017-10-03T15:42:31","modified_gmt":"2017-10-03T15:42:31","slug":"ablatia-fibrilatiei-arteriale-2","status":"publish","type":"cure","link":"https:\/\/humanitas-net.humweb.webiz.team\/ro\/treatments\/ablatia-fibrilatiei-arteriale-2\/","title":{"rendered":"Abla\u0163ia fibrila\u0163iei arteriale"},"content":{"rendered":"

Abla\u0163ia fibrila\u0163iei arteriale<\/h2>\n

 <\/p>\n

Abla\u021bia fibrila\u021biilor arteriale este o procedur\u0103 mai complex\u0103 ca alte proceduri folosite pentru tratarea aritmiilor. Izoleaz\u0103 electric venele pulmonare utiliz\u00e2nd surse de energie electric\u0103 prin radiofrecven\u021b\u0103.<\/p>\n

<\/h2>\n

Ce este abla\u021bia fibrila\u021biilor arteriale?<\/h2>\n

Fibrila\u021bia atrial\u0103 este o aritmie supra ventricular\u0103, care este declan\u0219at\u0103 de impulsuri electrice, provenite de la celulele musculare miocardice prezente la jonc\u021biunea dintre cele patru vene pulmonare, care transport\u0103 s\u00e2ngele oxigenat din circula\u0163ia pulmonar\u0103 st\u00e2ng\u0103 \u00een atriu.<\/p>\n

Scopul procedurii este s\u0103 izoleze electric venele pulmonare cre\u00e2nd o cicatrice circular\u0103 la nivelul orificiului de evacuare \u00een atriul st\u00e2ng prin livrarea de radiofrecven\u021b\u0103 (energie electric\u0103).<\/p>\n

Abla\u021bia fibrila\u021biilor arteriale este o procedur\u0103 mai complex\u0103 ca alte proceduri folosite pentru tratarea aritmiilor deoarece necesit\u0103 trecerea cateterului de abla\u021bie din sec\u021biunea dreapt\u0103 a inimii (la care se poate ajunge prin venepunctur\u0103) \u00een sec\u021biunea st\u00e2ng\u0103. Iar acesta se realizeaz\u0103 trec\u00e2nd printr-un orificiu (foramen ovale), care este \u00eenchis de o membran\u0103 fibroas\u0103 la adul\u021bi. Dup\u0103 efectuarea acestor pa\u0219i \u00een sec\u021biunea st\u00e2ng\u0103 a inimii, patru vene pulmonare sunt izolate electric. Navigatorul de plumb este eliberat sub fluoroscopie (raze X) bazat pe harta anatomic\u0103 ob\u021binut\u0103 printr-un software special (CARTO 3), precum \u0219i expunerile imaginilor ob\u021binute prin scanarea CT a inimii (se face la fiecare pacient \u00eenainte de procedur\u0103). Datorit\u0103 prezen\u021bei cateterului \u00een sec\u021biunile din st\u00e2nga ale inimii cre\u0219te riscul form\u0103rii emboliei \u0219i din aceast\u0103 cauz\u0103 pacien\u021bii sunt \u021binu\u021bi pe anticoagulante pe \u00eentreaga durat\u0103 a procedurii, pentru a men\u021bine o fluiditate ridicat\u0103 a s\u00e2ngelui \u0219i pentru a reduce posibilitatea form\u0103rii trombozelor. Pacien\u021bii sunt monitoriza\u021bi cu aten\u021bie, iar valorile sanguine sunt verificate \u00een mod regulat, indic\u00e2nd gradul de anticoagulare.<\/p>\n

 <\/p>\n

Cum se realizeaz\u0103 procedura?<\/h2>\n

Ini\u021bial pacientul este supus unei ecocardiografii trans esofagiene pentru a elimina prezen\u021ba trombozei intra cavitare \u0219i a unui CT a inimii care se suprapune sistemului de cartografiere carto. Procedura are loc \u00een sala de opera\u021bie \u00een care are loc \u0219i stereotaxia.<\/p>\n

Av\u00e2nd \u00een vedere durat\u0103 procedurii (p\u00e2n\u0103 la 5 ore), pacien\u021bii sunt \u021binu\u021bi \u00een sedare profund\u0103 \u0219i monitoriza\u021bi sub anestezie. Etapele principale sunt: g\u0103sirea unui acces venos femural potrivit, introducerea catetelor venoase (num\u0103rul 3) \u00een partea dreapt\u0103 a inimii, executarea punc\u021biei transseptale (tranzi\u021bie din partea dreapt\u0103 a inimii spre partea st\u00e2ng\u0103), introducerea navigatorului \u00een sec\u021biunea st\u00e2ng\u0103 \u0219i \u00een cele din urm\u0103 abla\u021bia prin cateter prin izolarea a 4 ostii circulare \u00een venele pulmonare. Dup\u0103 procedur\u0103 de abla\u021bie pacientul este trezit \u00een mod lent. Av\u00e2nd \u00een vedere regimul de anticoagulare, cateterele de acces venos pe femurul drept sunt \u021binute \u00een loc \u0219i \u00eendep\u0103rtate dup\u0103 c\u00e2teva ore atunci c\u00e2nd exist\u0103 o reducere a dimensiunii anticoagulare; \u00een aceast\u0103 faz\u0103 pacientul este luat din sala de opera\u021bie, iar \u00een cazul \u00een care nu sunt complica\u021bii externat a doua zi.<\/p>\n

 <\/p>\n

Care sunt avantajele \u0219i dezavantajele tratamentului?<\/h2>\n

Procedura de abla\u021bie a fibrila\u021biilor arteriale duce \u00eentr-un procent variat \u00een jur de 75% \u0219i 90% la eliminarea complet\u0103 a aritmiei;\u00a0\u00een consecin\u021b\u0103 pe baza aceleia\u0219i ipoteze luarea medicamentelor antiaritmice poate fi suspendat\u0103. Dup\u0103 monitorizarea ritmului ritmului cardiac urm\u0103toarele luni (prin implantarea unui loop recorder) condi\u021bia poate fi evaluat\u0103 \u0219i dup\u0103 suspendarea terapiei medicamentoase. \u00cen contrast \u00eentr-un num\u0103r mic de cazuri pot ap\u0103rea aritmii recurente care necesit\u0103 terapie continu\u0103 \u0219i \u00een unele cazuri pot fi tratate prin alte proceduri de abla\u021bie.<\/p>\n

Abla\u021bia fibrila\u021biilor arteriale dureroas\u0103 sau periculoas\u0103?<\/h2>\n

\u00cen general procedur\u0103 este bine tolerat\u0103 de pacien\u021bi deoarece este efectuat\u0103 sub sedare ad\u00e2nc\u0103. Un oarecare disconfort poate surveni \u00een timpul procur\u0103rii accesului vascular femural (procedura care este efectuat\u0103 uneori \u00een timp ce pacientul este treaz).<\/p>\n

Care pacien\u021bi pot lua tratamentul?<\/h2>\n

Pacien\u0163ii cu fibrila\u021bie atrial\u0103 paroxistic\u0103 sau persistent\u0103, sau to\u021bi pacien\u021bii care au episoade de aritmii care nu sunt bine controlate de terapia antiaritmic\u0103 sau pacien\u021bii care nu vor s\u0103 ia medicamente.<\/p>\n

Control<\/h2>\n

\u00cen scopul monitoriz\u0103rii performan\u021bei ritmului inimii, este recomandat ca la to\u021bi pacien\u021bii la care s-a efectuat abla\u021bie s\u0103 se implementeze un loop recorder. \u00cen caz contrar mai ales \u00een fazele ini\u021biale este important s\u0103 se implementeze un monitoring ECG cel pu\u021bin trimestrial.<\/p>\n

Abla\u021bia fibrila\u021biilor arteriale este o procedur\u0103 mai complex\u0103 ca alte proceduri folosite pentru tratarea aritmiilor. Izoleaz\u0103 electric venele pulmonare utiliz\u00e2nd surse de energie electric\u0103 prin radiofrecven\u021b\u0103.<\/p>\n","protected":false},"featured_media":0,"template":"","class_list":["post-78238","cure","type-cure","status-publish","hentry"],"yoast_head":"\nAbla\u0163ia fibrila\u0163iei arteriale - Humanitas.net<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Abla\u0163ia fibrila\u0163iei arteriale - Humanitas.net\" \/>\n<meta property=\"og:description\" content=\"Abla\u0163ia fibrila\u0163iei arteriale   Abla\u021bia fibrila\u021biilor arteriale este o procedur\u0103 mai complex\u0103 ca alte proceduri folosite pentru tratarea aritmiilor. Izoleaz\u0103 electric venele pulmonare utiliz\u00e2nd surse de energie electric\u0103 prin radiofrecven\u021b\u0103. 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Izoleaz\u0103 electric venele pulmonare utiliz\u00e2nd surse de energie electric\u0103 prin radiofrecven\u021b\u0103. Ce este abla\u021bia fibrila\u021biilor arteriale? 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