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Características anatómicas de la aurícula izquierda en sujetos sometidos a ablación por radiofrecuencia de fibrilación auricular
Anatomic characteristics of the left atrium in subjects undergoing radiofrequency ablation for atrial fibrillation
U. Martínez Urabayena, M. Caballerosb, I. Sorianoa, P. Ramosc, I. García Bolaoc, G. Bastarrikaa,
Autor para correspondencia
bastarrika@unav.es

Autor para correspondencia.
a Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
b Sección de imagen cardiotorácica, Servicio de Radiología, Clínica Universidad de Navarra, Madrid, España
c Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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el seno coronario o la vena y el ligamento de Marshall<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Estos dan lugar a impulsos r&#225;pidos y anormales que hacen que la aur&#237;cula se contraiga de forma irregular&#44; provocando un flujo sangu&#237;neo descoordinado hacia el ventr&#237;culo<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">4</span></a>&#46; La estasis sangu&#237;nea&#44; junto al medio protromb&#243;tico generado en la aur&#237;cula&#44; hacen que aumente el riesgo de eventos card&#237;acos&#44; accidentes cerebrovasculares&#44; insuficiencia cardiaca y muerte s&#250;bita<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Inicialmente&#44; la FA se trata con f&#225;rmacos antiarr&#237;tmicos y con anticoagulantes orales&#46; En caso de que persistan los s&#237;ntomas&#44; el ritmo sinusal se puede revertir mediante cardioversi&#243;n farmacol&#243;gica o el&#233;ctrica&#46; Si la FA es recurrente&#44; se plantea la ablaci&#243;n por cat&#233;ter para aislar las venas pulmonares empleando radiofrecuencia&#46; Se trata de un procedimiento seguro&#44; con una tasa de complicaciones similar a la del tratamiento con f&#225;rmacos antiarr&#237;tmicos&#46; Se ha descrito que un 5-7&#37; de los pacientes sufren complicaciones graves tras la ablaci&#243;n con cat&#233;ter&#44; que un 2-3&#37; padece complicaciones potencialmente mortales&#44; pero generalmente tratables&#44; y que rara vez se produce la muerte &#40;&#60; 0&#44;2&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">3&#44;5</span></a>&#46; Tras el procedimiento de ablaci&#243;n&#44; aproximadamente el 70&#37; de los pacientes con FA parox&#237;stica y el 50&#37; de los pacientes con FA persistente revierten a ritmo sinusal<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">6</span></a>&#46; Entre los factores de riesgo de recurrencia se han descrito el tipo de FA &#40;mayor en la FA persistente&#41; y su duraci&#243;n&#44; el volumen y geometr&#237;a de la aur&#237;cula izquierda<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#44; el tama&#241;o de las venas pulmonares<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a>&#44; la presencia de variantes anat&#243;micas de las venas pulmonares<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">9</span></a>&#44; la hipertensi&#243;n arterial&#44; la diabetes mellitus&#44; la obesidad&#44; el s&#237;ndrome de apnea obstructiva del sue&#241;o &#40;SAOS&#41; y el s&#237;ndrome metab&#243;lico<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0005" class="elsevierStylePara elsevierViewall">La planificaci&#243;n del procedimiento de ablaci&#243;n se suele realizar mediante angiograf&#237;a por tomograf&#237;a computarizada &#40;angio-TC&#41;&#46; Esta t&#233;cnica permite establecer el n&#250;mero&#44; el tama&#241;o y la localizaci&#243;n de las venas pulmonares con gran detalle anat&#243;mico&#46; Adem&#225;s&#44; tambi&#233;n permite conocer la anatom&#237;a de la aur&#237;cula izquierda&#44; medir su tama&#241;o y descartar la presencia de trombos<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">11</span></a>&#46; Este trabajo se realiz&#243; con el objetivo de establecer las caracter&#237;sticas anat&#243;micas de las venas pulmonares y de la aur&#237;cula izquierda en pacientes con FA y estudiar si existen datos por imagen que pudieran predecir el &#233;xito de la ablaci&#243;n o establecer factores de riesgo de recurrencia&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pacientes</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se incluyeron de manera retrospectiva 95 pacientes a quienes se realiz&#243; angio-TC antes del procedimiento de ablaci&#243;n de arritmias auriculares &#40;FA&#44; <span class="elsevierStyleItalic">flutter</span>&#44; taquicardia auricular&#41; durante el a&#241;o 2015&#46; Se excluyeron aquellos pacientes sometidos a ablaci&#243;n en a&#241;os anteriores&#44; los pacientes hemodin&#225;micamente inestables y aquellos pacientes que presentaron contraindicaciones cl&#225;sicas para tomograf&#237;a computarizada &#40;TC&#41;&#44; como son la insuficiencia renal cr&#243;nica &#40;creatinina s&#233;rica&#160;&#62;&#160;1&#44;4&#160;mg&#47;dl&#41; y antecedente de reacci&#243;n al&#233;rgica al contraste yodado&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se obtuvo el consentimiento informado por escrito de todos los individuos&#46; El estudio fue aprobado por el comit&#233; de &#233;tica de nuestro centro&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protocolo de angio-TC</span><p id="par0020" class="elsevierStylePara elsevierViewall">Los estudios de angio-TC se llevaron a cabo en un equipo de doble fuente &#40;Somaton Definition&#44; Siemens Healthineers&#44; Forchheim&#44; Alemania&#41; con el paciente en dec&#250;bito supino&#44; en inspiraci&#243;n&#44; en sentido craneocaudal&#44; en un rango que se extend&#237;a desde la mitad del cayado a&#243;rtico hasta el final del coraz&#243;n&#44; y con sincronizaci&#243;n ECG-retrospectiva&#46; Se emplearon los siguientes par&#225;metros de adquisici&#243;n&#58; 120&#160;kVp&#44; 350&#160;mAs para cada tubo&#44; grosor de corte 64&#160;&#215;&#160;0&#44;6&#160;mm&#44; colimaci&#243;n 64&#160;&#215;&#160;0&#44;6&#160;mm&#44; tiempo de rotaci&#243;n de gantry 330&#160;ms y resoluci&#243;n temporal &#40;83&#160;ms&#41;&#46; Se utiliz&#243; un pitch variable &#40;0&#44;2-0&#44;45&#41; adaptado a la frecuencia card&#237;aca&#46; Se utiliz&#243; modulaci&#243;n autom&#225;tica de la corriente del tubo &#40;<span class="elsevierStyleItalic">ECG pulsing</span>&#41;<span class="elsevierStyleItalic">&#44;</span> con administraci&#243;n de dosis m&#225;xima de radiaci&#243;n entre el 30&#37; y el 80&#37; del ciclo card&#237;aco y reducci&#243;n de la corriente nominal del tubo al 25&#37; en el resto de las fases del ciclo card&#237;aco&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se inyectaron 80&#160;ml de contraste yodado intravenoso &#40;Iomeron 400&#44; Iomeprol&#44; Bracco s&#46;p&#46;a&#44; Milan&#44; Italia&#41; a 4&#160;ml&#47;s&#44; seguidos de un bolo de 50&#160;ml de suero fisiol&#243;gico&#44; mediante un inyector de doble jeringa &#40;CT Stellant&#44; Medrad Inc&#46; Indianota&#44; EE&#46;&#160;UU&#46;&#41;&#44; empleando la t&#233;cnica de bolo autom&#225;tico y un umbral de disparo de 100&#160;unidades Hounsfield &#40;UH&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las im&#225;genes se reconstruyeron con un grosor de corte de 0&#44;75&#160;mm&#44; incremento de reconstrucci&#243;n de 0&#44;4&#160;mm&#44; algoritmo de reconstrucci&#243;n monosegmento&#44; filtro de reconstrucci&#243;n de partes blandas &#40;B26f&#41; y una matriz de 512&#160;&#215;&#160;512&#160;p&#237;xeles&#46; Para reconstruir las im&#225;genes y evaluar la anatom&#237;a de las venas pulmonares se escogi&#243; una fase diast&#243;lica en pacientes con frecuencia card&#237;aca menor de 60&#160;latidos por minuto &#40;lpm&#41; y una fase sist&#243;lica en los pacientes con frecuencia card&#237;aca mayor de 60&#160;lpm o que presentaran arritmia&#46; Los di&#225;metros de las venas pulmonares y el volumen de la aur&#237;cula izquierda se calcularon en una reconstrucci&#243;n sist&#243;lica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ning&#250;n paciente fue excluido del estudio por arritmia o irregularidad del ritmo card&#237;aco ni se emplearon f&#225;rmacos betabloqueantes para reducir la frecuencia card&#237;aca&#46; Todas las angio-TC se realizaron en un intervalo de tiempo m&#225;ximo inferior a 1 semana del procedimiento de ablaci&#243;n&#46; Los estudios se guardaron en el sistema de archivo de digital &#40;PACS&#41; del hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis de las im&#225;genes</span><p id="par0040" class="elsevierStylePara elsevierViewall">El posprocesamiento de las im&#225;genes se realiz&#243; en una estaci&#243;n de trabajo equipada con un programa espec&#237;fico que permite reconstrucciones multiplanares y volum&#233;tricas &#40;MM Reading&#44; Syngo&#46;via&#44; Siemens Healthineers&#41;&#46; Se defini&#243; como anatom&#237;a normal la presencia de dos venas pulmonares izquierdas y dos venas pulmonares derechas que drenaran en la aur&#237;cula izquierda&#46; Entre las variantes anat&#243;micas&#44; se defini&#243; como vena pulmonar accesoria aquella que presentara un drenaje venoso independiente de las venas pulmonares principales en la aur&#237;cula izquierda y se nombr&#243; de acuerdo con el segmento pulmonar que drenara&#46; Se consider&#243; como tronco de drenaje venoso com&#250;n la uni&#243;n de las venas pulmonares superiores e inferiores al menos 5&#160;mm antes de desembocar en la aur&#237;cula izquierda<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">12</span></a>&#46; Los di&#225;metros de los <span class="elsevierStyleItalic">ostia</span> de las venas pulmonares &#40;vena pulmonar superior derecha&#44; VPSD&#59; vena pulmonar inferior derecha&#44; VPID&#59; vena pulmonar superior izquierda&#44; VPSI&#59; vena pulmonar inferior izquierda&#44; VPII&#41; se midieron a menos de 1&#160;cm de su entrada en la aur&#237;cula izquierda&#44; en un plano perpendicular doble oblicuo&#44; siguiendo los ejes principales de cada una de las venas pulmonares &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Los di&#225;metros de la aur&#237;cula izquierda se midieron en los planos de cuatro c&#225;maras y tres c&#225;maras del ventr&#237;culo izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; El volumen de la aur&#237;cula izquierda se calcul&#243; de acuerdo con la siguiente ecuaci&#243;n&#58; Vol&#160;&#61;&#160;&#40;D1&#160;&#215;&#160;D2&#160;&#215;&#160;D3&#41;&#160;&#215;&#160;&#40;0&#44;523&#41;&#44; donde D1 es el di&#225;metro transverso en el plano de cuatro c&#225;maras&#44; D2 es el di&#225;metro anteroposterior en el plano de cuatro c&#225;maras y D3&#44; el di&#225;metro craneocaudal en el plano de tres c&#225;maras<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">13</span></a>&#46; Para el c&#225;lculo volum&#233;trico se excluy&#243; la orejuela&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables de estudio</span><p id="par0045" class="elsevierStylePara elsevierViewall">En todos los pacientes se recogieron los datos demogr&#225;ficos&#44; la frecuencia card&#237;aca&#44; la presi&#243;n arterial&#44; los factores de riesgo cardiovascular y otras variables&#44; como la edad en el primer episodio de arritmia&#44; tipo de arritmia&#44; complicaciones de la ablaci&#243;n&#44; recurrencia y tiempo libre de arritmia&#46; Se consideraron recurrencias en periodo de &#8220;blanking&#8221; aquellas que aparecieron en los primeros 3 meses posteriores a la ablaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">14</span></a>&#46; En este periodo&#44; la recurrencia de arritmias puede atribuirse a los cambios inflamatorios que se dan en la aur&#237;cula despu&#233;s del procedimiento y no necesariamente predicen la recurrencia tard&#237;a de arritmias&#46; Las recurrencias definitivas se definieron como las arritmias que reaparecieron pasados 3 meses desde la ablaci&#243;n&#46; Las variables de imagen que se recogieron fueron los di&#225;metros de los <span class="elsevierStyleItalic">ostia</span> de las venas pulmonares&#44; los di&#225;metros de la aur&#237;cula izquierda y el volumen de la aur&#237;cula izquierda&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los datos se presentan como media &#177; desviaci&#243;n est&#225;ndar o como frecuencia&#44; seg&#250;n su naturaleza&#46; La distribuci&#243;n normal de los datos se confirm&#243; con la prueba de Kolmog&#243;rov-Smirnov&#46; Se emplearon las pruebas <span class="elsevierStyleItalic">t</span> de Student para muestras independientes o pareadas para la comparaci&#243;n de las variables cuantitativas continuas y la prueba de &#967;<span class="elsevierStyleSup">2</span> para comparar las variables categ&#243;ricas&#46; El an&#225;lisis estad&#237;stico de los datos se llev&#243; a cabo mediante el programa SPSS &#40;IBM SPSS Statistics para Mac&#44; versi&#243;n 20&#46;0&#41;&#46; Se consider&#243; significativo un valor de <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Pacientes</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; una angio-TC previa al procedimiento de ablaci&#243;n a 95 pacientes &#40;57 hombres y 38 mujeres&#44; con una edad media de 65&#160;&#177;&#160;10 a&#241;os&#41;&#46; La edad media de aparici&#243;n del primer episodio de arritmia fue de 60&#160;&#177;&#160;11 a&#241;os&#46; Las arritmias m&#225;s frecuentes fueron la FA parox&#237;stica &#40;43&#44;2&#37;&#41;&#44; la FA persistente &#40;30&#44;5&#37;&#41; y la FA parox&#237;stica con <span class="elsevierStyleItalic">flutter</span> &#40;14&#44;7&#37;&#41;&#46; La edad media de los pacientes con FA parox&#237;stica &#40;66&#160;&#177;&#160;9 a&#241;os&#41; y FA persistente &#40;66&#160;&#177;&#160;10 a&#241;os&#41; y el perfil de factores de riesgo cardiovascular entre ambos grupos fueron similares&#46; El tiempo de duraci&#243;n medio de la FA desde el primer episodio hasta que se realiz&#243; la ablaci&#243;n fue de 5&#44;6&#160;&#177;&#160;6&#44;9 a&#241;os&#46; Los datos demogr&#225;ficos&#44; los factores de riesgo cardiovascular y los antecedentes personales y familiares de cardiopat&#237;a de los sujetos incluidos en el estudio se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">El producto de dosis longitud &#40;DLP&#41; medio fue de 694&#44;1&#160;&#177;&#160;273&#44;6<span class="elsevierStyleHsp" style=""></span>mGy&#42;cm&#44; lo que equivale a una dosis de radiaci&#243;n efectiva media de 9&#44;7&#160;&#177;&#160;8&#44;8 mSv &#40;factor de conversi&#243;n k&#160;&#61;&#160;0&#44;014 mSv&#47;mGy<span class="elsevierStyleSup">&#47;</span>cm&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">15</span></a>&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Anatom&#237;a de la aur&#237;cula izquierda y de las venas pulmonares en los estudios preablaci&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">La anatom&#237;a de las venas pulmonares fue normal en la mayor&#237;a de los pacientes incluidos en el estudio &#40;71 pacientes&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Las variantes anat&#243;micas observadas fueron una vena accesoria derecha&#44; correspondiente al drenaje independiente de la vena del l&#243;bulo medio en la aur&#237;cula izquierda &#40;13 pacientes&#41;&#44; un tronco de drenaje venoso com&#250;n izquierdo &#40;8 pacientes&#41;&#44; una vena accesoria derecha junto a un tronco venoso com&#250;n izquierdo &#40;2 pacientes&#41; y dos troncos de drenaje venoso comunes &#40;1 paciente&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Los di&#225;metros de las venas pulmonares y los di&#225;metros y vol&#250;menes de la aur&#237;cula izquierda obtenidos en la angio-TC se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Las venas pulmonares superiores presentaron mayor tama&#241;o que las inferiores&#59; la vena pulmonar inferior izquierda fue la vena m&#225;s peque&#241;a&#46; No se observaron diferencias significativas en los di&#225;metros de las venas pulmonares entre hombres y mujeres&#46; El volumen medio de la aur&#237;cula izquierda fue de 77&#44;5&#160;&#177;&#160;23&#44;7&#160;cm<span class="elsevierStyleSup">3</span>&#44; tambi&#233;n similar en ambos sexos &#40;80&#44;8&#160;&#177;&#160;22&#44;5&#160;cm<span class="elsevierStyleSup">3</span> para hombres y 72&#44;5&#160;&#177;&#160;24&#44;8&#160;cm<span class="elsevierStyleSup">3</span> para mujeres&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;09&#44; intervalo de confianza &#91;IC&#93; al 95&#37;&#58; -15&#44;6&#59;17&#44;9&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En funci&#243;n del tipo de arritmia&#44; no se observaron diferencias en la anatom&#237;a de las venas pulmonares entre pacientes con FA parox&#237;stica y FA persistente&#44; aunque los pacientes con FA persistente presentaron dimensiones ligeramente superiores de las venas pulmonares izquierdas &#40;VPSI de 17&#44;9&#160;&#177;&#160;2&#44;6&#160;mm vs&#46; 16&#44;7&#160;&#177;&#160;2&#44;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;04&#44; IC 95&#37;&#58; -2&#44;2&#59;-0&#44;4&#41;&#59; VPII de 15&#44;3&#160;&#177;&#160;2&#160;mm vs&#46; 13&#44;8&#160;&#177;&#160;2&#44;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;009&#44; IC 95&#37;&#58; -2&#44;4&#59;-0&#44;4&#41;&#46; Los pacientes con FA persistente tambi&#233;n demostraron mayor volumen de la aur&#237;cula izquierda &#40;91&#44;9&#160;&#177;&#160;24&#44;9&#160;cm<span class="elsevierStyleSup">3</span>&#41; que los sujetos con FA parox&#237;stica &#40;70&#44;7&#160;&#177;&#160;20&#44;3&#160;cm<span class="elsevierStyleSup">3</span>&#41; &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;001&#44; IC 95&#37;&#58; -28&#44;4&#59;-87&#44;7&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultado cl&#237;nico de la ablaci&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Tras un seguimiento medio despu&#233;s del procedimiento de ablaci&#243;n de 22&#44;1&#160;&#177;&#160;12&#44;1&#160;meses se observ&#243; que 41 pacientes &#40;43&#37;&#41; pasaron a ritmo sinusal&#46; Se objetiv&#243; recurrencia de la arritmia en 48&#160;sujetos &#40;51&#37;&#41;&#44; 16 en el periodo de &#8220;blanking&#8221; &#40;tiempo medio de 1&#44;2&#160;&#177;&#160;0&#44;6&#160;meses&#41; y 32 de forma tard&#237;a &#40;tiempo de medio de 14&#44;2&#160;&#177;&#160;13&#44;1&#160;meses&#41;&#46; Se realiz&#243; un nuevo procedimiento de ablaci&#243;n en 42 sujetos&#44; con &#233;xito en 27 &#40;64&#44;3&#37;&#41; y con nueva recurrencia en 15 &#40;15&#44;8&#37;&#41;&#46; No se dispone del seguimiento de 6 pacientes&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Al comparar los grupos seg&#250;n la eficacia del procedimiento de ablaci&#243;n&#44; no se observaron diferencias estad&#237;sticamente significativas en la edad&#44; sexo&#44; factores de riesgo cardiovascular&#44; tipo de arritmia&#44; edad de aparici&#243;n del primer episodio de FA o duraci&#243;n de la arritmia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Desde el punto de vista morfol&#243;gico&#44; la anatom&#237;a y dimensiones de las venas pulmonares fueron similares en ambos grupos&#44; objetiv&#225;ndose como &#250;nica diferencia que los pacientes con recurrencia presentaban mayores di&#225;metros transverso &#40;62&#44;5&#160;&#177;&#160;6&#44;6&#160;mm vs&#46; 58&#44;9&#160;&#177;&#160;7&#44;7&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;02&#44; IC 95&#37;&#58; -6&#44;6&#59; -0&#44;6&#41; y longitudinal &#40;50&#44;6&#160;&#177;&#160;7&#44;4&#160;mm vs&#46; a 47&#44;2&#160;&#177;&#160;6&#44;5&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;02&#44; IC 95&#37;&#58; -6&#44;3&#59; -0&#44;4&#41; de la aur&#237;cula izquierda&#46; En estos pacientes&#44; el volumen de la aur&#237;cula izquierda tambi&#233;n fue mayor &#40;81&#44;4&#160;&#177;&#160;23&#160;mm<span class="elsevierStyleSup">3</span> vs&#46; a 71&#44;1&#160;&#177;&#160;23&#44;2&#160;mm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;03&#44; IC 95&#37;&#58; -20&#59; -50&#44;6&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">El control evolutivo tras el procedimiento de ablaci&#243;n demostr&#243; ligera disminuci&#243;n de los di&#225;metros de las venas pulmonares y del di&#225;metro longitudinal de la aur&#237;cula izquierda&#46; El volumen de la aur&#237;cula izquierda no sufri&#243; modificaciones significativas &#40;82&#44;2&#160;&#177;&#160;21&#44;7&#160;cm<span class="elsevierStyleSup">3</span> vs&#46; 81&#44;6&#160;&#177;&#160;21&#44;4&#160;cm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;75&#44; IC 95&#37;&#58; -44&#44;8&#59;32&#44;7&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Las observaciones m&#225;s importantes de este trabajo son&#58; primero&#44; que la mayor&#237;a de los pacientes con arritmia posee una anatom&#237;a normal de las venas pulmonares&#44; sin que existan diferencias entre sexos&#59; segundo&#44; que los pacientes con FA persistente presentaron dimensiones ligeramente superiores de las venas pulmonares izquierdas y de la aur&#237;cula izquierda respecto a los sujetos con FA parox&#237;stica&#44; y tercero&#44; que los pacientes que sufrieron recurrencia tras el procedimiento de ablaci&#243;n presentaban una aur&#237;cula izquierda de mayor tama&#241;o&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La realizaci&#243;n de la angio-TC previa al procedimiento de ablaci&#243;n proporciona informaci&#243;n acerca del n&#250;mero de venas pulmonares y sus di&#225;metros&#44; permite medir las dimensiones de la aur&#237;cula izquierda&#44; identificar trombos en la orejuela&#44; detectar anomal&#237;as del drenaje venoso pulmonar&#44; establecer la integridad del tabique interauricular y definir la localizaci&#243;n del es&#243;fago&#44; de manera que se ha convertido en una herramienta indispensable para realizar el procedimiento con &#233;xito y evitar complicaciones<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">16</span></a>&#46; La anatom&#237;a y variantes de la normalidad de las venas pulmonares halladas en nuestro trabajo &#40;25&#37;&#41; concuerdan con lo publicado en la literatura&#46; Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a> refieren un 28&#44;5&#37; de variantes de la normalidad en pacientes con FA&#44; donde las venas accesorias &#40;17&#37;&#41; predominaban en el lado derecho y el tronco com&#250;n era m&#225;s frecuente en el lado izquierdo &#40;7&#44;5&#37;&#41;&#46; Dado que toda variante anat&#243;mica puede ser potencialmente arritmog&#233;nica&#44; detectarlas es importante para planificar el procedimiento de ablaci&#243;n&#44; controlar la t&#233;cnica y reducir el riesgo de complicaciones<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">18</span></a>&#46; Se ha descrito que&#44; debido a su peque&#241;o tama&#241;o&#44; la vena pulmonar accesoria derecha puede pasar desapercibida durante el proceso de ablaci&#243;n y ser causa de recurrencia<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">17</span></a>&#46; En cuanto a la recurrencia de la FA y su relaci&#243;n con la presencia de variantes anat&#243;micas de las venas pulmonares&#44; existe discrepancia en la literatura cient&#237;fica&#46; Si bien algunos estudios se&#241;alan que los pacientes con variantes anat&#243;micas poseen mayor riesgo de recurrencia de FA<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">9&#44;19</span></a>&#44; otros trabajos no encuentran dicha asociaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; En nuestro trabajo no se observaron diferencias anat&#243;micas entre los pacientes que respondieron y los que sufrieron recurrencia de su arritmia&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Conocer el tama&#241;o de las venas pulmonares es importante para escoger el tama&#241;o del cat&#233;ter para realizar la ablaci&#243;n y minimizar las complicaciones&#46; Tambi&#233;n se ha descrito que el tama&#241;o de las venas pulmonares puede tener implicaci&#243;n pron&#243;stica&#46; Aunque en nuestro estudio no observamos diferencias significativas entre los dos grupos&#44; algunos autores como Shimamoto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">8</span></a> describen que el tama&#241;o de las venas pulmonares estimado mediante angio-TC puede ser un factor de riesgo independiente de recurrencia de la FA&#46; Estos autores demostraron que&#44; en pacientes con FA parox&#237;stica&#44; a mayor &#225;rea de los <span class="elsevierStyleItalic">ostia</span> de las venas pulmonares exist&#237;a mayor riesgo de recurrencia&#46; La discrepancia entre nuestros resultados y los descritos por dicho grupo de trabajo puede ser debida a que en este &#250;ltimo se midi&#243; el &#225;rea de los <span class="elsevierStyleItalic">ostia</span> en vez de los di&#225;metros de las venas pulmonares&#44; como realizamos en nuestro estudio&#46; Dado que los <span class="elsevierStyleItalic">ostia</span> de las venas pulmonares presentan una forma el&#237;ptica con un eje largo en orientaci&#243;n vertical&#44; es probable que cuantificar el &#225;rea de los <span class="elsevierStyleItalic">ostia</span> sea m&#225;s exacto que medir los di&#225;metros&#46; En otro trabajo&#44; Lambert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">22</span></a> tambi&#233;n describieron que el &#225;rea del ostium de la VPSI era un factor de recurrencia de FA&#46; Adem&#225;s&#44; estos autores identificaron el &#225;ngulo existente entre el tabique interauricular y la VPSD como un par&#225;metro con valor pron&#243;stico&#46; Seg&#250;n ellos&#44; un &#225;ngulo m&#225;s estrecho implicaba que fuera m&#225;s dif&#237;cil el contacto del cat&#233;ter de ablaci&#243;n con la VPSD&#44; por lo que el tratamiento podr&#237;a ser menos eficaz&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre los predictores m&#225;s importantes de recurrencia tras la ablaci&#243;n destaca el volumen de la aur&#237;cula izquierda<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">17&#44;20&#44;23</span></a>&#46; En nuestra cohorte observamos que los sujetos que respondieron a la ablaci&#243;n presentaban un volumen auricular izquierdo significativamente menor que los que sufrieron recurrencia de su arritmia&#44; hallazgo similar a lo descrito por Ejima et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#46; Estos autores estudiaron 80 pacientes con taquiarritmia auricular resistente al tratamiento antiarr&#237;tmico que fueron sometidos a ablaci&#243;n&#46; Tras un seguimiento mayor de 2 a&#241;os&#44; el 21&#37; de los pacientes sufri&#243; recurrencia de su arritmia&#46; Al comparar las variables de estudio&#44; observaron que el volumen de la aur&#237;cula izquierda era el &#250;nico predictor de recurrencia tanto en pacientes que hab&#237;an sufrido una &#250;nica ablaci&#243;n como m&#250;ltiples ablaciones&#46; Seg&#250;n Ejima et al&#46;&#44; los valores del volumen de aur&#237;cula izquierda que mejor discriminaban el riesgo de recurrencia estaban por encima de 86&#160;cm<span class="elsevierStyleSup">3</span> y de 92&#160;cm<span class="elsevierStyleSup">3</span> seg&#250;n se tratara de la primera ablaci&#243;n o tras m&#250;ltiples procedimientos&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">24</span></a>&#46; Otros autores destacan que el volumen de la aur&#237;cula izquierda parece ser predictor de recurrencia en pacientes con FA persistente y no tanto en pacientes con FA parox&#237;stica<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">25</span></a>&#46; Por otro lado&#44; adem&#225;s de las dimensiones y del volumen&#44; algunos autores subrayan la utilidad de clasificar la aur&#237;cula seg&#250;n su geometr&#237;a<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">7</span></a>&#44; habi&#233;ndose descrito que la esfericidad de la aur&#237;cula izquierda es un predictor importante de recurrencia de FA<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestro trabajo presenta algunas limitaciones&#46; El estudio se llev&#243; a cabo en un &#250;nico hospital&#44; por lo que los resultados pueden diferir de los de otros centros&#46; Las angio-TC se realizaron con sincronizaci&#243;n electrocardiogr&#225;fica para poder cuantificar los par&#225;metros de la forma m&#225;s exacta posible y poder descartar con fiabilidad la presencia de trombo intraauricular&#46; Este protocolo de adquisici&#243;n implic&#243; dosis de radiaci&#243;n relativamente altas&#46; En este sentido&#44; un estudio reciente destaca que se puede descartar trombo auricular con una fiabilidad similar si se realizan estudios sin sincronizaci&#243;n electrocardiogr&#225;fica empleando&#44; adem&#225;s&#44; menor dosis de radiaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">27</span></a>&#46; Los datos se recogieron de forma retrospectiva desde las historias cl&#237;nicas realizadas por el m&#233;dico responsable del paciente&#46; Dado que la FA se puede presentar como episodios asintom&#225;ticos&#44; no detectables por el paciente&#44; es posible que la tasa de recurrencia de arritmia haya sido infraestimada&#46; En este trabajo no se estudiaron de forma espec&#237;fica la morfolog&#237;a y el tama&#241;o de la orejuela&#46; En la literatura existe discrepancia acerca de su valor como predictor de recurrencia de FA<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">28&#44;29</span></a>&#46; Por &#250;ltimo&#44; aunque el tama&#241;o de la muestra estudiada es similar al de otros estudios&#44; probablemente un mayor n&#250;mero de pacientes hubiera permitido obtener resultados m&#225;s extrapolables a la poblaci&#243;n con FA&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; la angio-TC es una t&#233;cnica que permite obtener un mapa detallado de la anatom&#237;a de las venas pulmonares y de la aur&#237;cula izquierda previo a la terapia de ablaci&#243;n de venas pulmonares en pacientes con FA y proporciona datos con valor pron&#243;stico&#46; Es necesario ampliar el estudio&#44; incluir un mayor n&#250;mero de sujetos y validar los resultados en una poblaci&#243;n m&#225;s amplia para establecer con mayor precisi&#243;n el valor cl&#237;nico de los par&#225;metros obtenidos mediante angio-TC en los pacientes con arritmias&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Autor&#237;a</span><p id="par0130" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Responsable de la integridad del estudio&#58; UMU&#44; MC&#44; IS y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Concepci&#243;n del estudio&#58; UMU&#44; PR&#44; IGB y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Dise&#241;o del estudio&#58;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Obtenci&#243;n de los datos&#58; UMU&#44; MC&#44; IS y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">An&#225;lisis e interpretaci&#243;n de los datos&#58; UMU&#44; MC y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Tratamiento estad&#237;stico&#58; UMU y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">B&#250;squeda bibliogr&#225;fica&#58; MC&#44; IS&#44; PR&#44; IGB y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Redacci&#243;n del trabajo&#58; UMU y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Revisi&#243;n cr&#237;tica del manuscrito con aportaciones intelectuales relevantes&#58; UMU&#44; MC&#44; IS&#44; PR&#44; IGB y GB&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Aprobaci&#243;n de la versi&#243;n final&#58; UMU&#44; MC&#44; IS&#44; PR&#44; IGB y GB&#46;</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0185" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Definir las caracter&#237;sticas anat&#243;micas de la aur&#237;cula izquierda y las venas pulmonares &#40;VP&#41; en sujetos sometidos a ablaci&#243;n de fibrilaci&#243;n auricular &#40;FA&#41; e identificar posibles factores anat&#243;micos relacionados con la recurrencia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron de manera retrospectiva los estudios de angio-TC de 95 pacientes &#40;57 hombres&#44; edad media 65&#160;&#177;&#160;10 a&#241;os&#41;&#44; realizados para planificaci&#243;n de ablaci&#243;n por radiofrecuencia de FA&#46; Se revis&#243; la anatom&#237;a de las VP y se recogieron los di&#225;metros de sus <span class="elsevierStyleItalic">ostia</span> y los di&#225;metros y volumen de la aur&#237;cula izquierda&#46; Estos par&#225;metros fueron comparados con el tipo de arritmia y la respuesta al tratamiento&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La anatom&#237;a de las venas pulmonares fue normal &#40;dos venas pulmonares derechas y dos izquierdas&#41; en la mayor&#237;a de los pacientes &#40;74&#44;7&#37;&#41;&#46; Los pacientes con FA persistente presentaron di&#225;metros ligeramente superiores de las venas pulmonares izquierdas &#40;VPSI de 17&#44;9&#160;&#177;&#160;2&#44;6&#160;mm vs&#46; 16&#44;7&#160;&#177;&#160;2&#44;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;04&#59; VPII de 15&#44;3&#160;&#177;&#160;2&#160;mm vs&#46; 13&#44;8&#160;&#177;&#160;2&#44;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;009&#41; y mayor volumen de la aur&#237;cula izquierda &#40;91&#44;9&#160;&#177;&#160;24&#44;9&#160;cm<span class="elsevierStyleSup">3</span> vs&#46; 70&#44;7&#160;&#177;&#160;20&#44;3&#160;mm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;001&#41; que los sujetos con FA parox&#237;stica&#46; Tras un seguimiento medio de 22&#44;1&#160;&#177;&#160;12&#44;1&#160;meses&#44; el 43&#37; de los pacientes presentaba ritmo sinusal&#46; Los pacientes con recurrencia mostraron mayor volumen de la aur&#237;cula izquierda &#40;81&#44;4&#160;&#177;&#160;23&#160;mm<span class="elsevierStyleSup">3</span> vs&#46; 71&#44;1&#160;&#177;&#160;23&#44;2&#160;mm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#44;03&#41;&#46; No se objetivaron diferencias significativas en los di&#225;metros de las VP ni en los par&#225;metros cl&#237;nicos estudiados en ambos grupos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El volumen de la aur&#237;cula izquierda es mayor en pacientes con FA persistente y en pacientes que no responden al procedimiento de ablaci&#243;n&#46;</p></span>"
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            "titulo" => "Resultados"
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            "identificador" => "abst0020"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients &#40;57 men&#59; mean age&#44; 65&#160;&#177;&#160;10 y&#41;&#46; We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium&#46; We analyzed these parameters according to the type of arrhythmia and the response to treatment&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In 71 &#40;74&#46;7&#37;&#41; patients&#44; the anatomy of the pulmonary veins was normal &#40;i&#46;e&#46;&#44; two right pulmonary veins and two left pulmonary veins&#41;&#46; Compared to patients with paroxysmal atrial fibrillation&#44; patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins &#40;left superior pulmonary vein 17&#46;9&#160;&#177;&#160;2&#46;6&#160;mm vs&#46; 16&#46;7&#160;&#177;&#160;2&#46;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;04&#59; left inferior pulmonary vein 15&#46;3&#160;&#177;&#160;2&#160;mm vs&#46; 13&#46;8&#160;&#177;&#160;2&#46;2&#160;mm&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;009&#41; and larger left atrial volume &#40;91&#46;9&#160;&#177;&#160;24&#46;9&#160;cm<span class="elsevierStyleSup">3</span> vs&#46; 70&#46;7&#160;&#177;&#160;20&#46;3&#160;mm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;001&#41;&#46; After 22&#46;1 &#177; 12&#46;1 months&#8217; mean follow-up&#44; 41 patients had sinus rhythm&#46; Compared to patients in whom the sinus rhythm was restored&#44; patients with recurrence had greater left atrial volume &#40;81&#46;4&#160;&#177;&#160;23&#46;0&#160;mm<span class="elsevierStyleSup">3</span> vs&#46; 71&#46;1&#160;&#177;&#160;23&#46;2&#160;mm<span class="elsevierStyleSup">3</span>&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;03&#41;&#46; No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objective"
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            "identificador" => "abst0030"
            "titulo" => "Material and methods"
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            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Medici&#243;n de los di&#225;metros de las venas pulmonares&#46; Tras trazar planos ortogonales en las im&#225;genes axial &#40;A&#41; y coronal &#40;B&#41; de tomograf&#237;a computarizada&#44; se obtuvo una imagen doble oblicua del <span class="elsevierStyleItalic">ostium</span> de la vena pulmonar &#40;C&#41;&#44; sobre la que se midieron los di&#225;metros&#46; En el ejemplo se muestran los di&#225;metros de la vena pulmonar superior derecha&#46;</p>"
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Anatom&#237;a normal de las venas pulmonares&#46; Reconstrucci&#243;n cinem&#225;tica&#46; Visi&#243;n posterior&#46; N&#243;tese que existen cuatro venas pulmonares que drenan de manera independiente en la aur&#237;cula izquierda&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota&#46;</span> Los datos se presentan como media &#177; desviaci&#243;n est&#225;ndar y como porcentajes&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ECV&#58; enfermedad cardiovascular&#59; FA&#58; fibrilaci&#243;n auricular&#59; FC&#58; frecuencia card&#237;aca&#59; IMC&#58; &#237;ndice de masa corporal&#59; HTA&#58; hipertensi&#243;n arterial&#59; PA&#58; presi&#243;n arterial&#59; SAOS&#58; s&#237;ndrome de apnea obstructiva del sue&#241;o&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Factores de riesgo cardiovascular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">65 &#177; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad en el primer episodio de FA &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo desde el diagn&#243;stico de FA hasta la ablaci&#243;n &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Factores de riesgo cardiovascular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hiperuricemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de fibrilaci&#243;n auricular</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parox&#237;stica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Persistente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anatom&#237;a de las venas pulmonares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tronco com&#250;n izquierdo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vena accesoria derecha &#43; tronco com&#250;n <span class="elsevierStyleHsp" style=""></span>izquierdo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Di&#225;metros de las venas pulmonares</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VPSD &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VPID &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VPSI &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>VPII &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dimensiones de la aur&#237;cula izquierda</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Di&#225;metro transverso &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Di&#225;metro anteroposterior &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                          "colaboracion" => "2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS"
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                            0 => "P&#46; Kirchhof"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28038729"
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                      "titulo" => "Ligament and Vein of Marshall&#46; A therapeutic opportunity in atrial fibrillation"
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                      "titulo" => "2017 HRS&#47;EHRA&#47;ECAS&#47;APHRS&#47;SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation"
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                            4 => "E&#46;B&#46; Saad"
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                      "doi" => "10.1093/europace/eux274"
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Información del artículo
ISSN: 00338338
Idioma original: Español
DOI:10.1016/j.rx.2020.03.003
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