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Ultraschall im elektrophysiologischen Herzkatheterlabor

Ultrasound in the electrophysiological cardiac catheterization laboratory

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Zusammenfassung

In den letzten Jahren hat der Bildgebungsbedarf im elektrophysiologischen Herzkatheterlabor enorm zugenommen. Fluoroskopie und Angiographie werden häufig durch präprozedurale Magnetresonanz- oder Computertomographien sowie elektroanatomische Mappingverfahren ergänzt. Nachteilig sind eine unzureichende Auflösung der Weichgewebe in Echtzeit sowie die notwendige Strahlen- und Kontrastmittelbelastung. Ultraschalltechniken zeichnen sich dagegen durch eine hohe Auflösung von Weichteilgewebe und die Möglichkeit einer intraprozeduralen Echtzeit-Bildgebung aus. Alle relevanten anatomischen Strukturen und deren Beziehungen zu eingebrachten Kathetern können jederzeit intraprozedural evaluiert werden. Weiterhin sind funktionelle Analysen, wie Flussmessungen und ein Monitoring im Hinblick auf Komplikationen möglich. Die transösophageale Echokardiographie (TEE) und besonders die intrakardiale Echokardiographie (ICE) tragen heute erheblich zur Effektivität und Sicherheit komplexer Prozeduren bei. Die ICE hat sich bei transseptalen Prozeduren wie Vorhofflimmerablationen, aber auch bei Ablationen von ventrikulären Tachykardien als sinnvoll erwiesen und wird von führenden Fachgesellschaften empfohlen.

Abstract

During recent years the need for intraprocedural imaging has increased. Fluoroscopy and angiography are frequently supplemented by pre-procedural magnetic resonance or computed tomography imaging as well as electroanatomic mapping techniques. However, poor real-time imaging quality of soft tissue, radiation exposure, and contrast media consumption are disadvantageous. Ultrasound techniques are characterized by high-quality imaging of soft tissue that can be obtained in real time. All relevant anatomical structures and their relationships to catheters can be evaluated at any time during the procedure. Moreover, functional analysis, e.g., flow measurements and monitoring for complications, is possible. Transesophageal and especially intracardiac echocardiography (ICE) contribute enormously to effectiveness and safety of complex procedures. ICE has been shown to be useful in transseptal procedures like atrial fibrillation ablation but also in ablation procedures for ventricular tachycardias.

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Abbreviations

CT::

Computertomographie

MRT::

Magnetresonanztomographie

ICE::

Intrakardiale Echokardiographie

PV::

Pulmonalvenen

TEE::

Transösophageale Echokardiographie

TTE::

Transthorakale Echokardiographie

VT::

Ventrikuläre Tachykardie

3D::

Dreidimensional

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Interessenkonflikte.

Klaus-Jürgen Gutleben: Vortragshonorare von den Firmen Biosense Webster, Medtronic und St. Jude Medical.

Jens Günther: Vortragshonorare und Proctoring von und für SJM, Biosense Webster.

Nikitas Lironis: keine

Georg Nölker: Vortragshonorare von den Firmen Biosense Webster, Medtronic und St. Jude Medical.

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Authors and Affiliations

  1. Klinik für Kardiologie Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    Klaus-Jürgen Gutleben & Georg Nölker

  2. Kardiocentrum Frankfurt am Main, Pfingstweidstr. 11, 60316, Frankfurt, Deutschland

    Nikitas Lironis & Jens Günther

Authors
  1. Klaus-Jürgen Gutleben
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  2. Georg Nölker
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  3. Nikitas Lironis
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  4. Jens Günther
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Correspondence to Klaus-Jürgen Gutleben.

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Gutleben, KJ., Nölker, G., Lironis, N. et al. Ultraschall im elektrophysiologischen Herzkatheterlabor. Herzschr Elektrophys 23, 260–268 (2012). https://doi.org/10.1007/s00399-012-0235-5

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