Calabrese Maria, Montini Luca, Arlotta Gabriella, La Greca Antonio, Biasucci Daniele G, Bevilacqua Francesca, Antoniucci Enrica, Scapigliati Andrea, Cavaliere Franco, Pittiruti Mauro
1 Department of Cardiovascular Surgery, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.
2 Department of Intensive Care and Anesthesia, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy.
J Vasc Access. 2019 Sep;20(5):516-523. doi: 10.1177/1129729818819422. Epub 2018 Dec 31.
The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called waves as a surrogate of the wave.
We studied 18 atrial fibrillation patients requiring simultaneously a central venous catheter and a trans-esophageal echocardiography. An intracavitary electrocardiographic trace was recorded with the catheter tip in three different positions defined by trans-esophageal echocardiography imaging: in the superior vena cava, 2 cm above the cavo-atrial junction; at the cavo-atrial junction; and in the right atrium, 2 cm below the cavo-atrial junction. Three different criteria of measurement of the wave pattern in the TQ tract were used: the mean height of waves (method A); the height of the highest wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).
There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the waves was significantly higher than in the other two positions. All three methods were effective in discriminating the tip position at the cavo-atrial junction, though method B proved to be the most accurate.
A modified intracavitary electrocardiographic technique can be safely used for detecting the location of the tip of central venous catheters in atrial fibrillation patients: the highest activity of the waves is an accurate indicator of the location of the tip at the cavo-atrial junction.
当存在可识别的P波时，腔内心电图方法被推荐用于评估中心静脉导管尖端的位置。先前的报告表明，考虑将所谓的f波作为P波的替代物，腔内心电图方法也可能适用于心房颤动患者。
我们研究了18例同时需要中心静脉导管和经食管超声心动图检查的心房颤动患者。通过经食管超声心动图成像确定导管尖端处于三个不同位置时记录腔内心电图轨迹：在上腔静脉，腔房交界处上方2 cm处；在腔房交界处；以及在右心房，腔房交界处下方2 cm处。采用三种不同的TQ段P波形态测量标准：P波平均高度（方法A）；最高P波高度（方法B）；最高正峰与最低负峰之间的差值（方法C）。
无并发症发生。当尖端置于腔房交界处时，P波的平均值显著高于其他两个位置。所有三种方法在鉴别腔房交界处的尖端位置方面均有效，不过方法B被证明是最准确的。
一种改良的腔内心电图技术可安全用于检测心房颤动患者中心静脉导管尖端的位置：P波的最高活动是尖端位于腔房交界处位置的准确指标。
