A modified intracavitary electrocardiographic method for detecting the location of the tip of central venous catheters in atrial fibrillation patients

J Vasc Access. 2019 Sep;20(5):516-523. doi: 10.1177/1129729818819422. Epub 2018 Dec 31.

Abstract

Introduction: The intracavitary electrocardiographic method is recommended for assessing the location of the tip of central venous catheter when there is an identifiable P wave. Previous reports suggested that intracavitary electrocardiographic method might also be applied to patients with atrial fibrillation, considering the so-called f waves as a surrogate of the P wave.

Methods: 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 f wave pattern in the TQ tract were used: the mean height of f waves (method A); the height of the highest f wave (method B); the difference between the highest positive peak and the lowest negative peak (method C).

Results: There were no complications. With the tip placed at the cavo-atrial junction, the mean value of the f 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.

Conclusion: 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 f waves is an accurate indicator of the location of the tip at the cavo-atrial junction.

Keywords: Atrial fibrillation; cavo-atrial junction; central venous catheter; intracavitary electrocardiographic method; tip location; trans-esophageal echocardiography.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Action Potentials
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / physiopathology
  • Catheterization, Central Venous / instrumentation*
  • Catheters, Indwelling*
  • Central Venous Catheters*
  • Echocardiography, Transesophageal
  • Electrocardiography / methods*
  • Female
  • Heart Rate
  • Humans
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Signal Processing, Computer-Assisted