Avances en la prevención de eventos tromboembólicos en pacientes con fibrilación auricular / Update on the prevention of thromboembolic phenomena in atrial fibrillation

Atrial fibrillation is the most common sustained arrhythmia in clinical practice and is associated to thromboembolic complications. Anticoagulation with vitamin K antagonists is clearly useful to reduce the incidence of emboli, but associated with important limitations. Therefore, there is an active search for medications that are more effective and simpler to prescribe and manage. Synthetic pentasaccharides of heparin such as idraparinux for parenteral use, showed promising results. Direct inhibitors of thrombin were also useful for the prevention of thromboembolism. However, they were withdrawn from the market due to potentially fatal adverse reactions. Other area of investigation has been the effectiveness of the combination of antiplatelet agents such as aspirin and clopidrogel. Although this combination is attractive, results of clinical trials must be awaited to have an opinion about its real usefulness. Finally, ieft atrial appendage transcatheter occlusion (PLAATO) is an effective and reasonably safe method for patients with contraindications for anticoagulation or those that continue to embolize despite well prescribed anticoagulation. The long term results of this intervention must also be awaited.

Muerte súbita por fibrilación ventricular recuperada: ¿síndrome de Brugada? / Sudden death due to ventricular fibrillation: a case of Brugada syndrome?

We report a 47 years old male who was recuperated from a sudden death, and in whom the cardiological assessment showed a right bundle branch block and a fluctuating ST segment elevation from V1 to V3. During the electrophysiological study, a polymorphic tachycardia and a ventricular fibrillation were induced. Procainamide administration enhanced ST segment alterations in right precordial leads, and isoproterenol normalized the EKG. All these disturbances are similar to the condition described by Brugada brothers. The patient was treated with an internal implantable defibrillator, without the use of antiarrhythmic drugs and is well after four months of follow up

Desfibrilación auricular transcatéter con baja energía en un caso de fibrilación auricular crónica refractaria / Low energy transcatheter defibrillation in one patient with a refractory atrial fibrillation

Most cases of atrial fibrillation are converted with antiarrhyhmic medications or external electric defibrillation. However, in some refractory patients,an internal transcatheter defibrillation must be attempted. We report a 50 years old male with an atrial fibrillation of one year duration that was refractory to pharmacological treatment and in whom external cardioversion was unsuccessful. After the application of a bifasic shock of 10 joules between a cather in the right atrium and another one located at the coronary sinus, the patient was converted to sinus rhythm. At two months of follow up, the patient continues in sinus rhythm