Post-cardioversion time Course of Atrial Remodeling Markers and their Association with Recurrence in Subjects with Long-standing, Persistent Atrial Fibrillation.

BACKGROUND: Activation of the renin-angiotensin-aldosterone axis with elevation of inflammatory markers and the resulting fibrosis play a very important role in atrial remodeling in patients with atrial fibrillation (AF), which is associated with post-cardioversion recurrence. AIM OF THE STUDY: The purpose of the study was to describe the time course of angiotensin II (AngII), aldosterone, and of the amino terminal pro-peptide of type III pro-collagen (PIIINP) following cardioversion, and their association with arrhythmia recurrence. METHODS: Ninety-nine subjects with long-standing, persistent, non-valvular atrial fibrillation who underwent successful electrical cardioversion were included, with a 6 month follow up. Angiotensin II (AngII), aldosterone and PIIINP concentrations were measured at 0, 1, 7, 30, and 180 d. Two groups were formed for the analysis: continuing sinus rhythm and recurrence of AF. RESULTS: 53% of the subjects experienced recurrence of AF. Subjects with recurrence had larger left atrial diameters and lower global peak atrial longitudinal strain (8.7 vs. 19.7%; p <0.001), higher levels of AngII (431.85 vs. 257.97 pg/mL; p = 0.003) at 180 d, higher pre-cardioversion levels of aldosterone, (11.42 vs. 5.46 pg/mL; p = 0.048) at 1 d (12.01 vs. 5.05 pg/mL; p = 0.004) and at 180 d (12.66 vs. 7.51 pg/mL; p = 0.011). There were no differences in PIIINP levels between both groups. CONCLUSIONS: Electrical post-cardioversion recurrence in subjects with long-standing, persistent AF is associated with elevated levels of AngII and aldosterone.

Reunión multidisciplinaria sobre el uso de los anticoagulantes orales directos en la fibrilación auricular no valvular / Multidisciplinary meeting about the use of direct oral anticoagulants in nonvalvular atrial fibrillation

Resumen: Conociendo el impacto real de la fibrilación auricular en el evento vascular cerebral, la Sociedad Mexicana de Electrofisiología y Estimulación Cardiaca (SOMEEC) contempló la iniciativa de desarrollar una reunión multidisciplinaria de expertos con la finalidad de actualizar la evidencia científica disponible a partir de guías de práctica clínica, metaanálisis y ensayos clínicos controlados, y complementarla con la experiencia y los puntos de vista de un grupo de expertos. Para cumplir con este objetivo, se reunió a un grupo de especialistas en el área de cardiología, electrofisiología, neurología y hematología que, dada su experiencia en ciertas áreas, compartieron la evidencia científica disponible ante el panel de expertos para dejar abierta una discusión sobre la información que se presentaría en el presente artículo. Este documento reúne la mejor evidencia científica disponible y pretende ser una herramienta útil que agilice la toma de decisiones para uso de los nuevos anticoagulantes orales en fibrilación auricular no valvular y cardiopatía isquémica, o referente al manejo de pacientes que presentan evento vascular cerebral, o insuficiencia renal, e incluso en aquellos que serán sometidos a procedimientos invasivos y cirugía electiva. En la misma se manejan esquemas comparativos de seguimiento y tratamiento que simplifica la toma de decisión por los especialistas participantes.

Abstract: Knowing the real impact of atrial fibrillation in the stroke, the Sociedad Mexicana of Electrofisiología y Estimulación Cardiaca (SOMEEC) had the initiative to develop a multidisciplinary meeting of experts the with the purpose to update the available scientific evidence from clinical practice guidelines, meta-analyses, controlled clinical trials, and complementing with the experience and views of a group of experts. To meet this goal, SOMEEC gathered a group of specialists in the area of cardiology, electrophysiology, neurology and hematology that given their experience in certain areas, they share the scientific evidence with the panel of experts to leave open a discussion about the information presented in this article. This document brings together the best scientific evidence available and aims to be a useful tool in the decision to use of new oral anticoagulants in nonvalvular atrial fibrillation and ischemic heart disease, or relating to the management of patients with stroke or renal failure, and even those that will be submitted to elective surgery and invasive procedures. In the same, they handled comparative schemes of follow-up and treatment which simplifies the decision making by the specialists participants.

[Multidisciplinary meeting about the use of direct oral anticoagulants in nonvalvular atrial fibrillation]. / Reunión multidisciplinaria sobre el uso de los anticoagulantes orales directos en la fibrilación auricular no valvular.

Knowing the real impact of atrial fibrillation in the stroke, the Sociedad Mexicana of Electrofisiología y Estimulación Cardiaca (SOMEEC) had the initiative to develop a multidisciplinary meeting of experts the with the purpose to update the available scientific evidence from clinical practice guidelines, meta-analyses, controlled clinical trials, and complementing with the experience and views of a group of experts. To meet this goal, SOMEEC gathered a group of specialists in the area of cardiology, electrophysiology, neurology and hematology that given their experience in certain areas, they share the scientific evidence with the panel of experts to leave open a discussion about the information presented in this article. This document brings together the best scientific evidence available and aims to be a useful tool in the decision to use of new oral anticoagulants in nonvalvular atrial fibrillation and ischemic heart disease, or relating to the management of patients with stroke or renal failure, and even those that will be submitted to elective surgery and invasive procedures. In the same, they handled comparative schemes of follow-up and treatment which simplifies the decision making by the specialists participants.

[Key recommendations of the clinical guidelines of arterial hypertension in primary care]. / Recomendaciones de la guía de práctica clínica de hipertensión arterial en el primer nivel de atención.

BACKGROUND: Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making. METHODS: The guide is integrated with recommendations of international guidelines and evidence of published studies indicated the changes regarding the management and treatment of hypertension, as well as differences between the target populations of the guide. Searching for information it is performed by means of a standardized sequence in PubMed and Cochrane Library Plus, from the questions asked. The key recommendations were chosen by a consensus of a group of professionals and health managers. CONCLUSIONS: The key recommendations evidence-based standardized help you make decisions about prevention, diagnosis and treatment in patients with hypertension, and will contribute to reducing cardiovascular risk, promote changes in lifestyle, control the disease and reduce complications.

Introducción: la hipertensión arterial (HA) ocupa el primer lugar de atención en unidades médicas de primer nivel. La mitad de los pacientes con HA no están controlados. El objetivo de este documento es proporcionar las recomendaciones de la guía de diagnóstico y tratamiento de HA en el primer nivel de atención que han sido consideradas clave para el proceso de atención, con el fin de ayudar a los profesionales de la salud, en la toma de decisiones clínicas. Métodos: la guía se integró con recomendaciones de guías internacionales y evidencias de estudios publicados que señalaron los cambios ocurridos en el abordaje y tratamiento de la HA, así como las diferencias entre los grupos poblacionales blanco de la guía. La búsqueda de información se realizó por medio de una secuencia estandarizada en Pubmed y Cochrane Library Plus. Las recomendaciones clave se eligieron por consenso de un grupo de profesionales y gestores de la salud. Conclusiones: las recomendaciones clave, basadas en evidencias, ayudarán a tomar decisiones estandarizadas sobre prevención, diagnóstico y tratamiento en pacientes con HA, y coadyuvarán a disminuir el riesgo cardiovascular, impulsar cambios en el estilo de vida, controlar la enfermedad y reducir las complicaciones.

[The Mexican Registry of Atrial Fibrillation (ReMeFa)]. / Registro Mexicano de Fibrilación Auricular (ReMeFa).

INTRODUCTION: The Mexican Registry of Atrial Fibrillation (ReMeFa) is the first national multicenter registry with one-year clinical follow-up on the treatment of atrial fibrillation (AF) in newly diagnosed patients. OBJECTIVE: To describe the demographics and treatment modalities for rhythm control (RC) strategy or heart rate (HR) control in patients with AF treated by cardiologists. A secondary objective was to prospectively evaluate the status of AF according to the chosen strategy; sinus rhythm in RC and mean ventricular rate at rest ≤ 80 bpm in HR, as well as the incidence of clinical outcomes at 12 month follow-up. METHODS: ReMeFa was a multicenter, prospective, descriptive study. We included adults with documented AF. We excluded those with AF secondary to reversible causes, undergoing pulmonary vein ablation, pacemaker or defibrillator users, with a life expectancy of less than one year, or with physical or mental impediments to meet the protocol objectives. Data were collected at baseline and at 6 and 12 months. RESULTS: We registered 1,201 subjects and 1,193 were eligible for evaluation: 40% were on RC strategy and 60% on HR control. In the RC strategy, the drugs most commonly used were class III antiarrhythmics (64%), beta-blockers (25%), and digoxin (24%). In HR control strategy, the drugs used were digoxin (69%), class III antiarrhythmics (59%), and beta-blockers (56%). Compared with those on HR control, patients in RC strategy were younger (64 ± 14 years), in sinus rhythm (55%) and with paroxysmal AF (60%) at baseline. Patients in HR control were older (68 ± 13 years), with non-paroxysmal AF (91%), valvular disease (42%), heart failure (35%), left ventricular dysfunction (33%), and diabetes (25%). At one year follow-up, a 3% incidence of ischemic stroke was observed in the HR control group, significantly higher than the 1% observed in the RC strategy (p = 0.041). CONCLUSIONS: ReMeFa registry results offer a current and comprehensive perspective on management strategies in Mexican patients with AF. The RC strategy provided better control of the arrhythmia as compared with the HR control strategy and it was associated with a lower rate of ischemic stroke. Nonetheless, current strategies of treatment of AF are not satisfactory.

[Design of a multicenter registry to evaluate rhythm versus rate control in atrial fibrillation: Atrial Fibrillation Mexican Registry (ReMeFA)]. / Diseño de un registro multicéntrico para evaluar control de ritmo contra control de la frecuencia en fibrilación auricular: Registro Mexicano de Fibrilación Auricular (ReMeFA).

UNLABELLED: Atrial fibrillation is the most common arrhythmia, predominantly affecting individuals older than 70 years of age. There is little information about its management in Mexico, for this purpose the Mexican Registry of Atrial Fibrillation (ReMeFa) was designed. METHODS: ReMeFA is a prospective multicentric, observational registry concerning the treatment of atrial fibrillation in Mexico. It includes patients 18 years and older, from both genders, with documented atrial fibrillation. Patients with secondary atrial fibrillation from a reversible cause, previous treatment with pulmonary vein ablation (percutaneous or surgical), pacemakers or defibrillators, and with a life expectancy of less than one year, physically or mentally impaired for completing the protocol were excluded. Clinical and demographic data were collected at enrollment and in two scheduled visits at 6 and 12 months. Information about pharmacologic treatment for rhythm or rate control was particularly obtained. PRELIMINARY RESULTS: Between December 2008 to July 2009, 1201 patients from 79 centers were enrolled. CONCLUSION: This registry will provide valuable information about the strategy chosen by physicians in Mexico for the treatment of atrial fibrillation.

Diseño de un registro multicéntrico para evaluar control de ritmo contra control de la frecuencia en fibrilación auricular: Registro Mexicano de Fibrilación Auricular (ReMeFA) / Design of a multicenter registry to evaluate rhythm versus rate control in atrial fibrillation: Atrial Fibrillation Mexican Registry (ReMeFA)

La fibrilación auricular es una arritmia muy frecuente y afecta predominantemente a individuos mayores de 70 años. Se dispone de poca información sobre su manejo en México por lo que se diseñó el Registro Mexicano de Fibrilación Auricular (ReMeFA). Método: Se trata de un estudio multicéntrico, observacional, prospectivo sobre el tratamiento de la fibrilación auricular. Se incluyeron sujetos de ambos géneros, mayores de 18 años de edad, con fibrilación auricular documentada. Se excluyeron aquellos con fibrilación auricular secundaria a una causa reversible, sometidos a ablación de venas pulmonares (quirúrgica o por catéter), portadores de marcapasos o desfibriladores, aquellos con expectativa de vida menor a un año o incapacitados física o mentalmente para cumplir con los requisitos del protocolo. Se recolectaron datos clínicos y demográficos en forma basal y en visitas programadas a los seis y doce meses. Especialmente, se recabó información acerca del tratamiento farmacológico para control del ritmo o de la frecuencia. Resultados preliminares: Entre el ocho de diciembre y el 29 de julio de 2009 se incluyeron 1201 pacientes provenientes de 79 centros, con diagnóstico de fibrilación auricular. Conclusión: El registro proporcionará información valiosa sobre las estrategias actualmente empleadas en la República Mexicana para el tratamiento de la fibrilación auricular, sea mediante control del ritmo o control de la frecuencia.

Atrial fibrillation is the most common arrhythmia, predominantly affecting individuals older than 70 years of age. There is little information about its management in Mexico, for this purpose the Mexican Registry of Atrial Fibrillation (ReMeFa) was designed. Methods: ReMeFA is a prospective multicentric, observational registry concerning the treatment of atrial fibrillation in Mexico. It includes patients 18 years and older, from both genders, with documented atrial fibrillation. Patients with secondary atrial fibrillation from a reversible cause, previous treatment with pulmonary vein ablation (percutaneous or surgical), pacemakers or defibrillators, and with a life expectancy of less than one year, physically or mentally impaired for completing the protocol were excluded. Clinical and demographic data were collected at enrollment and in two scheduled visits at 6 and 12 months. Information about pharmacologic treatment for rhythm or rate control was particularly obtained. Preliminary results: Between December 2008 to July 2009, 1201 patients from 79 centers were enrolled. Conclusion: This registry will provide valuable information about the strategy chosen by physicians in Mexico for the treatment of atrial fibrillation.

[Pentalogy of Cantrell. A case report]. / Pentalogía de Cantrell. A propósito de un caso.

Ectopia cordis is an extremely rare cardiac anomaly. The heart is localized partially or totally outside the thorax cavity. This anomaly occurs as an isolated defect or combined with others midline defects. Cantrell and colleagues described, in 1958, a syndrome including defects of the abdominal wall, sternum, diaphragm, pericardium and heart. There are few successful surgical cases with this pentalogy. We describe a case with this Cantrell's pentalogy. The cardiac malformation was a univentricular heart with pulmonary stenosis. The patient underwent successful surgical palliation with a systemic-to-pulmonary anastomosis and uneventful recovering.

Pentalogía de Cantrell. A propósito de un caso / Pentalogy of Cantrell. A case report

Ectopia cordis is an extremely rare cardiac anomaly. The heart is localized partially or totally outside the thorax cavity. This anomaly occurs as an isolated defect or combined with others midline defects. Cantrell and colleagues described, in 1958, a syndrome including defects of the abdominal wall, sternum, diaphragm, pericardium and heart. There are few successful surgical cases with this pentalogy. We describe a case with this Cantrell's pentalogy. The cardiac malformation was a univentricular heart with pulmonary stenosis. The patient underwent successful surgical palliation with a systemic-to-pulmonary anastomosis and uneventful recovering.