Caracterización clínica y tratamiento de pacientes con fibrilación auricular

Introducción: La fibrilación auricular o atrial fue considerada durante mucho tiempo como una alternativa al ritmo sinusal y es en la actualidad un serio problema de salud en muchos países del mundo, a la cual se le asocian muchos factores de riesgo como la insuficiencia cardiaca, la hipertensión arterial y la diabetes mellitus. Es la arritmia más prevalente en la práctica clínica. Objetivo: Caracterizar a la fibrilación auricular en cuanto a sus manifestaciones clínicas y tratamiento. Desarrollo: Se realizó una revisión bibliográfica de artículos publicados desde 2010 hasta 2020. Se consultaron las bases de datos SciELO, EBSCO, PubMed/Medline, Dialnet y revistas de acceso abierto, se emplearon los descriptores fibrilación auricular, arritmia supraventricular y mecanismos de reentrada, en idioma español e inglés. Se seleccionaron 25 referencias las cuales incluyen artículos científicos, anuario estadístico y guías de práctica clínica. En la literatura consultada se señaló que la fibrilación auricular es una arritmia supraventricular que se observa electrocardiográficamente como oscilaciones basales de baja amplitud con un ritmo ventricular irregular, que se produce por mecanismos de reentrada únicos o múltiples que generan una conducción eléctrica desordenada y generalmente se manifiesta por palpitaciones, fatiga y disnea, aunque pudiera ser asintomática. Conclusiones: Se constata que esta arritmia posee un cuadro clínico y electrocardiográfico reconocido y ampliamente estudiado. Se describen diversas clasificaciones y mecanismos fisiopatológicos, de acuerdo con sus etiologías. Los métodos diagnósticos y terapéuticos se encuentran en constante desarrollo y perfeccionamiento.

Introduction: Atrial fibrillation was considered for decades as an alternative for sinus rhythm and nowadays it is a severe health problem in many countries of the world associated with some risks factors as cardiac insufficiency, hypertension and diabetes mellitus. It is the most common type of arrhythmia in clinic marks. Objective: Characterize atrial fibrillation in terms of its clinical manifestations and treatment. Development: A bibliographical review was made on published articles from 2010 to 2020. Data Bases like SciELO, EBSCO, PubMed/Medline, Dialnet and open-access magazines were consulted, using the descriptive words atrial fibrillation, supraventricular arrhythmia and reentrance mechanisms for English and Spanish languages. A total of 28 references were selected. In the literature was checked that atrial fibrillation is a supraventricular arrhythmia that can be identified on electrocardiogram by low-amplitude basalts oscillations with an irregular ventricular rhythm. It is produced by unique or multiple reentrance mechanisms that generate a disordered electrical conduction and usually it is accompanied with palpitations, fatigue and dyspnea, but it could also be asymptomatic. Conclusions: Atrial fibrillation has studied clinical signs and treatment is oriented in four directions; frequency controlling, rhythm controlling, thromboembolism prevention and risks factors management.

Unilateral atrial ectopic rhythm in a golden retriever

Background: Atrial ectopic rhythm is a type of supraventricular arrhythmia, originating in two distinct points in the atrialregion. In the electrocardiographic (ECG) tracing, it is represented by independent depolarizations of sinus P waves andectopic P waves. The occurrence of this disorder is rare, and the diagnosis criteria are the presence of the described waveswithin the basal rhythm. In humans, there have been reports related to severe heart failure with an unfavorable prognosis.The present report aimed to describe the clinical case of a dog with unilateral atrial ectopic rhythm without any underlying cardiac disorder.Case: A 8-year-old male golden retriever was brought to a veterinary clinic for a preoperative evaluation for lipoma removalin the right forelimb. On clinical examination, the owner stated that the patient was active, with no signs of easy fatigueor cough. The canine displayed normophagy, normodipsia, normoquezia, and normouria. On physical examination, hedemonstrated a lymphatic temperament with tachypnea. The temperature and capillary filling time were within the normalrange, with a normokinetic pulse. Cardiac auscultation revealed a mild grade I/VI murmur in mitral focus and an 80-bpmheart rate. Respiratory auscultation revealed the presence of harshy lung sounds. The cough reflex was positive; the Piparotetest, negative. The blood test showed no noticeable changes in blood count and serum biochemistry. Systemic systolicblood pressure was 120 mmHg. On radiographic examination, no evidence of heart or lung abnormalities were identified.After the clinical evaluation, an ECG examination was performed; a unilateral atrial ectopic rhythm was observed withdifferent frequencies between atrial and ventricular rhythm and with P (164°) and P waves (80°). On echocardiographic...(AU)

Unilateral atrial ectopic rhythm in a golden retriever

Background: Atrial ectopic rhythm is a type of supraventricular arrhythmia, originating in two distinct points in the atrialregion. In the electrocardiographic (ECG) tracing, it is represented by independent depolarizations of sinus P waves andectopic P waves. The occurrence of this disorder is rare, and the diagnosis criteria are the presence of the described waveswithin the basal rhythm. In humans, there have been reports related to severe heart failure with an unfavorable prognosis.The present report aimed to describe the clinical case of a dog with unilateral atrial ectopic rhythm without any underlying cardiac disorder.Case: A 8-year-old male golden retriever was brought to a veterinary clinic for a preoperative evaluation for lipoma removalin the right forelimb. On clinical examination, the owner stated that the patient was active, with no signs of easy fatigueor cough. The canine displayed normophagy, normodipsia, normoquezia, and normouria. On physical examination, hedemonstrated a lymphatic temperament with tachypnea. The temperature and capillary filling time were within the normalrange, with a normokinetic pulse. Cardiac auscultation revealed a mild grade I/VI murmur in mitral focus and an 80-bpmheart rate. Respiratory auscultation revealed the presence of harshy lung sounds. The cough reflex was positive; the Piparotetest, negative. The blood test showed no noticeable changes in blood count and serum biochemistry. Systemic systolicblood pressure was 120 mmHg. On radiographic examination, no evidence of heart or lung abnormalities were identified.After the clinical evaluation, an ECG examination was performed; a unilateral atrial ectopic rhythm was observed withdifferent frequencies between atrial and ventricular rhythm and with P (164°) and P waves (80°). On echocardiographic...

Radiofrequency ablation of supraventricular arrhythmias after orthotopic heart transplantation: Long-term follow-up of a single-center experience.

BACKGROUND: Supraventricular arrhythmias (SVAs), commonly managed with radiofrequency ablation (RFA), may occur after orthotopic heart transplantation (OHT). METHODS: We retrospectively assessed 514 consecutive patients (pts.) undergoing OHT between January 1990 and July 2016 in a single-center. Patients with SVAs managed with RFA were included. Mechanisms of genesis of SVAs, association with surgical techniques and outcomes, were analyzed. RESULTS: Of 514 pts undergoing OHT, 53% (272 pts.) were managed with bicaval (BC) technique and 47% (242 pts.) with biatrial (BA) technique. Mean follow-up 10 ± 8.4 years. Nine pts. (1.7%) developed SVA requiring RFA. The BC technique was performed in 4 pts., 3 pts. presented cavotricuspid isthmus-dependent atrial flutter (CTI AFL), and 1 pt. double loop AFL. Five pts. were managed with BA technique, 4 pts. presented CTI AFL, and 1 pt. atrial tachycardia (AT). Mean time between OHT and SVA occurrence was 6.6 ± 5.5 years. The procedure was successful in 89% (8 pts.). Arrhythmia recurrence was seen in 3 pts (37%), all with BA technique. CONCLUSION: Supraventricular arrhythmias in heart transplantation may be associated with the surgical scar. Identifying the mechanism is vital to choose the appropriate treatment with radiofrequency ablation.

Update on Bayés' syndrome: the association between an interatrial block and supraventricular arrhythmias.

INTRODUCTION: The past few years have given rise to extensive research on an interatrial block and its clinical relevance, mainly its association with supraventricular arrhythmias. In 2015, the authors of this article reviewed the Bayes syndrome for the first time and after three years there has been so much evidence accumulated that it seems reasonable to rewrite an update, based fundamentally on the new findings. Focused on its relationship with cardioembolic strokes, today efforts are being targeted at understanding its pathophysiology, its diagnosis, and its prognostic implications, in order to learn if it should be treated. Areas covered: A non-systematic review of the literature was developed using the Pubmed and Cochrane databases, focusing on randomized clinical trials and large observational studies that evaluated new physiopathological and epidemiological aspects, new clinical scenarios in which it has been assessed and its association with dementia. Finally, those studies that proposed new possible treatments were reviewed. Expert commentary: Interatrial block is not only a predictor of supraventricular arrhythmias, is a subclinical disease that might be considered as a marker of risk for adverse outcomes. Although there is some evidence to suggest that early treatment may be beneficial, potential therapies have yet to be investigated.

Polymorphism, coupling interval and prematurity index in dogs with degenerative mitral valve disease and ventricular arrhythmias.

Ventricular arrhythmias (VA) are a recognized concern in dogs with degenerative mitral valve disease (DMVD). The coupling interval (CI) and the prematurity index (PI) have been shown to accurately differentiate between benign and malignant VA in people, where ventricular arrhythmias are known to be associated with an increased risk of development of signs of heart failure or sudden death. In this study, we characterized ventricular arrhythmias in dogs with symptomatic and asymptomatic DMVD. Seventy dogs with naturally-occurring DMVD and ventricular arrhythmias were retrospectively studied. A cross-sectional investigation including dogs with either symptomatic (stages C/D; n = 41) or asymptomatic (stages B1/B2; n = 29) DMVD was performed. Electrocardiographic tracings were reviewed to calculate both the CI and PI. In eight dogs these indices were compared with those obtained from both a Holter recording and a standard ECG tracing and no statistical differences were found (CI, p = 0.97; PI, p = 0.17). Even though CI and PI were determined in all animals enrolled in the study, VPC characteristics were only compared between symptomatic and asymptomatic dogs when a 24-h Holter recording was available (n = 49). The PI was different (p = 0.01) between symptomatic (0.65 ± 0.17) and asymptomatic (0.56 ± 0.18) dogs, but CI was considered similar (p = 0.91). Also, the symptomatic dogs had more polymorphic VPC (p = 0.002) and supraventricular arrhythmias (p = 0.0002) than the asymptomatic animals. Polymorphism, and repeating patterns of ventricular premature complexes, were characteristics frequently present in overtly symptomatic animals affected by mitral endocardiosis.

Bayés' syndrome: the association between interatrial block and supraventricular arrhythmias.

The past few years have given rise to extensive research on atrial conduction disorders and their clinical relevance. Most notably, an association between interatrial block and supraventricular arrhythmias has been discovered. This disorder, recently termed 'Bayés' syndrome', has important clinical implications. In this article, the authors review normal atrial conduction and associated disorders. A particular focus is placed on Bayés' syndrome and the relationship between interatrial block and supraventricular arrhythmias in different clinical scenarios. The report also outlines the current progress in the study of this syndrome and highlights areas requiring further investigation.