Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores ...de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.
Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF.
To identify cardiometabolic risk factors (CMRF) and ...antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender.
CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender.
Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women.
Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.
The endpoint of successful treatment of slow pathway ablation is elimination of AV nodal reentrant tachycardia (AVNRT). However, the mechanism of elimination is not well understood and is ...controversial if complete elimination or persistent dual AV nodal physiology is associated with a higher success, recurrence and/or complications rate.
The purpose was to examine the results after slow pathway ablation in AVNRT and changes in AV nodal conduction in patients with and without loss of dual AV nodal physiology.
The study included 106 patients (age 47 +/- 17 years). In 64% with elimination of inducible AVNRT still had dual AV nodal physiology (group I) and absent in 36%, group II). Both, anterograde fast pathway and slow pathway effective refractory period (ERP) showed a tendency to decrease but without statistical significance: 340 +/- 39 ms to 329 +/- 45 ms, 290 +/- 16 to 279 +/- 43 ms respectively, p = NS. In group II, anterograde fast pathway ERP decreased significantly 328 +/- 83 ms to 282 +/- 75 ms, p < 0.001. Anterograde Wenckebach cycle length increased in both groups: 360 +/- 65 to 375 +/- 61 ms, p < 0.05 group I, and 351 +/- 20 to 381 +/- 14 ms, p < 0.001 group II.
Ablation procedures of the AV node slow pathways that eliminate AVNRT modify the AV node electrophysiologic conduction properties. These modifications are more important in patients with complete elimination of dual AV nodal physiology; nonetheless, in a high rate of patients the elimination is incomplete but without reinduction of clinical tachycardia. It has been suggested that elimination of the AVNRT despite the persistence of dual AV nodal physiology is due to the presence of more than one AV node slow pathway with different electrophysiological properties.
Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic ...cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.
