Las arritmias y la electrofisiología cardíacas representan una de las disciplinas de la cardiología de más rápidodesarrollo, con avances que se producen tanto en los aspectos del tratamiento farmacológico como en los técnicos, de tan rápida evolución.
Durante el último año, se han seguido publicando datos de los estudios AFFIRM y RACE, sobre el manejo de la fibrilación auricular (FA) con control de la frecuencia cardíaca o del ritmo cardíaco. También se están desarrollando estudios con antiarrítmicos, como la azimilida o la drodenarona. Al mismo tiempo, se han publicado los resultados del estudio SPORTIF III, que muestran una reducción equivalente de riesgo embólico con un menor riesgo hemorrágico del ximelagatran frente a los anticoagulants orales clásicos en la FA no valvular. La investigación en la ablación de la FA sigue estando muy activa y se han publicado importantes referencias que depuran la técnica y aportan información sobre los mecanismos de esta arritmia. También se mantiene un gran interés en facilitar los procedimientos de ablación, con la aparición de nuevos sistemas de navegación intracardíaca no fluoroscópica o de navegación magnética remota. Por último, la prevención primaria de la muerte súbita con desfibriladores implantables en pacientes con disfunción ventricular sin arritmias ventriculares sostenidas espontáneas sigue siendo el campo de mayor interés actual con estos dispositivos, como muestra la publicación y presentación de los resultados de los estudios COMPANION, DEFINITE, SCD-HeFT y DINAMIT.
Palabras clave
Arritmias
Desfibrilador automático implantable
Electrocardiografía
Electrofisiología
Fármacos antiarrítmicos
Este artículo solo puede leerse en
pdf
Bibliografía
[1.]
D.G. Wyse, A.L. Waldo, J.P. DiMarco, M.J. Domanski, Y. Rosenberg, E.B. Schron, et al.
A comparison of rate control and rhythm control in patients with atrial fibrillation.
N Engl J Med, (2002), 347 pp. 1825-1833
[2.]
I.C. Van Gelder, V.E. Hagens, H.A. Bosker, J.H. Kingma, O. Kamp, T. Kingma, et al.
A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.
N Engl J Med, (2002), 347 pp. 1834-1840
[3.]
S.D. Corley, A.E. Epstein, J.P. DiMarco, M.J. Domanski, N. Geller, H.L. Greene, et al.
Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study.
Circulation, (2004), 109 pp. 1509-1513
[4.]
E.S. Kaufman, P.A. Zimmermann, T. Wang, G.W. Dennish III, P.D. Barrell, M.L. Chandler, et al.
Risk of proarrhythmic events in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study: a multivariate analysis.
J Am Coll Cardiol, (2004), 44 pp. 1276-1282
[5.]
J.S. Steinberg, A. Sadaniantz, J. Kron, A. Krahn, D.M. Denny, J. Daubert, et al.
Analysis of cause-Specific Mortality in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study.
Circulation, (2004), 109 pp. 1973-1980
[6.]
V.E. Hagens, K.M. Vermeulen, E.M. TenVergert, D.J. van Veldhuisen, H.A. Bosker, O. Kamp, et al.
Rate control is more cost-effective than rhythm control for patients with persistent atrial fibrillation - results from the RAte Control versus Electrical cardioversion (RACE) study.
Eur Heart J, (2004), 25 pp. 1542-1549
[7.]
A.J. Camm, C.M. Pratt, P.J. Schwartz, H.R. Al Khalidi, M.J. Spyt, M.J. Holroyde, et al.
Mortality in patients after a recent myocardial infarction: a randomized, placebo-controlled trial of azimilide using heart rate variability for risk stratification.
Circulation, (2004), 109 pp. 990-996
[8.]
C.M. Pratt, S.N. Singh, H.R. Al Khalidi, J.M. Brum, M.J. Holroyde, S.R. Marcello, et al.
The efficacy of azimilide in the treatment of atrial fibrillation in the presence of left ventricular systolic dysfunction: results from the Azimilide Postinfarct Survival Evaluation (ALIVE) trial.
J Am Coll Cardiol, (2004), 43 pp. 1211-1216
[9.]
S.A. Doggrell, J.C. Hancox.
Dronedarone: an amiodarone analogue.
Expert Opin Investig Drugs, (2004), 13 pp. 415-426
[10.]
P. Petersen, G. Boysen, J. Godtfredsen, E.D. Andersen, B. Andersen.
Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study.
Lancet, (1989), 1 pp. 175-179
[11.]
The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators.
N Engl J Med, (1990), 323 pp. 1505-1511
[12.]
S.J. Connolly, A. Laupacis, M. Gent, R.S. Roberts, J.A. Cairns, C. Joyner.
Canadian Atrial Fibrillation Anticoagulation (CAFA) Study.
J Am Coll Cardiol, (1991), 18 pp. 349-355
[13.]
M.D. Ezekowitz, S.L. Bridgers, K.E. James, N.H. Carliner, C.L. Colling, C.C. Gornick, et al.
Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke revention in Nonrheumatic Atrial Fibrillation Investigators.
N Engl J Med, (1992), 327 pp. 1406-1412
[14.]
A. Martin, J.L. Merino, C. Del Arco, A.J. Martinez, P. Laguna, F. Arribas, et al.
Documento de consenso sobre el tratamiento de la fibrilación auricular en los servicios de urgencias hospitalarios.
Rev Esp Cardiol, (2003), 56 pp. 801-816
[15.]
V. Fuster, L.E. Ryden, R.W. Asinger, D.S. Cannom, H.J. Crijns, R.L. Frye, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology.
Eur Heart J, (2001), 22 pp. 1852-1923
[16.]
J. Hambleton.
Home monitoring of anticoagulation.
J Thromb Thrombolysis, (2003), 16 pp. 39-42
[17.]
M.E. Cromheecke, M. Levi, L.P. Colly, B.J. De Mol, M.H. Prins, B.A. Hutten, et al.
Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised crossover comparison.
Lancet, (2000), 356 pp. 97-102
[18.]
J. Hirsh, V. Fuster, J. Ansell, J.L. Halperin.
American Heart Association/American College of Cardiology Foundation guide to warfarin therapy.
J Am Coll Cardiol, (2003), 41 pp. 1633-1652
[19.]
S.B. Olsson.
Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial.
Lancet, (2003), 362 pp. 1691-1698
[20.]
P. Petersen, M. Grind, J. Adler.
Ximelagatran versus warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. SPORTIF II: a dose-guiding, tolerability, and safety study.
J Am Coll Cardiol, (2003), 41 pp. 1445-1451
[21.]
J.L. Halperin.
Ximelagatran compared with warfarin for prevention of thromboembolism in patients with nonvalvular atrial fibrillation: Rationale, objectives, and design of a pair of clinical studies and baseline patient characteristics (SPORTIF III and V).
Am Heart J, (2003), 146 pp. 431-438
[22.]
G.A. Donnan, H.M. Dewey, B.R. Chambers.
Warfarin for atrial fibrillation: the end of an era?.
Lancet Neurol, (2004), 3 pp. 305-308
[23.]
D.C. Shah, M. Haissaguerre, P. Jais, M. Hocini, T. Yamane, I. Deisenhofer, et al.
Curative catheter ablation of paroxysmal atrial fibrillation in 200 patients: strategy for presentations ranging from sustained atrial fibrillation to no arrhythmias.
Pacing Clin Electrophysiol, (2001), 24 pp. 1541-1558
[24.]
C. Pappone, G. Oreto, S. Rosanio, G. Vicedomini, M. Tocchi, F. Gugliotta, et al.
Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation.
Circulation, (2001), 104 pp. 2539-2544
[25.]
C. Pappon, S. Rosanio, G. Oreto, M. Tocchi, F. Gugliotta, G. Vicedomini, et al.
Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.
Circulation, (2000), 102 pp. 2619-2628
[26.]
H. Oral, C. Scharf, A. Chugh, B. Hall, P. Cheung, E. Good, et al.
Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation.
Circulation, (2003), 108 pp. 2355-2360
[27.]
M. Mansour, J. Ruskin, D. Keane.
Efficacy and safety of segmental ostial versus circumferential extra-ostial pulmonary vein isolation for atrial fibrillation.
J Cardiovasc Electrophysiol, (2004), 15 pp. 532-537
[28.]
C. Pappone, H. Oral, V. Santinelli, G. Vicedomini, C.C. Lang, F. Manguso, et al.
Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
Circulation, (2004), 109 pp. 2724-2726
[29.]
M.I. Scanavacca, A. D’Avila, J. Parga, E. Sosa.
Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation.
J Cardiovasc Electrophysiol, (2004), 15 pp. 960-962
[30.]
K. Nademanee, J. McKenzie, E. Kosar, M. Schwab, B. Sunsaneewitayakul, T. Vasavakul, et al.
A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate.
J Am Coll Cardiol, (2004), 43 pp. 2044-2053
[31.]
R. Cappato, S. Negroni, D. Pecora, S. Bentivegna, P.P. Lupo, A. Carolei, et al.
Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation.
Circulation, (2003), 108 pp. 1599-1604
[32.]
Y. Takahashi, Y. Iesaka, A. Takahashi, M. Goya, K. Kobayashi, H. Fujiwara, et al.
Reentrant tachycardia in pulmonary veins of patients with paroxysmal atrial fibrillation.
J Cardiovasc Electrophysiol, (2003), 14 pp. 927-932
[33.]
Merino JL, Peinado R, Abello M, Gnoatto M, Vasserot M, Sobrino JA. Superior vena cava flutter: electrophysiology and ablation. J Cardiovasc Electrophysiol. En prensa.
[34.]
E.P. Gerstenfeld, D.J. Callans, S. Dixit, A.M. Russo, H. Nayak, D. Lin, et al.
Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation.
Circulation, (2004), 110 pp. 1351-1357
[35.]
T. Ooie, T. Tsuchiya, K. Ashikaga, N. Takahashi.
Electrical connection between the right atrium and the superior vena cava, and the extent of myocardial sleeve in a patient with atrial fibrillation originating from the superior vena cava.
J Cardiovasc Electrophysiol, (2002), 13 pp. 482-485
[36.]
M. Haissaguerre, P. Sanders, M. Hocini, L.F. Hsu, D.C. Shah, C. Scavee, et al.
Changes in atrial fibrillation cycle length and inducibility during catheter ablation and their relation to outcome.
Circulation, (2004), 109 pp. 3007-3013
[37.]
C. Pappone, V. Santinelli, F. Manguso, G. Vicedomini, F. Gugliotta, G. Augello, et al.
Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation.
Circulation, (2004), 109 pp. 327-334
[38.]
C. Blomstrom-Lundqvist, M.M. Scheinman, E.M. Aliot, J.S. Alpert, H. Calkins, A.J. Camm, et al.
ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executivesummary: a report of the American College of Cardiology/merican Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias).
Circulation, (2003), 108 pp. 1871-1909
[39.]
C. Pappone, F. Manguso, R. Santinelli, G. Vicedomini, S. Sala, G. Paglino, et al.
Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome.
N Engl J Med, (2004), 351 pp. 1197-1205
[40.]
L.M. Álvarez, F.E. Rodríguez.
Registro Español de Ablación con Catéter. II Informe Oficial de la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología (2002).
Rev Esp Cardiol, (2003), 56 pp. 1093-1104
[41.]
M. Álvarez, J.L. Merino.
Registro Español de Ablación con Catéter. I Informe Oficial de la Sección de Electrofisiología y Arritmiasde la Sociedad Española de Cardiología (Año 2001).
Rev Esp Cardiol, (2002), 55 pp. 1273-1285
[42.]
H.J. Wellens.
Catheter ablation for cardiac arrhythmias.
N Engl J Med, (2004), 351 pp. 1172-1174
[43.]
G.J. Almendral, T.E. González, F.F. Atienza, E.D. Vigil, M.A. Arenal.
Tratamiento de los pacientes con preexcitación ventricular.
Rev Esp Cardiol, (2004), 57 pp. 859-868
[44.]
S. Shpun, L. Gepstein, G. Hayam, S.A. Ben Haim.
Guidance of radiofrequency endocardial ablation with real-time three-dimensional magnetic navigation system.
Circulation, (1997), 96 pp. 2016-2021
[45.]
J.L. Smeets, S.A. Ben Haim, L.M. Rodríguez, C. Timmermans, H.J. Wellens.
New method for nonfluoroscopic endocardial mapping in humans: accuracy assessment and first clinical results.
Circulation, (1998), 97 pp. 2426-2432
[46.]
L. Gepstein, G. Hayam, S.A. Ben Haim.
A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart. In vitro and in vivo accuracy results.
Circulation, (1997), 95 pp. 1611-1622
[47.]
E. Gonzalez-Torrecilla, A. Arenal, J. Quiles, F. Atienza, J. Jiménez-Candil, S. Del Castillo, et al.
La cartografía electroanatómica no fluoroscópica (sistema CARTO) en la ablación de las taquicardias auriculares.
Rev Esp Cardiol, (2004), 57 pp. 37-44
[48.]
N.S. Peters, W.M. Jackman, R.J. Schilling, G. Beatty, D.W. Davies.
Images in cardiovascular medicine. Human left ventricular endocardial activation mapping using a novel noncontact catheter.
Circulation, (1997), 95 pp. 1658-1660
[49.]
R.J. Schilling, N.S. Peters, D.W. Davies.
Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter: comparison of contact and reconstructed electrograms during sinus rhythm.
Circulation, (1998), 98 pp. 887-898
[50.]
R.J. Schilling, N.S. Peters, D.W. Davies.
Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia.
Circulation, (1999), 99 pp. 2543-2552
[51.]
M. Abello, J.L. Merino, R. Peinado, M. Gnoatto, M.A. Arias, V.M. González, et al.
Ablación de taquicardias ventriculares guiada mediante sistema LocaLisa en pacientes con cardiopatía estructural.
Rev Esp Cardiol, (2004), 57 pp. 737-744
[52.]
J. Kammeraad, F.U. Ten Cate, T. Simmers, M. Emmel, F.H. Wittkampf, N. Sreeram.
Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in children aided by the LocaLisa mapping system.
Europace, (2004), 6 pp. 209-214
[53.]
T.A. Simmers, R. Tukkie.
How to perform pulmonary vein isolation for the treatment of atrial fibrillation: use of the LocaLisa catheter navigation system.
Europace, (2004), 6 pp. 92-96
[54.]
F.H. Wittkampf, E.F. Wever, K. Vos, J. Geleijns, M.J. Schalij, T.J. Van der, et al.
Reduction of radiation exposure in the cardiac electrophysiology laboratory.
Pacing Clin Electrophysiol, (2000), 23 pp. 1638-1644
[55.]
F.H. Wittkampf, E.F. Wever, R. Derksen, A.A. Wilde, H. Ramanna, R.N. Hauer, et al.
LocaLisa: new technique for real-time 3-dimensional localization of regular intracardiac electrodes.
Circulation, (1999), 99 pp. 1312-1317
[56.]
J. Sra, J. Hauck, D. Krum, J. Schweitzer.
Three-dimensional right atrial geometry construction and catheter tracking using cutaneous patches.
J Cardiovasc Electrophysiol, (2003), 14 pp. 897
[57.]
A. Verma, N. Marrouche, A. Natale.
Novel Method to integrate three-dimensional computed tomographic images of the Left atrium with real-time electroanatomic mapping.
J Cardiovasc Electrophysiol, (2004), 15 pp. 968
[58.]
F. Morady.
Catheter ablation of supraventricular arrhythmias: state of the art.
J Cardiovasc Electrophysiol, (2004), 15 pp. 124-139
[59.]
M. Gnoatto, J.L. Merino, M. Abello.
Reconstrucción anatómica digital (NavX) como guía de ablación.
Rev Esp Cardiol, (2004), 57 pp. 1233
[60.]
S. Ernst, F. Ouyang, C. Linder, K. Hertting, F. Stahl, J. Chun, et al.
Initial experience with remote catheter ablation using a novel magnetic navigation system: magnetic remote catheter ablation.
Circulation, (2004), 109 pp. 1472-1475
[61.]
S. Ernst, F. Ouyang, C. Linder, K. Hertting, F. Stahl, J. Chun, et al.
Modulation of the slow pathway in the presence of a persistent left superior caval vein using the novel magnetic navigation system Niobe.
Europace, (2004), 6 pp. 10-14
[62.]
M.R. Bristow, L.A. Saxon, J. Boehmer, S. Krueger, D.A. Kass, T. De Marco, et al.
Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure.
N Engl J Med, (2004), 350 pp. 2140-2150
[63.]
D.J. Bradley, E.A. Bradley, K.L. Baughman, R.D. Berger, H. Calkins, S.N. Goodman, et al.
Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials.
JAMA, (2003), 289 pp. 730-740
[64.]
J.B. Young, W.T. Abraham, A.L. Smith, A.R. Leon, R. Lieberman, B. Wilkoff, et al.
Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial.
JAMA, (2003), 289 pp. 2685-2694
[65.]
W.T. Abraham, W.G. Fisher, A.L. Smith, D.B. Delurgio, A.R. Leon, E. Loh, et al.
Cardiac resynchronization in chronic heart failure.
N Engl J Med, (2002), 346 pp. 1845-1853
[66.]
S. Cazeau, C. Leclercq, T. Lavergne, S. Walker, C. Varma, C. Linde, et al.
Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay.
N Engl J Med, (2001), 344 pp. 873-880
[67.]
A.E. Buxton, L. Lee, J.D. Fisher, M.E. Josephson, E.N. Prystowsky, G. Hafley.
A randomized study of the prevention of sudden deathin patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators.
N Engl J Med, (1999), 341 pp. 1882-1890
[68.]
A.J. Moss, W.J. Hall, D.S. Cannom, J.P. Daubert, S.L. Higgins, H. Klein, et al.
Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators.
N Engl J Med, (1996), 335 pp. 1933-1940
[69.]
D. Bansch, M. Antz, S. Boczor, M. Volkmer, J. Tebbenjohanns, K. Seidl, et al.
Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT).
Circulation, (2002), 105 pp. 1453-1458
[70.]
S.A. Strickberger, J.D. Hummel, T.G. Bartlett, H.I. Frumin, C.D. Schuger, S.L. Beau, et al.
Amiodarone versus implantable cardioverter-defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia-AMIOVIRT.
J Am Coll Cardiol, (2003), 41 pp. 1707-1712
[71.]
J.L. Merino.
Mechanisms underlying ventricular arrhythmias in idiopathic dilated cardiomyopathy: implications for management.
Am J Cardiovasc Drugs, (2001), 1 pp. 105-118
[72.]
W. Grimm.
Clinical trials of prophylactic implantable defibrillator therapy in patients with nonischemic cardiomyopathy: what have we learned and what can we expect from future trials?.
Card Electrophysiol Rev, (2003), 7 pp. 463-467
[73.]
D.S. Cannom.
Other primary prevention trials-what is clinically and economically necessary?.
J Interv Card Electrophysiol, (2000), 4 pp. 109-115
[74.]
G. Gronefeld, S.J. Connolly, S.H. Hohnloser.
The Defibrillator in Acute Myocardial Infarction Trial (DINAMIT): rationale, design and specific aims.
Card Electrophysiol Rev, (2003), 7 pp. 447-451
[75.]
S.H. Hohnoloser, K.H. Kuck, P. Dorian, R.S. Roberts, J.R. Hampton, R. Hatala, et al.
Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction.
N Engl J Med, (2004), 351 pp. 2481-2488
Copyright ©
2005. Sociedad Española de Cardiología