| Justificación y perspectiva actual de la terapia temprana en el control de la fibrilación auricular |
Rationale and current perspective for early rhythm control therapy in atrial fibrillation.
Van Gelder IC, Haegeli LM, Brandes A, Heidbuchel H, Aliot E, Kautzner J, Szumowski L, Mont L, Morgan J, Willems S, Themistoclakis S, Gulizia M, Elvan A, Smit MD, Kirchhof P.
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.i.c.van.gelder@thorax.umcg.nl
Europace. 2011 Nov;13(11):1517-25. Epub 2011 Jul 22.
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and an important source for mortality and morbidity on a population level. Despite the clear association between AF and death, stroke, and other cardiovascular events, there is no evidence that rhythm control treatment improves outcome in AF patients. The poor outcome of rhythm control relates to the severity of the atrial substrate for AF not only due to the underlying atrial remodelling process but also due to the poor efficacy and adverse events of the currently available ion-channel antiarrhythmic drugs and ablation techniques. Data suggest, however, an association between sinus rhythm maintenance and improved survival. Hypothetically, sinus rhythm may also lead to a lower risk of stroke and heart failure. The presence of AF, thus, seems one of the modifiable factors associated with death and cardiovascular morbidity in AF patients. Patients with a short history of AF and the underlying heart disease have not been studied before. It is fair to assume that abolishment of AF in these patients is more successful and possibly also safer, which could translate into a prognostic benefit of early rhythm control therapy. Several trials are now investigating whether aggressive early rhythm control therapy can reduce cardiovascular morbidity and mortality and increase maintenance of sinus rhythm. In the present paper we describe the background of these studies and provide some information on their design
http://europace.oxfordjournals.org/content/13/11/1517.full.pdf+html |
| Lo que los pacientes quieren y necesitan saber sobre la fibrilación auricular |
What patients want and need to know about atrial fibrillation. McCabe PJ. Saint Mary's Hospital, Mayo Clinic, Rochester, MN, USA. J Multidiscip Healthc. 2011;4:413-9. Epub 2011 Nov 3. Abstract Clinicians in a variety of settings are called upon to care for patients diagnosed with atrial fibrillation (AF), a common chronic condition that affects up to 3 million people in the USA. Evidence-based guidelines provide clinicians with direction for treatment of AF, but recommended content for educating patients and counseling about self-management of AF is not included in published guidelines. When patients believe they have a good understanding of AF they report fewer symptoms, perceive greater control over AF, and attribute less emotional distress to AF. Thus, providing patients with information about AF and how to manage it is important for promoting positive outcomes. The purpose of this article is to offer evidence-based recommendations for content to include in self-management education and counseling for patients with AF. Approaches for educating and counseling patients related to AF pathophysiology, the nature of AF (its cause, consequences, and trajectory), treatments, action plans, and symptom management, and managing the psychosocial challenges of living with AF, are discussed http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215351/pdf/jmdh-4-413.pdf |
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