Catálogo de publicaciones - libros

The advent of digital technology in implantable cardiac stimulators will open up new frontiers for the automatic analysis and diagnosis of endocardial signals. This will dramatically increase the reliability of the therapies delivered and the amount of information that can be processed and stored for clinical and scientific purposes. In the next few years, we can expect specific algorithms to be developed for morphological discrimination of the farfield R-wave in the atrium and the retrograde P-wave. The use of blanking periods will gradually be phased out, since the system will instantly classify what it receives from the implanted electrodes, without needing to mask undesired signals. Such devices w ill really and continuously monitor every cardiac event.

The benefits of oral anticoagulation have been consistently proven in many prospective studies. Hence, all patients at risk for thromboembolism due to AF and without contraindications for oral anticoagulants should receive appropriate treatment. According to more recent findings, thrombembolic prophylaxis should be continued even with the strategy of rhythm control since many paroxysmal episodes of AF may be asymptomatic and will go unrecognised by patients and doctors. The availability of oral direct thrombin inhibitors may become a preferable alternative to warfarin. Ximelagatran has shown equal effectiveness compared to warfarin and has a lower risk of bleeding complications. Currently, the occurrence of liver toxicity has jeop-ardised approval of this drug for wider applications in Europe and the USA. Other substances from the same class are currently under investigation in clinical phase I and phase II trials, but it may take more than 5 years until a protocol comparable to that of the SPORTIF trials and using any of these new compounds has been evaluated.

Several areas regarding use of oral anticoagulation have been identified which are in need of updating or reconsideration. Recommendations are always best when data-driven. For some of these areas, the data are lacking, weak, or controversial. For others, the data seem clear. Because these several areas are important, we hope they will gain the attention they deserve from the ACC/AHA/ESC and ACCP guideline committees.

Epicardial VT may occur in ischaemic, non-ischaemic, and idiopathic VT. Truly subepicardial VT can preferentially be ablated from the epicardial surface. The percutaneous subxiphoid approach to the pericardial space is easy and can be done safely in the EP laboratory by an electrophysiologist. This approach may improve the results of the catheter ablation procedure.

MRI and MDCT can play important roles in understanding the underlying causes of atrial and ventricular arrhythmias. In addition, they are becoming more and more often incorporated into the development of new interventional therapies for these clinical conditions.

TEE is a useful tool to investigate patients undergoing ablation therapy of atrial fibrillation. The technique provides important information about the presence of thrombus and SEC in the left atrium and LAa, and about minor IAS abnormalities, which seem to occur more frequently than in the normal population. Such information is necessary for planning the approach to the PV by catheters that must cross the septum and the atrial cavity.

After ablation, TEE can be used to monitor possible minor complications, such as a residual IAS shunt or pericardial effusion. It also allows the detection of PV stenosis, a rare but dreaded complication of PVAI. A control TEE examination 3 months after the ablation procedure is probably adequate for this purpose.

The LocaLisa mapping system provides an economical means of continuous online monitoring of multiple catheters, the annotation of anatomic structures, and the tagging of previously ablated regions. These features significantly reduce the fluoroscopic exposure and procedural duration associated with PV isolation and linear substrate modification for AF.

Although final results are not yet available, it is interesting to note that patients who had complete disconnection of the superior vena cava have had a good initial follow-up. However, these preliminary results must be confirmed by studies that include a larger number of patients and a longer follow-up time.

Water drinking elicits a profound pressor response in autonomic failure patients. It increases blood pressure to a lesser degree in tetraplegic patients, cardiac transplant recipients, and older healthy subjects. Blood pressure does not change in healthy young subjects. The haemodynamic response to water drinking appears to be mediated through sympathetic activation via an unknown mechanism. Water drinking improves orthostatic responses in patients with orthostatic hypotension and orthostatic tachycardia, and delays the onset of neurocardiogenic syncope in healthy subjects. Thus, water drinking may be a promising and essentially cost-free intervention for all these conditions, either as monotherapy or in conjunction with other non-pharmacological or pharmacological treatments.