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Atrial and dual defibrillators held great promise when they were introduced in the 1990s.

The devices are effective and safe in selected patients. Tolerability and acceptance by patients is good in the short term but only moderate in the longer term. The complication rate is relatively low. However, advances in ablation techniques for the treatment of atrial fibrillation have limited and will continue to limit the use of implantable atrial defibrillators. In combination with ICDs they may find a continued role in a patient group that should be further defined.

Upon completion of the chapter, the student will be able to:

There is a high and in many cases inappropriate use of ICDs in patients with long QT syndrome with syncope. The pros and cons of the ICD and of the other available therapies should be clearly explained to all patients before recommending one or another.

It should be remembered that LQTS is profoundly different from most of the more prevalent conditions for which an ICD is usually recommended, and that among the special features of LQTS the tight relationship between release of catecholamines and life-threatening arrhythmias is an important one capable of initiating storms of shocks.

The wise use of the ICD in LQTS can save many lives. The unwise use of the ICD in LQTS can ruin many lives. A competent and caring physician should not be unmindful of his/her complex responsibilities toward the - usually young - LQTS patients.

The diagnosis of an idiopathic RVOT-VT is made by exclusion of ARVC or any other structural heart disease. If there are no signs of RV myocardial changes, such as dilatation, dyskinesia, hypokinesia, or aneurysms and wall thickening, and there are no electrocardiographic signs of ARVC, the patient most likely has an idiopathic RVOT-VT. However, especially in families with a history of sudden death, close follow-up may be useful. When enough minor or major criteria are met, the patient should be risk-stratified and treatment options should be tailored to the individual, taking into consideration the risks and benefits. In some younger patients with, e.g. syncope and one other minor criterion and RVOT-VT, this decision is often very difficult and will probably remain difficult. Genetic testing should be performed in all patients with a family history in order to detect relatives at risk.

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.

In adults, regular physical exercise offers protection against coronary events and SD. Conversely, sport activity is associated with a significantly higher rate of SD in adolescents and young adults. Sports does not enhance mortality per se; rather, it acts as a trigger of cardiac arrest in those athletes with silent cardiovascular conditions, mostly cardiomyopathy, premature coronary artery disease, and congenital coronary anomalies, each of which predisposes to life-threatening ventricular arrhythmias during physical exercise. These results should not discourage young people from participating in sports, but point to the need for an extensive and accurate pre-participation screening strategy aimed at early identification and disqualification of those subjects affected by cardiovascular diseases associated with the risk of SD.

Atrial and dual defibrillators held great promise when they were introduced in the 1990s.

The devices are effective and safe in selected patients. Tolerability and acceptance by patients is good in the short term but only moderate in the longer term. The complication rate is relatively low. However, advances in ablation techniques for the treatment of atrial fibrillation have limited and will continue to limit the use of implantable atrial defibrillators. In combination with ICDs they may find a continued role in a patient group that should be further defined.

Patients with right ventricular pacing and heart failure may be candidates for resynchronisation therapy with the upgrading to biventricular pacing.

The procedure has been shown to be simple and safe. In addition, the results of the above-mentioned studies are encouraging and show that upgraded patients may profit from a better quality of life. However, the life expectancy of these patients remains to be investigated.

There is a high and in many cases inappropriate use of ICDs in patients with long QT syndrome with syncope. The pros and cons of the ICD and of the other available therapies should be clearly explained to all patients before recommending one or another.

It should be remembered that LQTS is profoundly different from most of the more prevalent conditions for which an ICD is usually recommended, and that among the special features of LQTS the tight relationship between release of catecholamines and life-threatening arrhythmias is an important one capable of initiating storms of shocks.

The wise use of the ICD in LQTS can save many lives. The unwise use of the ICD in LQTS can ruin many lives. A competent and caring physician should not be unmindful of his/her complex responsibilities toward the - usually young - LQTS patients.

Low levels of EPA and DHA are independently associated with increased risk of death from coronary heart disease, especially with sudden cardiac death. In randomised secondary prevention trials, fish or fish oil have been demonstrated to reduce total and CHD mortality. RBC fatty acid composition reflects long-term intake of EPA and DHA. RBC EPA and DHA levels may be considered a new risk factor for death from CHD. This potential new risk factor, the Omega-3 Index, seems to be inversely associated with risk for CHD mortality. An Omega-3 Index of 8% or greater was associated with the greatest cardioprotection, whereas an index of 4% or less was associated with the least. Thus, the Omega-3 Index may represent a novel, physiologically relevant, easily modified, independent, and graded risk factor for death from CHD that could have significant clinical utility.