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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Background&#58;</span> Obesity and atrial fibrillation &#40;AF&#41; frequently coexist&#46; Weight loss reduces the burden of AF&#44; but whether this is sustained&#44; has a dose effect&#44; or is influenced by weight fluctuation is unknown&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Objectives&#58;</span> This study sought to evaluate the long&#8208;term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Methods&#58;</span> Of 1&#44;415 consecutive patients with AF&#44; 825 had a body mass index&#160;&#8805;<span class="elsevierStyleHsp" style=""></span>27<span class="elsevierStyleHsp" style=""></span>kg&#47;m&#40;2&#41; and were offered weight management&#46; After screening for exclusion criteria&#44; 355 were included in this analysis&#46; Weight loss was categorized as group 1 &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41;&#44; group 2 &#40;3&#37;&#160;to&#160;9&#37;&#41;&#44; and group 3 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>3&#37;&#41;&#46; Weight trend and&#47;or fluctuation was determined by yearly follow&#8208;up&#46; We determined the impact on the AF severity scale and 7&#8208;day ambulatory monitoring&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> There were no differences in baseline characteristics or follow&#8208;up among the groups&#46; AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all&#41;&#46; Arrhythmia&#8208;free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41;&#46; In multivariate analyses&#44; weight loss and weight fluctuation were independent predictors of outcomes &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41;&#46; Weight loss&#160;&#8805;<span class="elsevierStyleHsp" style=""></span>10&#37; resulted in a 6&#8208;fold &#40;95&#37; confidence interval&#58; 3&#46;4 to 10&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; greater probability of arrhythmia&#8208;free survival compared with the other 2 groups&#46; Weight fluctuation &#62;5&#37; partially offset this benefit&#44; with a 2&#8208;fold &#40;95&#37; confidence interval&#58; 1&#46;0 to 4&#46;3&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; increased risk of arrhythmia recurrence&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#58;</span> Long&#8208;term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm&#46; &#40;Long&#8208;Term Effect of Goal directed weight management on Atrial Fibrillation Cohort&#58; A 5 Year follow&#8208;up study &#91;LEGACY Study&#93;&#59; ACTRN12614001123639&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Coment&#225;rio</span><p id="par0040" class="elsevierStylePara elsevierViewall">A fibrilha&#231;&#227;o auricular &#40;FA&#41; e a obesidade s&#227;o consideradas&#44; na atualidade&#44; epidemias em crescendo &#224; escala global<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;4</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A import&#226;ncia da FA deve&#8208;se &#224; elevada preval&#234;ncia e constitui a arritmia mais frequente na pr&#225;tica cl&#237;nica&#46; Afeta 2&#44;5&#37; da popula&#231;&#227;o acima dos 40 anos<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> e aumenta progressivamente com a idade &#40;em m&#233;dia cerca de 5&#37; ao ano<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a>&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Reconhece&#8208;se&#44; tamb&#233;m&#44; no seu processo&#44; o impacto hemodin&#226;mico resultante da perda do contributo auricular&#44; da manifesta&#231;&#227;o de di&#225;stoles irregulares e incompletas e&#44; ainda&#44; da amplifica&#231;&#227;o da resposta ventricular&#44; com aumento da frequ&#234;ncia&#44; cuja persist&#234;ncia pode resultar em remodelagem ventricular&#44; levando&#44; ent&#227;o&#44; &#224; dilata&#231;&#227;o e progressiva disfun&#231;&#227;o mioc&#225;rdica &#40;taquicardiomiopatia&#41;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; As implica&#231;&#245;es hemodin&#226;micas podem condicionar&#44; tamb&#233;m&#44; pelas altera&#231;&#245;es a n&#237;vel cerebral&#44; o agravamento ou mesmo aparecimento de doen&#231;a cerebrovascular &#40;estabelecida finalmente como uma dem&#234;ncia de origem vascular&#41;&#46; Note&#8208;se que a varia&#231;&#227;o da frequ&#234;ncia&#44; quer por aumento quer por diminui&#231;&#227;o&#44; pode provocar e explicar altera&#231;&#245;es no processo que conduz a este tipo de dem&#234;ncia<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Pelo seu potencial c&#225;rdio&#8208;emb&#243;lico&#44; a presen&#231;a de FA associa&#8208;se a um risco acrescido de acidente vascular transit&#243;rio&#47;acidente vascular cerebral&#44; obrigando a medidas de preven&#231;&#227;o que assentam na hipocoagula&#231;&#227;o oral&#44; referidas&#44; atualmente&#44; a modelos de decis&#227;o bem implementados&#44; atrav&#233;s da utiliza&#231;&#227;o de <span class="elsevierStyleItalic">scores</span> de risco &#40;CHADSVasc2 <span class="elsevierStyleItalic">versus</span> HAS&#8208;BLED&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Tratando&#8208;se de uma patologia continuadamente evolutiva&#44; a hist&#243;ria natural da doen&#231;a come&#231;a por epis&#243;dios curtos e isolados &#40;frequentemente assintom&#225;ticos&#41;&#44; passa por surtos de FA parox&#237;stica&#44; depois por FA persistente e FA persistente de longa dura&#231;&#227;o e&#44; por fim&#44; estabelece&#8208;se como FA permanente&#44; situa&#231;&#227;o em que se aceita a n&#227;o exist&#234;ncia de condi&#231;&#245;es para a sua revers&#227;o ao ritmo sinusal<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Neste contexto&#44; pensa&#8208;se&#44; hoje&#44; que deve ser feito um esfor&#231;o de interven&#231;&#227;o terap&#234;utica &#224;s primeiras manifesta&#231;&#245;es da doen&#231;a&#44; designadamente para prevenir a recorr&#234;ncia&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Deste modo&#44; face &#224;s limita&#231;&#245;es da terap&#234;utica farmacol&#243;gica no controlo da doen&#231;a<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#44; o tratamento da FA por abla&#231;&#227;o &#40;isolamento el&#233;trico das veias pulmonares&#41; deve ser equacionado numa fase precoce&#46; Este procedimento&#44; atualmente bem estabelecido como sendo eficaz e com uma rela&#231;&#227;o risco&#47;benef&#237;cio geralmente favor&#225;vel&#44; est&#225;&#44; essencialmente&#44; indicado em jovens muito sintom&#225;ticos&#44; sem ou com m&#237;nima cardiopatia estrutural&#44; refrat&#225;rios &#224; terap&#234;utica m&#233;dica com pelo menos um anti&#8208;arr&#237;tmico&#46; Pode ser mesmo considerada como terap&#234;utica de 1<span class="elsevierStyleMonospace">&#46;</span>&#170; linha &#40;antes da institui&#231;&#227;o de um f&#225;rmaco anti&#8208;arr&#237;tmico&#41; nas situa&#231;&#245;es de FA parox&#237;stica&#44; recorrente e sintom&#225;tica&#44; se o cora&#231;&#227;o se encontrar estruturalmente normal&#8211;FA isolada &#40;indica&#231;&#227;o classe <span class="elsevierStyleSmallCaps">II</span>a&#41; com a concord&#226;ncia do doente<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">O sucesso desta terap&#234;utica&#44; para al&#233;m da experi&#234;ncia do respetivo Centro&#44; est&#225; diretamente ligado a outros aspetos&#44; tais como as comorbilidades coexistentes&#46; Assim&#44; condi&#231;&#245;es como a obesidade<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> e as doen&#231;as cardiometab&#243;licas a esta associada&#44; nomeadamente a HTA n&#227;o controlada<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a>&#44; a diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> e a apneia de sono<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#44; podem p&#244;r em causa o benef&#237;cio do investimento&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Os autores do artigo proposto &#40;estudo LEGACY&#41; avaliaram o impacto que a redu&#231;&#227;o do peso pode ter na diminui&#231;&#227;o da recorr&#234;ncia arr&#237;tmica num grupo de doentes com hist&#243;ria de FA parox&#237;stica ou persistente&#44; sintom&#225;tica&#46; Conclu&#237;ram&#44; ent&#227;o&#44; que a redu&#231;&#227;o sustentada do peso&#44; a longo prazo&#44; pode contribuir para a redu&#231;&#227;o quer da carga arr&#237;tmica quer da gravidade e do n&#250;mero de epis&#243;dios de FA&#44; favorecendo&#44; assim&#44; condi&#231;&#245;es para a manuten&#231;&#227;o do ritmo sinusal&#46; Este efeito &#233; &#171;dose&#8208;dependente&#187;&#44; ou seja&#44; doentes com obesidade e FA quando perdem pelo menos 10&#37; do seu peso t&#234;m cerca de seis vezes aumentada a probabilidade de permanecerem livres de epis&#243;dios de FA&#44; quando comparados com os doentes que n&#227;o reduziram o excesso ponderal&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Existe a evid&#234;ncia de a obesidade criar&#44; por si s&#243;&#44; condi&#231;&#245;es promotoras de doen&#231;a arr&#237;tmica&#44; ao associar&#8208;se &#224; disfun&#231;&#227;o diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#44; a um estado pr&#243;&#8208;inflamat&#243;rio sist&#233;mico<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&#44; a altera&#231;&#245;es do t&#243;nus auton&#243;mico<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> e &#224; dilata&#231;&#227;o auricular<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46; Um estudo recente demonstra que a obesidade se acompanha de um efeito direto na modifica&#231;&#227;o do substrato auricular<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A perda de peso em doentes obesos pode condicionar altera&#231;&#245;es favor&#225;veis nos fatores de risco cardiovascular&#44; tais como a HTA&#44; a diabetes <span class="elsevierStyleItalic">mellitus</span> e a s&#237;ndrome da apneia obstrutiva de sono&#44; juntamente com melhorias na estrutura e na fun&#231;&#227;o do cora&#231;&#227;o&#46; Estas evid&#234;ncias v&#234;m refor&#231;ar a necessidade da otimiza&#231;&#227;o destes fatores de risco em doentes com FA&#44; de forma a reduzir a probabilidade do aparecimento e da progress&#227;o da doen&#231;a arr&#237;tmica e a aumentar o sucesso da terap&#234;utica por abla&#231;&#227;o&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Conclui&#8208;se que os resultados deste estudo &#40;levado a cabo na Austr&#225;lia com seguimento durante cinco anos&#41; evidenciam a associa&#231;&#227;o da perda de peso com a redu&#231;&#227;o da carga de FA e permitem recomendar a realiza&#231;&#227;o dum ensaio cl&#237;nico randomizado que possa integrar o contributo do progressivo conhecimento da bioqu&#237;mica das situa&#231;&#245;es e mostrar o impacto duma estrat&#233;gia sistem&#225;tica de diminui&#231;&#227;o do peso na evolu&#231;&#227;o de doentes com FA&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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Artigo recomendado do mês
«Estudo LEGACY: Efeitos a longo prazo do controlo de peso guiado por objetivos numa coorte com fibrilhação auricular»
Comment on ‘Long‐Term Effect of Goal‐Directed Weight Management in an Atrial Fibrillation Cohort: A Long‐Term Follow‐Up Study (LEGACY)’
António Hipólito Reis
Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia
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        "titulo" => "Comment on &#8216;Long&#8208;Term Effect of Goal&#8208;Directed Weight Management in an Atrial Fibrillation Cohort&#58; A Long&#8208;Term Follow&#8208;Up Study &#40;LEGACY&#41;&#8217;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Background&#58;</span> Obesity and atrial fibrillation &#40;AF&#41; frequently coexist&#46; Weight loss reduces the burden of AF&#44; but whether this is sustained&#44; has a dose effect&#44; or is influenced by weight fluctuation is unknown&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Objectives&#58;</span> This study sought to evaluate the long&#8208;term impact of weight loss and weight fluctuation on rhythm control in obese individuals with AF&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Methods&#58;</span> Of 1&#44;415 consecutive patients with AF&#44; 825 had a body mass index&#160;&#8805;<span class="elsevierStyleHsp" style=""></span>27<span class="elsevierStyleHsp" style=""></span>kg&#47;m&#40;2&#41; and were offered weight management&#46; After screening for exclusion criteria&#44; 355 were included in this analysis&#46; Weight loss was categorized as group 1 &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41;&#44; group 2 &#40;3&#37;&#160;to&#160;9&#37;&#41;&#44; and group 3 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>3&#37;&#41;&#46; Weight trend and&#47;or fluctuation was determined by yearly follow&#8208;up&#46; We determined the impact on the AF severity scale and 7&#8208;day ambulatory monitoring&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Results&#58;</span> There were no differences in baseline characteristics or follow&#8208;up among the groups&#46; AF burden and symptom severity decreased more in group 1 compared with groups 2 and 3 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for all&#41;&#46; Arrhythmia&#8208;free survival with and without rhythm control strategies was greatest in group 1 compared with groups 2 and 3 &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41;&#46; In multivariate analyses&#44; weight loss and weight fluctuation were independent predictors of outcomes &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both&#41;&#46; Weight loss&#160;&#8805;<span class="elsevierStyleHsp" style=""></span>10&#37; resulted in a 6&#8208;fold &#40;95&#37; confidence interval&#58; 3&#46;4 to 10&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; greater probability of arrhythmia&#8208;free survival compared with the other 2 groups&#46; Weight fluctuation &#62;5&#37; partially offset this benefit&#44; with a 2&#8208;fold &#40;95&#37; confidence interval&#58; 1&#46;0 to 4&#46;3&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; increased risk of arrhythmia recurrence&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conclusions&#58;</span> Long&#8208;term sustained weight loss is associated with significant reduction of AF burden and maintenance of sinus rhythm&#46; &#40;Long&#8208;Term Effect of Goal directed weight management on Atrial Fibrillation Cohort&#58; A 5 Year follow&#8208;up study &#91;LEGACY Study&#93;&#59; ACTRN12614001123639&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Coment&#225;rio</span><p id="par0040" class="elsevierStylePara elsevierViewall">A fibrilha&#231;&#227;o auricular &#40;FA&#41; e a obesidade s&#227;o consideradas&#44; na atualidade&#44; epidemias em crescendo &#224; escala global<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;4</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A import&#226;ncia da FA deve&#8208;se &#224; elevada preval&#234;ncia e constitui a arritmia mais frequente na pr&#225;tica cl&#237;nica&#46; Afeta 2&#44;5&#37; da popula&#231;&#227;o acima dos 40 anos<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> e aumenta progressivamente com a idade &#40;em m&#233;dia cerca de 5&#37; ao ano<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a>&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Reconhece&#8208;se&#44; tamb&#233;m&#44; no seu processo&#44; o impacto hemodin&#226;mico resultante da perda do contributo auricular&#44; da manifesta&#231;&#227;o de di&#225;stoles irregulares e incompletas e&#44; ainda&#44; da amplifica&#231;&#227;o da resposta ventricular&#44; com aumento da frequ&#234;ncia&#44; cuja persist&#234;ncia pode resultar em remodelagem ventricular&#44; levando&#44; ent&#227;o&#44; &#224; dilata&#231;&#227;o e progressiva disfun&#231;&#227;o mioc&#225;rdica &#40;taquicardiomiopatia&#41;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; As implica&#231;&#245;es hemodin&#226;micas podem condicionar&#44; tamb&#233;m&#44; pelas altera&#231;&#245;es a n&#237;vel cerebral&#44; o agravamento ou mesmo aparecimento de doen&#231;a cerebrovascular &#40;estabelecida finalmente como uma dem&#234;ncia de origem vascular&#41;&#46; Note&#8208;se que a varia&#231;&#227;o da frequ&#234;ncia&#44; quer por aumento quer por diminui&#231;&#227;o&#44; pode provocar e explicar altera&#231;&#245;es no processo que conduz a este tipo de dem&#234;ncia<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Pelo seu potencial c&#225;rdio&#8208;emb&#243;lico&#44; a presen&#231;a de FA associa&#8208;se a um risco acrescido de acidente vascular transit&#243;rio&#47;acidente vascular cerebral&#44; obrigando a medidas de preven&#231;&#227;o que assentam na hipocoagula&#231;&#227;o oral&#44; referidas&#44; atualmente&#44; a modelos de decis&#227;o bem implementados&#44; atrav&#233;s da utiliza&#231;&#227;o de <span class="elsevierStyleItalic">scores</span> de risco &#40;CHADSVasc2 <span class="elsevierStyleItalic">versus</span> HAS&#8208;BLED&#41;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Tratando&#8208;se de uma patologia continuadamente evolutiva&#44; a hist&#243;ria natural da doen&#231;a come&#231;a por epis&#243;dios curtos e isolados &#40;frequentemente assintom&#225;ticos&#41;&#44; passa por surtos de FA parox&#237;stica&#44; depois por FA persistente e FA persistente de longa dura&#231;&#227;o e&#44; por fim&#44; estabelece&#8208;se como FA permanente&#44; situa&#231;&#227;o em que se aceita a n&#227;o exist&#234;ncia de condi&#231;&#245;es para a sua revers&#227;o ao ritmo sinusal<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Neste contexto&#44; pensa&#8208;se&#44; hoje&#44; que deve ser feito um esfor&#231;o de interven&#231;&#227;o terap&#234;utica &#224;s primeiras manifesta&#231;&#245;es da doen&#231;a&#44; designadamente para prevenir a recorr&#234;ncia&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Deste modo&#44; face &#224;s limita&#231;&#245;es da terap&#234;utica farmacol&#243;gica no controlo da doen&#231;a<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#44; o tratamento da FA por abla&#231;&#227;o &#40;isolamento el&#233;trico das veias pulmonares&#41; deve ser equacionado numa fase precoce&#46; Este procedimento&#44; atualmente bem estabelecido como sendo eficaz e com uma rela&#231;&#227;o risco&#47;benef&#237;cio geralmente favor&#225;vel&#44; est&#225;&#44; essencialmente&#44; indicado em jovens muito sintom&#225;ticos&#44; sem ou com m&#237;nima cardiopatia estrutural&#44; refrat&#225;rios &#224; terap&#234;utica m&#233;dica com pelo menos um anti&#8208;arr&#237;tmico&#46; Pode ser mesmo considerada como terap&#234;utica de 1<span class="elsevierStyleMonospace">&#46;</span>&#170; linha &#40;antes da institui&#231;&#227;o de um f&#225;rmaco anti&#8208;arr&#237;tmico&#41; nas situa&#231;&#245;es de FA parox&#237;stica&#44; recorrente e sintom&#225;tica&#44; se o cora&#231;&#227;o se encontrar estruturalmente normal&#8211;FA isolada &#40;indica&#231;&#227;o classe <span class="elsevierStyleSmallCaps">II</span>a&#41; com a concord&#226;ncia do doente<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">O sucesso desta terap&#234;utica&#44; para al&#233;m da experi&#234;ncia do respetivo Centro&#44; est&#225; diretamente ligado a outros aspetos&#44; tais como as comorbilidades coexistentes&#46; Assim&#44; condi&#231;&#245;es como a obesidade<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> e as doen&#231;as cardiometab&#243;licas a esta associada&#44; nomeadamente a HTA n&#227;o controlada<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a>&#44; a diabetes <span class="elsevierStyleItalic">mellitus</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> e a apneia de sono<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a>&#44; podem p&#244;r em causa o benef&#237;cio do investimento&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Os autores do artigo proposto &#40;estudo LEGACY&#41; avaliaram o impacto que a redu&#231;&#227;o do peso pode ter na diminui&#231;&#227;o da recorr&#234;ncia arr&#237;tmica num grupo de doentes com hist&#243;ria de FA parox&#237;stica ou persistente&#44; sintom&#225;tica&#46; Conclu&#237;ram&#44; ent&#227;o&#44; que a redu&#231;&#227;o sustentada do peso&#44; a longo prazo&#44; pode contribuir para a redu&#231;&#227;o quer da carga arr&#237;tmica quer da gravidade e do n&#250;mero de epis&#243;dios de FA&#44; favorecendo&#44; assim&#44; condi&#231;&#245;es para a manuten&#231;&#227;o do ritmo sinusal&#46; Este efeito &#233; &#171;dose&#8208;dependente&#187;&#44; ou seja&#44; doentes com obesidade e FA quando perdem pelo menos 10&#37; do seu peso t&#234;m cerca de seis vezes aumentada a probabilidade de permanecerem livres de epis&#243;dios de FA&#44; quando comparados com os doentes que n&#227;o reduziram o excesso ponderal&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Existe a evid&#234;ncia de a obesidade criar&#44; por si s&#243;&#44; condi&#231;&#245;es promotoras de doen&#231;a arr&#237;tmica&#44; ao associar&#8208;se &#224; disfun&#231;&#227;o diast&#243;lica<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#44; a um estado pr&#243;&#8208;inflamat&#243;rio sist&#233;mico<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&#44; a altera&#231;&#245;es do t&#243;nus auton&#243;mico<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> e &#224; dilata&#231;&#227;o auricular<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46; Um estudo recente demonstra que a obesidade se acompanha de um efeito direto na modifica&#231;&#227;o do substrato auricular<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A perda de peso em doentes obesos pode condicionar altera&#231;&#245;es favor&#225;veis nos fatores de risco cardiovascular&#44; tais como a HTA&#44; a diabetes <span class="elsevierStyleItalic">mellitus</span> e a s&#237;ndrome da apneia obstrutiva de sono&#44; juntamente com melhorias na estrutura e na fun&#231;&#227;o do cora&#231;&#227;o&#46; Estas evid&#234;ncias v&#234;m refor&#231;ar a necessidade da otimiza&#231;&#227;o destes fatores de risco em doentes com FA&#44; de forma a reduzir a probabilidade do aparecimento e da progress&#227;o da doen&#231;a arr&#237;tmica e a aumentar o sucesso da terap&#234;utica por abla&#231;&#227;o&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Conclui&#8208;se que os resultados deste estudo &#40;levado a cabo na Austr&#225;lia com seguimento durante cinco anos&#41; evidenciam a associa&#231;&#227;o da perda de peso com a redu&#231;&#227;o da carga de FA e permitem recomendar a realiza&#231;&#227;o dum ensaio cl&#237;nico randomizado que possa integrar o contributo do progressivo conhecimento da bioqu&#237;mica das situa&#231;&#245;es e mostrar o impacto duma estrat&#233;gia sistem&#225;tica de diminui&#231;&#227;o do peso na evolu&#231;&#227;o de doentes com FA&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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ISSN: 21742049
Original language: Portuguese
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Revista Portuguesa de Cardiologia (English edition)
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