que se leu este artigo
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[ "pt" => array:1 [ "titulo" => "Impacto da ablação por cateter de fibrilhação auricular em doentes com insuficiência cardíaca e disfunção sistólica do ventrículo esquerdo" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 985 "Ancho" => 2714 "Tamanyo" => 106264 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Improvements after catheter ablation in left ventricular ejection fraction (A), left atrial diameter (B) and left ventricular end-diastolic diameter (C). CI: confidence interval; LVEF: left ventricular ejection fraction.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joana Maria Ribeiro, Pedro A. Sousa, Natália António, Rui Baptista, Luís Elvas, Sérgio Barra, Lino Gonçalves" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Joana Maria" "apellidos" => "Ribeiro" ] 1 => array:2 [ "nombre" => "Pedro A." 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "445" "paginaFinal" => "446" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Mauricio I. Scanavacca" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Mauricio I." "apellidos" => "Scanavacca" "email" => array:1 [ 0 => "mauricio.scanavacca@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Heart Institute (InCor) University of São Paulo Medical School, Brazil" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Melhoria da função ventrícular esquerda após ablação por cateter de fibrilhacão auricular. Que tipo de procedimento de ablação e para quem?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It is well known that high heart rate, loss of atrial systole and variable diastolic time resulting from atrial fibrillation (AF) induce heart failure (HF), and that pathophysiological hemodynamic and hormonal mechanisms involved in HF create conditions for AF occurrence and maintenance.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> When these disorders coexist, a vicious circle is thus created. In this context, it seems obvious that restoring and maintaining sinus rhythm in patients with HF and AF should lead to clinical benefits. However, several clinical studies performed over the years have failed to demonstrate significant improvement in clinical endpoints by maintaining sinus rhythm with antiarrhythmic drugs compared to heart rate control.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the Rhythm Control Versus Rate Control for Atrial Fibrillation and Heart Failure (AF-CHF) trial,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> a randomized study comparing rhythm control with ventricular rate control in patients with HF (left ventricular ejection fraction [LVEF] <35%) and AF, no significant benefit of rhythm control was demonstrated in mortality or surrogate clinical endpoints. One possible explanation for those results was the adverse effects of antiarrhythmic drugs, which may have counterbalanced the potential benefit of maintaining sinus rhythm.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> However, no clinical benefit was demonstrated even when antiarrhythmic drugs recommended for patients with HF, such as dofetilide and amiodarone, were used in clinical studies.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">More recently, rhythm control has been demonstrated to be an effective strategy for AF when catheter ablation is used to treat selected patients with heart failure and reduced LVEF.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5–7</span></a> CASTLE-AF, a multicenter study involving patients with these characteristics, first demonstrated reductions in all-cause mortality and cardiovascular mortality after catheter ablation. Additionally, patients undergoing catheter ablation presented lower hospitalization rates due to heart failure, lower AF burden, and improvements in LVEF and physical capacity.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Data from other studies have confirmed these observations.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the CAMTAF trial, a randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure, patients with HF (LVEF <50% and New York Heart Association [NYHA] functional classes II and III) and persistent AF were randomized to medical heart rate control (24 patients) or catheter ablation (26 patients). Although most patients required more than one procedure, freedom from AF after the last ablation procedure was achieved in 19/26 patients (73%) off antiarrhythmic drugs. There was a significant improvement in LVEF in the ablation group (40±12%) compared with the rate-control group (31±13%) (p=0.015). Ablation was also associated with better scores on the Minnesota Living with Heart Failure Questionnaire compared to heart rate control (24±22 vs. 47±22; p=0.001).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The Ablation Versus Amiodarone For Treatment Of Persistent Atrial Fibrillation In Patients With Congestive Heart Failure And An Implanted Device (AATAC) trial was an open-label, randomized, parallel-group, multicenter study assessing patients with AF and heart failure (NYHA II to III and LVEF <40%), who received a dual-chamber implantable cardioverter-defibrillator or cardiac resynchronization therapy. Patients were randomly assigned to undergo catheter ablation (n=102) or medical treatment with amiodarone (n=101). In this study, AF recurrence was planned as the primary endpoint and all-cause mortality and unplanned hospitalization as the secondary endpoints. During a minimum follow-up of 24 months, 71 (70%) patients in the ablation group were free of recurrence after one or more procedures, compared to 34 (34%) patients in the amiodarone group (p<0.001). The unplanned hospitalization rate was 31% in the ablation group and 57% in the amiodarone group (p<0.001). More importantly, significantly lower mortality was observed in the catheter ablation group (8% vs. 18%, p=0.03).<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Ribeiro et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> retrospectively assess a group of 153 patients who underwent AF ablation between July 2016 and November 2018. Of these, 22 patients with heart failure (32% NYHA class II and 58% class III) and LVEF <50% fulfilled the inclusion criteria. Selected patients were presumed to have persistent tachycardia related to AF, but left ventricular dysfunction could have been caused by dilated cardiomyopathy.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although the study included a small number of patients, the results were favorable to rhythm control and in agreement with recent publications. In a mean follow-up of 11 months, catheter ablation resulted in an increase in LVEF from 40% to 58% (p<0.01) and NYHA functional class improved from 2.35±0.49 to 1.3±0.47 (p<0.001). Additionally, left atrial and left ventricular dimensions decreased from 48.0 mm to 44 mm (p<0.01) and from 61.0 mm to 55.0 mm (p<0.1), respectively.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Despite these important observations, there are still many unanswered questions regarding this subject. For example, are these results reproducible in HF patients with different profiles? It should be borne in mind that CASTLE-AF assessed 3013 patients for eligibility, of whom only 363 were included in the primary analysis. Is AF ablation as effective in patients with previous dilated cardiomyopathy as in those with AF-induced heart failure (tachycardiomyopathy)? How much does left atrial contraction status impact the clinical results?</p><p id="par0045" class="elsevierStylePara elsevierViewall">Additionally, catheter ablation for persistent AF is still evolving. Different strategies have been proposed to improve results, but there is still no clear benefit beyond that expected from antral pulmonary vein isolation. Could left atrial magnetic resonance imaging or echocardiographic assessment of LA function help select patients in whom ablation brings benefits?<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9,10</span></a> We still have a long way to go to better understand, select and manage these patients.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. 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Ano/Mês | Html | Total | |
---|---|---|---|
2024 Novembro | 10 | 6 | 16 |
2024 Outubro | 53 | 41 | 94 |
2024 Setembro | 38 | 29 | 67 |
2024 Agosto | 42 | 30 | 72 |
2024 Julho | 39 | 33 | 72 |
2024 Junho | 34 | 25 | 59 |
2024 Maio | 47 | 26 | 73 |
2024 Abril | 36 | 27 | 63 |
2024 Maro | 28 | 25 | 53 |
2024 Fevereiro | 26 | 27 | 53 |
2024 Janeiro | 34 | 23 | 57 |
2023 Dezembro | 24 | 14 | 38 |
2023 Novembro | 37 | 42 | 79 |
2023 Outubro | 20 | 15 | 35 |
2023 Setembro | 27 | 28 | 55 |
2023 Agosto | 29 | 14 | 43 |
2023 Julho | 27 | 4 | 31 |
2023 Junho | 27 | 16 | 43 |
2023 Maio | 31 | 22 | 53 |
2023 Abril | 19 | 2 | 21 |
2023 Maro | 25 | 21 | 46 |
2023 Fevereiro | 23 | 18 | 41 |
2023 Janeiro | 13 | 18 | 31 |
2022 Dezembro | 25 | 22 | 47 |
2022 Novembro | 36 | 28 | 64 |
2022 Outubro | 31 | 24 | 55 |
2022 Setembro | 24 | 35 | 59 |
2022 Agosto | 27 | 36 | 63 |
2022 Julho | 24 | 34 | 58 |
2022 Junho | 20 | 35 | 55 |
2022 Maio | 23 | 32 | 55 |
2022 Abril | 28 | 34 | 62 |
2022 Maro | 34 | 39 | 73 |
2022 Fevereiro | 23 | 38 | 61 |
2022 Janeiro | 25 | 33 | 58 |
2021 Dezembro | 18 | 36 | 54 |
2021 Novembro | 26 | 44 | 70 |
2021 Outubro | 54 | 64 | 118 |
2021 Setembro | 33 | 34 | 67 |
2021 Agosto | 32 | 49 | 81 |
2021 Julho | 27 | 25 | 52 |
2021 Junho | 124 | 75 | 199 |
2021 Maio | 27 | 39 | 66 |
2021 Abril | 28 | 35 | 63 |
2021 Maro | 28 | 24 | 52 |
2021 Fevereiro | 5 | 4 | 9 |