RESUMEN
In 2030, the European Union will include 14 to 17 million atrial fibrillation (AF) patients, with 120,000 to 215,000 new cases each year. The increase in the prevalence of this arrhythmia has led to the development of new therapeutic intervention strategies to manage the different aspects of this disease. Thus, endocavitary or epicardial ablation of AF, by radiofrequency or cryoablation, provides superior results to antiarrhythmic therapy in controlling symptoms and preventing heart failure in paroxysmal or persistent AF. In heart failure patients with advanced AF, the ablation of the atrioventricular junction associated with the implantation of a bi-ventricular pacemaker has just demonstrated its clear superiority, bringing this technique up to date. Finally, in the event of a major bleeding risk and contraindication to anticoagulants, percutaneous occlusion of the left atrium has proven its value in preventing AF-related embolic events. The future will certainly see the emergence of new technologies but also personalized strategies based on an optimal selection of the right candidates for these interventions, thanks in particular to the contribution of imaging before the procedure.
Asunto(s)
Fibrilación Atrial/terapia , Fibrilación Atrial/clasificación , Fibrilación Atrial/epidemiología , Crioterapia , Desfibriladores Implantables , Insuficiencia Cardíaca/terapia , Humanos , Marcapaso Artificial , Ablación por Radiofrecuencia , Recurrencia , Factores de Riesgo , Dispositivo Oclusor SeptalRESUMEN
Each year, 5 million new cases of atrial fibrillation (AF) are diagnosed, and the data for the last 20 years show that its incidence has continued to grow. The aging of the population is considered a major explanation for this pandemic phenomenon. The complications associated with atrial arrhythmia are numerous and frequent, with in the first place thromboembolic events. In addition to symptomatic atrial fibrillation, AF may be diagnosed by chance during a systematic ECG, an external Holter or a continuous ECG monitor, or in the memories of implanted cardiac devices. This is called silent AF. Despite numerous studies, silent AF is still largely under-diagnosed and unrecognized in everyday clinical practice, although it is a frequent condition with potentially serious consequences (especially thromboembolic events). Thanks to the development of new diagnostic tools, which are scientifically validated and readily available, the detection of AF has improved significantly, leading to better therapeutic management, in particular anticoagulant therapy. From this perspective, mass screening for silent AF using these new technologies is a major step forward in e-health development. The cost of screening and the heterogeneity of populations affected by silent AF, however, remain major obstacles.
Asunto(s)
Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Tamizaje Masivo/métodos , Enfermedades Asintomáticas , Fibrilación Atrial/epidemiología , Electrocardiografía , Humanos , Incidencia , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiologíaRESUMEN
The relationship between endogenous oleic acid produced by hepatic delta9-desaturase and the secretion of VLDL-triglycerides was investigated in a primary culture of chicken hepatocytes. When the fatty acid compositions of the secreted and intracellular triglycerides (TG) (or triacylglycerols) were compared, an imbalance between monoenes and saturated fatty acids was observed, with the secreted TG being significantly more unsaturated than the intracellular TG. The addition of a mixture of cyclopropenic fatty acids (specific inhibitors of fatty acid desaturation) to the culture medium of cells 24 h before measurement of their delta9-desaturase activity and TG secretion rate caused a significant impairment of both desaturase activity and TG secretion, without affecting total TG synthesis. However, the addition of oleic acid to the culture medium of cells treated with cyclopropenic fatty acids restored the TG secretion rate. Palmitic acid did not restore the TG secretion rate and linoleic acid partly restored the TG secretion rate. Finally, even in the presence of oleic acid in the culture medium of secreting cells, those which had been treated with cyclopropenic fatty acids had a significantly lower TG secretion rate than nontreated cells. Taken together, these results show that TG secretion is highly dependent on the delta9-desaturase activity and suggest that oversecretion of VLDL-TG in chickens and subsequent fattening could originate in a high hepatic delta9-desaturation of saturated fatty acids.