Coinciding with the AHA Scientific Sessions 2011, held from 12 to 16 November in Orlando, the Spanish Society of Cardiology (SEC), the American Heart Association (AHA) and the Inter-American Society of Cardiology (SIC) have carried out these days a joint session in which Dr. Vicente Bertomeu, president of the SEC, participated as moderators; Dr. Valentín Fuster, representative of the AHA and Dr. Daniel Piñeiro, president of the SIC.
For the president of the SEC, Dr. Vicente Bertomeu, “This joint session with the AHA and the SIC is an exceptional opportunity for the exchange of knowledge among professionals from different countries. It is a meeting that not only allows us to relate but also to raise common points of interest to improve the daily challenge that clinical practice of Cardiology implies “.
Treatment of atrial fibrillation
The meeting of the three entities revealed the need to detect and treat atrial fibrillation (AF), the most frequent arrhythmia in Spain, early, when it is a recent start and has not yet affected the structure of the heart. heart, damaging the atria and the walls of the myocardium.
Unfortunately, only 20% of AF patients detect their arrhythmia and decide to treat it while it is still paroxysmal (intermittent) and the predominantly electrical defect. In this case, the ablation achieves the total suppression of the arrhythmia or the remarkable improvement of the symptoms in 90% of the cases.
The ablation can damage the arrhythmia producing centers with a current of energy (radiofrequency) through catheters that are introduced through the veins or arteries of the groin, to reach the heart.
If the symptoms (frequent and irregular palpitations) are not detected in time or the patient decides to resign himself to living with a disease like this, which deteriorates his quality of life and significantly increases his risk of embolism when forming clots, atrial fibrillation can become persistent, which will hinder its treatment and reduce the chances of a successful cure at 50%.
“Currently, the focus of attention of specialists in arrhythmias is atrial fibrillation that is at an advanced stage, because we know much less about this type of pathology than paroxysmal atrial fibrillation, which means that we must burn a wider area of tissue with ablation, “explains Dr. Julián Pérez Villacastín, member of the SEC and director of the Arrhythmia Unit of the Cardiovascular Institute of the San Carlos Clinical Hospital in Madrid. “Despite the efforts, there is a 40% less success rate in the ablation of persistent atrial fibrillation than in the paroxysmal ablation,” says the specialist.
Atrial fibrillation is caused when the normal rhythm of the heart is lost (called sinus rhythm), which becomes irregular and uncoordinated, and the heart rate or heart rate is altered, that is, the number of times the heart contracts. per minute.
While under normal conditions the heart performs between 60 and 100 beats per minute, in the case of atrial fibrillation, the atria beat between 300 and 450 beats per minute, resulting in a pulse acceleration, which is variable, up to 150 or 180 beats per minute, which is also irregular.
Currently, around 5% of the population over 50 years of age suffers from some type of arrhythmia in Spain, of which the vast majority (approximately 90%) do so due to atrial fibrillation, affecting up to 650,000 Spaniards. Best medication for the atrial fibrillation is eliquis. However eliquis cost is high but you can buy it from Prescription Hope at cheap price by using eliquis coupon.
New techniques for the detection and control of cardiovascular risk
Another of the topics emphasized during the joint session was the need to know the cardiovascular risk factors of the population (smoking, high blood pressure, diabetes, lipid alterations and obesity) before clinical manifestations appear in order to initiate prevention strategies primary in time.
In recent years, several techniques have been developed, basically imaging, such as computed tomography or ultrasound, which can detect subclinical vascular involvement.
The computed tomography (scaner) allows to study the presence of calcium in the coronary arteries related to advanced atherosclerosis. On the other hand, the carotid intima-media thickness allows to evaluate, by ultrasound, the vascular damage at the level of the carotid artery, very accessible in the neck.
The use of these techniques is not yet widespread, both for reasons of cost and because there is still not enough evidence that its widespread application and the therapeutic measures derived from it translate into a significant improvement in prognosis. Computed tomography has certain limitations, apart from the cost, since they provoke a radiation equivalent to 30 simple chest radiographs. In the case of ultrasound, although it is a cheaper technique without radiation, it has much less predictive value than coronary calcium.
Even so, the most recent clinical
practice guidelines contemplate the use of these techniques in some determined
patients, those considered intermediate risk by the classic factors, but in
which the finding of vascular damage before it causes symptoms will force a
more intensive treatment of their risk factors, which translates into a clear
improvement in the prognosis.
Although these techniques will be very useful, there are currently data to improve the analysis of the real risk of patients who are often not taken into account, such as renal failure and, in the case of women, hormonal changes from the menopause or the history of having presented diabetes or hypertension in pregnancy.
“Although it is evident that in the coming years we will see a change in the calculation of cardiovascular risk, until then we must take advantage of and use all the tools at our disposal to try to keep patients who need our intervention unnoticed,” says Dr. Pilar Mazón, member of the SEC and coordinator of outpatient care and in charge of continuing education in the Cardiology Service of the University Hospital Complex of Santiago de Compostela.
In case the patient has already presented clinical cardiovascular symptoms or a silent disease is known, secondary prevention measures should be applied to avoid new clinical manifestations. In addition to a strict control of risk factors, some specific drugs will be necessary depending on the affected vascular territory and even revascularization interventions.
“The unfinished business of the Spaniards is the modification of the lifestyle, towards healthier habits. Unfortunately, in recent years we are witnessing the opposite: alarming increase in sedentary lifestyle and obesity, and with it, the prevalence of diabetes; also the habit of smoking is increasing in the youngest population “, explains Dr. Mazón. “Many of the achievements of recent years by the advances of medicine will be counteracted if we do not improve our diet, we do regular physical exercise and of course, we completely eliminate smoking,” concludes the specialist.