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2001, Número 5

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Gac Med Mex 2001; 137 (5)


Fibrilación auricular. Nuevos aspectos sobre una vieja enfermedad

Enrique Asensio-Lafuente, José Benito Alvarez-Mosquera, J. Enrique Lozano-Díaz, Alfonso Farías Vega, René Narváez-David, Joel Dorantes-García, Arturo Orea-Tejeda, Verónica Rebollar-González, J. Manuel Portos-Silva, Jorge Oseguera-Moguel

Idioma: Español
Referencias bibliográficas: 82
Paginas: 445-458
Archivo PDF: 119.17 Kb.


RESUMEN

La fibrilación auricular es la arritmia encontrada más frecuentemente en la clínica. Los principales problemas derivados de ella son los eventos trombóticos recurrentes y el deterioro de la clase funcional. La fibrilación auricular induce alteraciones de los canales iónicos, que la perpetúan. El tratamiento de la FA se encamina a corregir estas alteraciones y regresar al ritmo sinusal, al tiempo que se debe controlar la frecuencia cardiaca y prevenir eventos embólicos por medio de anticoagulación o tratamiento con antiagregantes plaquetarios. Actualmente existen recursos con antiarrítmicos de clase IC o clase III para intentar recuperar el ritmo sinusal. Las tasas de éxito son variables y las mejores se obtienen con flecainida o propafenona en los casos sin cardiopatía estructural y amiodarona cuando ésta existe. Las combinaciones de pacientes y fármacos son múltiples, cada caso debe ser individualizado. Los nuevos antiarrítmicos de clase III han mostrado eficacia pero con tasas relativamente altas de reacciones adversas como taquicardia helicoidal. La anticoagulación sería el tratamiento preferido para la mayoría de los enfermos, pero se debe ajustar en cada caso. Las terapias como la ablación con catéter focal o lineal, así como la estimulación auricular o biauricular y los desfibriladores implantables requieren de un seguimiento a mayor plazo y también necesitan de tratamiento antiarrítmico agregado. La cirugía tiene una morbi-mortalidad alta, por lo que el riesgo supera al beneficio.


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