Martín Ibarrola
Figura 4. RMN de cerebro donde se observa una imagen focal hiperintensa en secuencia FLAIR y T2 en la sustancia blanca yuxtacortical subcortical de la región subinsular izquierda
ras. La evolución es favorable hasta el presente. De todos modos, no resulta clara la causa del síncope, que podría atribuirse a un episodio más prolongado de taquiarritmia auricular con frecuencia ventricular muy elevada, aunque otras posibilidades no son descartables, por ej. depresión severa de la actividad del nódulo sinusal postaquicardia.
Bibliografía Coppens M, Eikelboom JW, Hart RG, Yusuf S, Lip GY, Dorian P, Shestakovska O, Connolly SJ.. The CHA2DS2-VASc score identifies those patients with atrial fibrillation and aCHADS2score of 1 who are unlikely to benefit from oral anticoagulant therapy. Eur Heart J(2013; 34 (3): 170-176 2. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ.. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285:2864–2870. 3. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A 1.
Electrofisiología y Arritmias, Vol 6, N° 2 / Mayo - Agosto 2013
novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010 Nov;138(5):1093-100 4. Lip GY. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HASBLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011; 11; 57(2):173-80. 5. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL,Wann S, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ,Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e257–e354 6. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH.. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31:2369–2429 7. Detection of Paroxysmal Atrial Fibrillation in Stroke/Tia Patients. Muhib Khan and Daniel J. Miller. Stroke Res Treat. 2013; 2013:840265. 8. Lip GY. Can we predict stroke in atrial fibrillation? Clin Cardiol. 2012 Jan;35 Suppl 1:21-7. 9. Bogousslavsky J, Cachin C, Regli F, Despland PA, Van Melle G, Kappenberger L.Cardiac sources of embolism and cerebral infarction. Clinical consequences and vascular concomitants: The Lausanne Stroke Registy. Neurology 1991; 41: 855-959. 10. Insular Ischemic Stroke: Clinical Presentation and Outcome. Lemieux F, Lanthier S, Chevrier MC, Gioia L, Rouleau I, Cereda C, Nguyen DK. Cerebrovasc Dis Extra. 2012 Jan-Dec; 2(1): 80–87.
Nota del Director: Este caso es ilustrativo del riesgo de ACV que puede implicar la presencia de FAP silenciosas u oligosintomáticas, aun cuando su duración es breve, en concordancia con lo señalado por el Dr. Jorge Garguichevich en su artículo de opinión.
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