Información del artículo
Resumen
El ictus y la fibrilación auricular (FA) son una verdadera epidemia vascular y sus consecuencias son catastróficas. La complicación mas común y devastadora de la FA es el ictus cardioembólico, pero esta catástrofe es previsible y prevenible.
El diagnóstico etiológico correcto del ictus es esencial para poder realizar una prevención adecuada. Hay un porcentaje de ictus isquémicos criptogénicos demasiado elevado, y es preciso mejorar la detección de la FA y otras fuentes cardioembólicas.
La isquemia cerebral cardioembólica es prevenible; sin embargo, la inercia medica, la falta de adherencia del paciente y los problemas de los antagonistas de la vitamina K, llevan a que muchos pacientes estén en riesgo de sufrir una isquemia cerebral.
Los relevantes avances recientes con fármacos como la dronedarona y el dabigatrán e inhibidores del FXa, abren una esperanza real para mejorar su prevención, y ya se reflejan en las guías terapéuticas y, por tanto, los neurólogos los debemos conocer. El mundo vascular y la sociedad están de enhorabuena, podemos evitar mucho sufrimiento.
Palabras clave:
Ictus
Fibrilación auricular
Prevención
Dronedarona
Dabigatrán
Inhibidores FXa
Cardioembolia
Abstract
Stroke and atrial fibrillation (AF) constitute a true vascular epidemic with catastrophic consequences. The most common and devastating complication of AF is cardioembolic stroke but this catastrophic event can be predicted and prevented.
Accurate etiologic diagnosis of stroke is essential for effective prevention. The percentage of cryptogenic ischemic strokes is too high and detection of AF and other causes of cardioembolic events should be improved.
Cardioembolic cerebral ischemia can be prevented. However, because of physician inertia, lack of patient adherence and the problems of vitamin K antagonists, many patients are at risk of cerebral ischemia.
Recently, major advances with drugs such as dronedarone, dabigatran and FXa inhibitors have opened the way to improving stroke prevention, as reflected in therapeutic guidelines, and neurologists should be familiar with these drugs. There is reason to hope that much suffering can be avoided.
Keywords:
Stroke
Atrial fibrillation
Prevention
Dronedarone
Dabigatran
Fxa inhibitors
Cardioembolism
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Bibliografía
[1.]
A. Gil Núñez.
Advances in the prevention of cerebral ischaemia due to atrial fibrillation.
Neurologia, 25 (2010), pp. 401-408
[2.]
J. Díaz-Guzmán, J.A. Egido-Herrero, B. Fuentes, C. Fernández-Pérez, R. Gabriel-Sánchez, G. Barberà, et al.
Proyecto Ictus del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología. Incidence of strokes in Spain: the Iberictus study. Data from the pilot study.
Rev Neurol, 48 (2009), pp. 61-65
[3.]
J. Díaz-Guzmán, F. Bermejo-Pareja, J. Benito-León, S. Vega, R. Gabriel, M.J. Medrano.
Prevalence of stroke and transient ischemic attack in three elderly populations of central Spain. Neurological Disorders in Central Spain (NEDICES) Study Group.
Neuroepidemiology, 30 (2008), pp. 247-253
[4.]
Y. Winter, C. Wolfram, M. Schaeg, J.P. Reese, W.H. Oertel, R. Dodel, et al.
Evaluation of costs and outcome in cardioembolic stroke or TIA.
J Neurol, 256 (2009), pp. 954-963
[5.]
A. Gil-Núñez, J. Vivancos, R. Gabriel.
Proyecto Ictus del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología. Diagnosis and secondary prevention measures in patients hospitalized for cerebral infarction in Spain. The DIAPRESIC study.
Med Clin (Barc), 131 (2008), pp. 765-769
[7.]
D. Rigau Comas, J. Álvarez-Sabín, A. Gil Núñez, S. Abilleira Castells, F.X. Borras Pérez, P. Armario García, et al.
Primary and secondary prevention of stroke: A guideline.
Med Clin (Barc), 133 (2009), pp. 754-762
[8.]
E.H. Yu, C. Lungu, R.M. Kanner, R.B. Libman.
The use of diagnostic tests in patients with acute ischemic stroke.
J Stroke Cerebrovasc Dis, 18 (2009), pp. 178-184
[9.]
A.H. Tayal, M. Tian, K.M. Kelly, S.C. Jones, D.G. Wrigth, D. Singh, et al.
Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke.
Neurology, 71 (2008), pp. 1696-1701
[10.]
J. Liao, Z. Khalid, C. Scallan, C. Morillo, M. O’Donnell.
Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke. A Systematic Review.
Stroke, 38 (2007), pp. 2935-2940
[11.]
A.G. Douen, N. Pageau, S. Medic.
Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke.
Stroke, 39 (2008), pp. 480-482
[12.]
R.M. Vivanco Hidalgo, A. Rodríguez Campello, A. Ois Santiago, E. Cuadrado Godia, C. Pont Sunyer, J. Roquer.
Monitorización cardiaca en la unidad de ictus: importancia del diagnóstico de fibrilación auricular en el ictus isquémico agudo.
Rev Esp Cardiol, 62 (2009), pp. 564-567
[13.]
L. Elijovich, S.A. Josephson, G.L. Fung, W.S. Smith.
Intermittent atrial fibrillation may account for a large proportion of otherwise cryptogenic stroke: a study of 30-day cardiac event monitors.
J Stroke Cerebrovasc Dis, 18 (2009), pp. 185-189
[14.]
N. Gaillard, S. Deltour, B. Vilotijevic, A. Hornych, S. Crozier, A. Leger, et al.
Detection of paroxysmal atrial fibrillation with transtelephonic EKG in TIA or stroke patients.
Neurology, 74 (2010), pp. 1666-1670
[15.]
T. Rizos, C. Rasch, E. Jenetzky, C. Hametner, S. Kathoefer, R. Reinhardt, et al.
Detection of paroxysmal atrial fibrillation in acute stroke patients.
Cerebrovasc Dis, 30 (2010), pp. 410-417
[16.]
P.D. Ziegler, T.V. Glotzer, E.M. Daoud, D.G. Wyse, D.E. Singer, M.D. Ezekowitz.
Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events.
Stroke, 41 (2010), pp. 256-260
[17.]
H.-J. Cho, H.-J. Choi, Y.D. Kim, H.-S. Nam, S.W. Han, J.W. Ha, et al.
Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history.
J Neurol Neurosurg Psychiatry, 81 (2010), pp. 412-415
[18.]
V. Fuster, L.E. Rydén, D.S. Cannom, H.J. Crijns, A.B. Curtis, K.A. Ellenbogen, American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society, et al.
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, 114 (2006), pp. e257-e354
[19.]
S.H. Hohnloser, H.J.G.M. Crijns, M. Van Eickels, C. Gaudin, R.L. Page, C. Torp-Pedersen, et al.
Effect of dronedarone on cardiovascular events in atrial fibrillation.
N Engl J Med, 360 (2009), pp. 668-678
[20.]
S.J. Connolly, H.J. Crijns, C. Torp-Pedersen, M. Van Eickels, C. Gaudin, R.L. Page, ATHENA Investigators, et al.
Analysis of Stroke in ATHENA: A Placebo-Controlled, Double-Blind. Parallel-Arm Trial to Assess the Efficacy of Dronedarone 400mg BID for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter.
Circulation, 120 (2009), pp. 1174-1180
[21.]
S.J. Connolly, A.J. Camm, J.L. Halperin, C. Joyner, M. Alings, J. Amerena, PALLAS Investigators, et al.
Dronedarone in high-risk permanent atrial fibrillation.
N Engl J Med, 365 (2011), pp. 2268-2276
[22.]
L. Fauchier, B. Pierre, A. De Labriolle, C. Grimard, N. Zannad, D. Babuty.
Antiarrhythmic effect of statin therapy and atrial fibrillation a meta-analysis of randomized controlled trials.
J Am Coll Cardiol, 51 (2008), pp. 828-835
[23.]
B.A. Schaer, C. Schneider, S.S. Jick, D. Conen, S. Osswald, C.R. Meier.
Risk for incident AF in patients who receive antihypertensive drugs.
Ann Intern Med, 152 (2010), pp. 78-84
[24.]
R.G. Hart, L.A. Pearce, M.I. Aguilar.
Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
Ann Intern Med, 146 (2007), pp. 857-867
[25.]
E. Díez Tejedor, B. Fuentes, A.C. Gil Núñez, A. Gil Peralta, J. Matias Guiu, por el comité ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN.
Guía para el tratamiento preventivo de la isquemia cerebral.
Guía para el tratamiento y la prevención del ictus. GEECV-SEN,
[26.]
European Stroke Organisation (ESO) Executive Committee.
ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008, 25 (2008), pp. 457-507
[27.]
A.J. Camm, P. Kirchhof, G.Y. Lip, U. Schotten, I. Savelieva, S. Ernst, et al.
European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. 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, 31 (2010), pp. 2369-2429
[28.]
Harrison P. The latest on new developments in atrial fibrillation. Canadian Cardiovascular Congress Clinical Supplement. Based on: CCS Atrial Fibrillation Guidelines & The Evolution of ACS: A Town Hall Discussion Focusing on Practical Considerations in Antiplatelet Therapy [consultado 26-10-2010]. Disponible en: http://www.cardiocongress.org/pdf/infocardio/Clinical_ Supplement_07.pdf
[29.]
K.L. Furie, S.E. Kasner, R.J. Adams, G.W. Albers, R.L. Bush, S.C. Fagan, on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research, et al.
Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
Stroke, 42 (2011), pp. 227-276
[30.]
G.Y. Lip, R. Nieuwlaat, R. Pisters, D.A. Lane, H.J. Crijns.
Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
Chest, 137 (2010), pp. 263-272
[31.]
F. Pérez-Gómez, E. Alegría, J. Berjón, J.A. Iriarte, J. Zumalde, A. Salvador, NASPEAF Investigators, et al.
Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation: a randomized multicenter study.
J Am Coll Cardiol, 44 (2004), pp. 1557-1566
[32.]
The ACTIVE Investigators.
Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation.
N Engl J Med, 360 (2009), pp. 2066-2078
[33.]
D.R. Holmes, V.Y. Reddy, Z.G. Turi, S.K. Doshi, H. Sievert, M. Buchbinder, for the PROTECT AF Investigators, et al.
Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial. brillation: a randomised non-inferiority trial.
Lancet, 374 (2009), pp. 534-542
[34.]
H.D. White, M. Gruber, J. Feyzi, S. Kaatz, H.F. Tse, S. Husted, et al.
Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control. Results From SPORTIF III and V.
Arch Intern Med, 167 (2007), pp. 239-245
[35.]
C.L. Morgan, P. McEwan, A. Tukiendorf, P.A. Robinson, A. Clemens, J.M. Plumb.
Warfarin treatment in patients with atrial fibrillation: observing outcomes associated with varying levels of INR control.
Thrombosis Research, 124 (2009), pp. 37-41
[36.]
G.P. Samsa, D.B. Matchar, L.B. Goldstein, A.J. Bonito, L.J. Lux, D.M. Witter, et al.
Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities.
Arch Intern Med, 160 (2000), pp. 967-973
[37.]
D.J. Gladstone, E. Bui, B. Fang, A. Laupacis, M.P. Lindsay, J.V. Tu, et al.
Potentially preventable strokes in high risk patients with atrial fibrillation who are not adequately anticoagulated.
Stroke, 40 (2009), pp. 235-240
[38.]
R.G. Hart, M.I. Aguilar.
Anticoagulation in atrial fibrillation: selected controversies including optimal anticoagulation intensity, treatment of intracerebral hemorrhage.
J Thromb Thrombolysis, 25 (2008), pp. 26-32
[39.]
R. Pisters, D.A. Lane, R. Nieuwlaat, C.B. De Vos, H.J. Crijns, G.Y. Lip.
A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.
Chest, 138 (2010), pp. 1093-1100
[40.]
D.E. Singer, Y. Chang, M.C. Fang, L.H. Borowsky, N.K. Pomernacki, N. Udaltsova, et al.
Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular nonvalvular atrial fibrillation? The ATRIA Study.
Circ Cardiovasc Qual Outcomes, 2 (2009), pp. 297-304
[41.]
J. Mant, F.D. Hobbs, K. Fletcher, A. Roalfe, D. Fitzmaurice, G.Y. Lip, et al.
BAFTA investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study BAFTA): a randomised controlled trial.
Lancet, 370 (2007), pp. 493-503
[42.]
D.E. Singer, Y. Chang, M.C. Fang, L.H. Borowsky, N.K. Pomernacki, N. Udaltsova, et al.
The net clinical benefit of warfarin anticoagulation in atrial fibrillation.
Ann Intern Med, 151 (2009), pp. 297-305
[43.]
P. Laguna, A. Martín, C. Del Arco, P. Gargantilla, Investigators in the Spanish Atrial Fibrillation in Emergency Medicine Study Group (GEFAUR).
Risk factors for stroke and thromboprophylaxis in atrial fibrillation: what happens in daily clinical practice? The GEFAUR-1 study.
Ann Emerg Med, 44 (2004), pp. 3-11
[44.]
S.J. Connolly, M.D. Ezekowitz, S. Yusuf, J. Eikelboom, J. Oldgren, A. Parekh, and the RE-LY Steering Committee and Investigators, et al.
Dabigatran versus warfarin in patients with atrial fibrillation.
N Engl J Med, 361 (2009), pp. 1139-1151
[45.]
Connolly SJ, Ezekowitz MD, Yusuf S, Reilly PA, Lars Wallentin; for the Randomized Evaluation of Long-TermAnticoagulation Therapy Investigators. Newly identified events in the RE-LY trial. N Engl J Med. 363: 1875–6.
[46.]
Atrial fibrillation investigators.
Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials.
Arch Intern Med, 154 (1994), pp. 1449-1457
[47.]
J. Eikeboom, L. Wallentin, S.J. Connolly, M. Ezekowitz, J.S. Healey, J. Oldgren, et al.
Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial.
Circulation, 123 (2011), pp. 2363-2372
[48.]
H.-C. Diener, S.J. Connolly, M.D. Ezekowitz, L. Wallentin, P.A. Reilly, S. Yang, for the RE-LY study group, et al.
Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial.
Lancet Neurol, 9 (2010), pp. 1157-1163
[49.]
L. Wallentin, S. Yusuf, M.D. Ezekowitz, on behalf of the RE-LY Investigators, et al.
Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial.
Lancet, 376 (2010), pp. 975-983
[50.]
S.V. Sorensen, A.R. Kansal, S. Connolly, S. Peng, J. Linnehan, C. Bradley-Kennedy, et al.
Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrialfibrillation: A Canadian payer perspective.
Thromb Haemost, 105 (2011), pp. 908-919
[51.]
National Institute for Health and Clinical Excellence (NICE). Final Appraisal Determination. Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation. Disponible en: http://guidance.nice.org.uk/TA/Wave21/10/FAD/FinalAppraisalDetermination/pdf/English
[52.]
Canadian Agency for Drugs and Technologies in Health. Common Drug Review. Dabigatran etexilate. Disponible en: http://www.cadth.ca/media/cdr/complete/cdr_complete_Pradax_ June-27-11.pdf
[53.]
Australian Department on Health and ageing. Dabigatran etexilate. 2011. Disponible en: http://www.health.gov.au/internet/main/publishing.nsf/Content/1863CE366CA53443CA2578BE001241DB/$File/Dabigatran%20PRADAXA%20Boehringer%20Ingelheim%206-3%202011-03%20PSD%20FINAL.pdf
[54.]
Scottish Medicines Consortium. dabigatran etexilate 110mg and 150mg hard capsules (Pradaxa®) SMC No. (672/11). Disponible en: http://www.scottishmedicines.org.uk/files/advice/dabigatran_Pradaxa_FINAL_August_2011_Amended_05.09.11_for_website.pdf
[55.]
J.V. Freeman, R.P. Zhu, D.K. Owens, et al.
Cost-effectiveness of dabigatrancompared with warfarinfor stroke prevention in atrialfibrillation.
Ann Intern Med, 154 (2011), pp. 1-11
[56.]
Evaluación económica de dabigatrán etexilato para la prevención de ictus en pacientes con FANV en España. Disponible en: http://www.jano.es/jano/actualidad/ultimas/noticias/janoes/antiacoagulante/dabigatran/etexilato/disminuye/eventos/sufridos/pacientes/fibrilacion/auricular/_f-11+iditem-15746+idtabla-1. Revisado 1/12/2011.
[57.]
B. Fuentes, J. Gállego, A. Gil-Núñez, A. Morales, F. Purroy, J. Roquer, en representación del Comité ad hoc del Grupo de Estudio de Enfermedades Cerebrovasculares de la Sociedad Española de Neurología, et al.
Guía para el tratamiento preventivo del ictus isquémico y AIT (II). Recomendaciones según subtipo etiológico.
Neurología, (2011),
[58.]
S.J. Connolly, J. Eikelboom, C. Joyner, H.C. Diener, R. Hart, S. Golitsyn, AVERROES Steering Committee and Investigators, et al.
Apixaban in patients with atrial fibrillation.
N Engl J Med, 364 (2011), pp. 806-817
[59.]
M.R. Patel, K.W. Mahaffey, J. Garg, G. Pan, D.E. Singer, W. Hacke, ROCKET AF Investigators, et al.
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
N Engl J Med, 365 (2011), pp. 883-891
[60.]
C.B. Granger, J.H. Alexander, J.J. McMurray, R.D. Lopes, E.M. Hylek, M. Hanna, ARISTOTLE Committees and Investigators, et al.
Apixaban versus warfarin in patients with atrial fibrillation.
N Engl J Med, 365 (2011), pp. 981-992
[61.]
J.L. Mega.
A new era for anticoagulation in atrial fibrillation.
N Engl J Med, 365 (2011), pp. 1052-1054
[62.]
N.U. Weir.
An update on cardioembolic stroke.
Postgrad Med J, 84 (2008), pp. 133-142
[63.]
J. Hirsh, G. Guyatt, G.W. Albers, R. Harrington, H.J. Schünemann.
Executive Summary: American College of Chest Chest Physicians Evidence-Based Clinical Practice Guidelines.
Chest, 133 (2008), pp. 71S-109S
[64.]
R.C. Becker, T.W. Meade, P.B. Berger, M. Ezekowitz, C.M. O’Connor, D.A. Vorchheimer, et al.
The primary and secondary prevention of coronary artery disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Chest, 133 (2008), pp. 776S-814S
[65.]
S.A. Haq, J.F. Heitner, T.J. Sacchi, S.J. Brener.
Long-term effect of chronic oral anticoagulation with warfarin after acute myocardial infarction.
Am J Med, 123 (2010), pp. 250-258
[66.]
B.M. Massie, J.F. Collins, S.E. Ammon, P.W. Armstrong, J.G. Cleland, M. Ezekowitz, WATCH Trial Investigators, et al.
Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial.
Circulation, 119 (2009), pp. 1616-1624
[67.]
S. Homma, R.L. Sacco, M.R. Di Tullio, R.R. Sciacca, J.P. Mohr.
Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study.
Circulation, 105 (2002), pp. 2625-2631
[68.]
J.L. Mas, C. Arquizan, C. Lamy, M. Zuber, L. Cabanes, G. Derumeaux, et al.
Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both.
N Engl J Med, 345 (2001), pp. 1740-1746
[69.]
J. Serena, J. Martí-Fabregas, E. Santamarina, J.J. Rodríguez, M.J. Pérez- Ayuso, J. Masjuan, et al.
Recurrent stroke and massive right-to-left shunt: results from the prospective Spanish multicenter (CODICIA) study.
Stroke, 39 (2008), pp. 3131-3136
[70.]
M.A. Almekhlafi, S.B. Wilton, D.M. Rabi, W.A. Ghali, D.L. Lorenzetti, M.D. Hill.
Recurrent cerebral ischemia in medically treated patent foramen ovale. A meta-analysis.
Neurology, 73 (2009), pp. 89-97
[71.]
Furlan A. LBCT II. American Heart Association Scientific Sessions 2010. Chicago. Nov. 13–17 2010. Abstract 21572.
[72.]
P.T. O’Gara, S.R. Messe, E.M. Tuzcu, G. Catha, J.C. Ring.
Percutaneous device closure of patent foramen ovale for secondary stroke prevention: a call for completion of randomized clinical trials: a science advisory from the American Heart Association/American Stroke Association and the American College of Cardiology Foundation.
Circulation, 119 (2009), pp. 2743-2747
[73.]
E. Bertaglia, C. Tondo, A. De Simone, F. Zoppo, M. Mantica, P. Turco, et al.
Does catheter ablation cure atrial fibrillation? Singleprocedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicentre experience.
Europace, 12 (2010), pp. 181-187
[74.]
A. Natale, A. Raviele, T. Arentz, H. Calkins, S.A. Chen, M. Haïssaguerre, et al.
Venice Chart international consensus document on atrial fibrillation ablation.
J Cardiovasc Electrophysiol, 18 (2007), pp. 560-580
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