RESUMO
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Overactivation of the sympathetic nervous system (SNS) plays an important role in the pathogenesis of comorbidities related to AF such as hypertension, congestive heart failure, obesity, insulin resistance, and obstructive sleep apnea. Methods that reduce sympathetic drive, such as centrally acting sympatho-inhibitory agents, have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. Moxonidine acts centrally to reduce activity of the SNS, and clinical trials indicate that this is associated with a decreased AF burden in hypertensive patients with paroxysmal AF and reduced post-ablation recurrence of AF in patients with hypertension who underwent pulmonary vein isolation (PVI). Furthermore, device-based approaches to reduce sympathetic drive, such as renal denervation, have yielded promising results in the prevention and treatment of cardiac arrhythmias. In light of these recent findings, targeting elevated sympathetic drive with either pharmacological or device-based approaches has become a focus of clinical research. Here, we review the data currently available to explore the potential utility of sympatho-inhibitory therapies in the prevention and treatment of cardiac arrhythmias.
Assuntos
Arritmias Cardíacas/terapia , Animais , Denervação , Humanos , Hipertensão/tratamento farmacológico , Rim/cirurgia , Sistema Nervoso Simpático/fisiopatologia , Resultado do TratamentoAssuntos
Hemofilia A/tratamento farmacológico , Hemofilia A/etiologia , Linfoma não Hodgkin/complicações , Idoso de 80 Anos ou mais , Testes de Coagulação Sanguínea , Fator VIII/antagonistas & inibidores , Fator VIII/imunologia , Hemofilia A/diagnóstico , Humanos , Imunossupressores/uso terapêutico , Isoanticorpos/imunologia , Linfoma não Hodgkin/imunologia , Masculino , Resultado do TratamentoAssuntos
Eosinofilia/imunologia , Síndrome Hipereosinofílica/imunologia , Subpopulações de Linfócitos T/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD/análise , Doença Crônica , Células Clonais/imunologia , Células Clonais/patologia , Progressão da Doença , Eosinofilia/complicações , Eosinofilia/patologia , Feminino , Rearranjo Gênico da Cadeia beta dos Receptores de Antígenos dos Linfócitos T , Humanos , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/patologia , Imunofenotipagem , Linfocitose/complicações , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Subpopulações de Linfócitos T/imunologiaRESUMO
The purging efficacy of the Miltenyi sorting system was evaluated by qualitative and TaqMan quantitative polymerase chain reaction (PCR) in myeloma patients, using immunoglobulin genes. After small-scale selection, qualitative PCR showed that in 6 of 12 leukaphereses myeloma cells were no longer detectable. Envisaging a possible clinical application, the leukaphereses from three patients underwent large-scale selection. Qualitative PCR showed that myeloma cells were still detectable. Quantitative PCR, performed in two patients, showed a tumour depletion of 1 and 2 logs respectively. Although numbers are small, the promising results obtained with small-scale selection were not reproduced in large-scale experiments.