[Antithrombotic prevention in atrial fibrillation: the new anticoagulant drugs]. / I nuovi anticoagulanti nella profilassi antitrombotica della fibrillazione atriale.

Thromboembolic events are the most dangerous complications in patients with atrial fibrillation, affecting the central nervous system in 93% of cases. Vitamin K antagonists have been in clinical use since the '50s for the prevention of thromboembolism. Although effective, vitamin K antagonists have several limitations that render them difficult to administer, which have prompted the need for new antithrombotic strategies. The new class of oral anti-IIa and anti-Xa agents appears to be a promising alternative to overcome these limitations.

[Does echocardiography have any role in selecting patients for cardiac resynchronization therapy?]. / Quale ruolo per l'ecocardiografia nella selezione dei pazienti candidati a terapia di resincronizzazione cardiaca.

Cardiac resynchronization therapy (CRT) has an established role in the treatment of end-stage, drug-refractory heart failure patients. Large randomized controlled trials have demonstrated that CRT improves morbidity and mortality and, in current practice, there is a substantial number of patients treated with CRT for off-label indications. Nevertheless, a significant proportion of patients lack clinical and echocardiographic improvement or even deteriorate. Novel, sophisticated echocardiographic techniques seem promising in predicting response to CRT but need adequate training and refinements. In the meantime, a comprehensive, multiparametric echocardiographic approach is probably required for a better evaluation of mechanical dyssynchrony. Other non-invasive cardiac imaging modalities, including magnetic resonance and multislice computed tomography, are providing further insight into the pathophysiological mechanisms underlying CRT response. An integrated approach based on multimodality cardiac imaging may aid to optimize the selection of heart failure patients who are candidate to CRT.