No abstract

This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.

Objective: To analyze the in-hospital outcome of elderly patients aged 70 years and older who were operated on, using the beating heart coronary artery bypass grafting with an intraluminal shunt, in urgent, emergent and elective coronary revascularizations. Methods: From July 1989 to July 2005, prospectively, we analyzed 87 patients aged 70 to 92 years old. In the whole group, 50 (57.5%) patients had unstable angina, with three (3.4%) acute myocardial infarction. Thirty-one (35.6%) patients underwent urgent and emergent surgery. Thirteen (14.9%) patients had myocardial infarction in less than 30 days and 34 (39.1%) in more than 30 days.Results: The main postoperative complications were: atrial fibrillation (32.2%), heart failure (12.6%), pneumonia (10.3%), septicemia (3.4%), acute myocardial infarction (2.3%), mediastinitis (1.1%) transient ischemic attack (1.1%) and pneumothorax (1.1%). The mean extubation time was 18.50±19.09 hours, the intensive care unit stay was 2.92±2.03 days, and hospital stay was 10.55±7.16 days. Nine (10.34%) patients received blood transfusion with no reoperation for bleeding. The in-hospital mortality was 4.6%.Conclusions: In 70 years old and over patients, elective and non-elective off-pump coronary artery bypass grafting with intracoronary shunt showed to be safe and effective, associated with low rates of postoperative complications and mortality in relation to the studied population. 41SILVA, AMRP ET AL -Off-pump myocardial revascularization in the elderly:analysis of morbidity and mortality Bras Cir Cardiovasc 2008; 23(1): 40-45 Rev

The authors discuss the epidemiology and pathogenesis of Chagas' disease in Brazil, including the use of treatment with a cardioverter-defibrillator in patients with low ejection fraction. Select patients may benefit from resynchronization therapy associated with cardioverter-defibrillator treatment. Electrophysiologic study is indicated in the assessment of the potential utility of an implantable cardioverter-defibrillator.