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Perspectivas contemporáneas sobre los síndromes de onda J: una declaración de consenso de expertos

Koonlawee Nademanee1,2,3, Arthur A Wilde4,5,6, Michael J Ackerman7

  • 1Department of Medicine, Faculty of Medicine, Center of Excellence in Arrhythmia Research Chulalongkorn University Chulalongkorn University Bangkok Thailand.

Journal of arrhythmia
|February 25, 2026
PubMed
Resumen
Este resumen es generado por máquina.

Los síndromes de onda J (JWS), que incluyen el síndrome de Brugada (BrS) y el síndrome de repolarización temprana (ERS), ahora se entienden como un espectro de enfermedades microestructurales-eléctricas. La ablación epicárdica del sustrato es un avance clave para el manejo de estas afecciones, mejorando los resultados para los pacientes en riesgo de muerte súbita cardíaca.

Palabras clave:
síndrome de Brugadasíndromes de onda JSCN5Aablación por catétersíndrome de repolarización tempranadesfibrilador cardioversor implantableestratificación de riesgosmuerte súbita cardíacafibrilación ventricular

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Área de la Ciencia:

  • Cardiología
  • Electrofisiología
  • Genética

Sus antecedentes:

  • Los síndromes de onda J (JWS), que incluyen el síndrome de Brugada (BrS) y el síndrome de repolarización temprana (ERS), son causas importantes de muerte súbita cardíaca en corazones estructuralmente normales.
  • Los avances recientes han redefinido la comprensión de BrS como un continuo microestructural-eléctrico y ERS como una condición con riesgo significativo cuando se asocia con hallazgos específicos de ECG y arritmias.

Objetivo del estudio:

  • Actualizar y ampliar las directrices de consenso anteriores sobre el diagnóstico, la estratificación de riesgos y el manejo de JWS.
  • Enfatizar la comprensión evolutiva de JWS como un espectro de enfermedad microestructural-eléctrica.
  • Destacar la ablación epicárdica del sustrato como un avance terapéutico importante.

Principales métodos:

  • Actualización del consenso internacional basada en avances recientes en genética, fisiopatología y terapia.
  • Revisión de grandes registros y ensayos aleatorizados sobre ablación epicárdica del sustrato.
  • Integración de características clínicas, marcadores de ECG, estudios electrofisiológicos y datos genéticos para la estratificación de riesgos.

Principales resultados:

  • SCN5A sigue siendo el gen principal asociado con JWS, pero la susceptibilidad poligénica juega un papel importante.
  • La estratificación de riesgos requiere una evaluación multiparamétrica, y el paro cardíaco previo o el síncope indican el mayor riesgo.
  • La ablación epicárdica del sustrato demuestra una supresión duradera de la fibrilación ventricular con una seguridad aceptable.

Conclusiones:

  • Los síndromes de onda J representan un espectro de enfermedad microestructural-eléctrica.
  • La ablación epicárdica del sustrato es una terapia transformadora para el manejo de las arritmias ventriculares en JWS.
  • Los marcos de diagnóstico contemporáneos, las herramientas de estratificación de riesgos y los algoritmos de tratamiento son esenciales para la atención óptima del paciente.