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La perforación de miocardio por electrodo de marcapasos es una complicación muy importante tras el implante de marcapasos, siendo poco habitual su presentación sin taponamiento cardíaco. La perforación afecta más frecuentemente al ventrículo derecho, siendo más rara la afectación del miocardio ventricular izquierdo. Presentamos 2 casos clínicos, ambas mujeres de edad avanzada (80 y 85 años) a las que previamente se les implantó un marcapasos definitivo bicameral DDDR por bloqueo aurículo-ventricular completo, y semanas después se diagnosticaron de perforación ventricular por electrodo de marcapasos, siendo en un caso la afectación del ventrículo derecho y en otro caso del ventrículo izquierdo. Ambos casos se presentaron con derrame pleural izquierdo, sin embargo ningún caso se presentó con taponamiento cardíaco tanto clínico como radiológico. Los pacientes se intervinieron con carácter urgente, mediante esternotomía convencional y reparación de la zona perforada con parches de Teflón®.

Epicardial fat thickness is associated with cardiovascular disease. Mineralocorticoid receptor antagonist (MRA), a pharmaceutical treatment for CVD, was found to have an effect on adipose tissue. Our aim was to analyse the main epicardial fat genesis and inflammation-involved cell markers and their regulation by risk factors and MRA. We included blood and epicardial or subcutaneous fat (EAT or SAT) from 71 patients undergoing heart surgery and blood from 66 patients with heart failure. Cell types (transcripts or proteins) were analysed by real-time polymerase chain reaction or immunohistochemistry. Plasma proteins were analysed by Luminex technology or enzyme-linked immunoassay. Our results showed an upregulation of fatty acid transporter levels after aldosterone-induced genesis. The MRA intake was the main factor associated with lower levels in epicardial fat. On the contrary, MRA upregulated the levels and its secretion of the anti-inflammatory marker intelectin 1 and reduced the proliferation of epicardial fibroblasts. Our results have shown the local MRA intake effect on fatty acid transporters and anti-inflammatory marker levels and the proliferation rate on epicardial fat fibroblasts. They suggest the role of MRA on epicardial fat genesis and remodelling in patients with cardiovascular disease. Translational perspective: the knowledge of epicardial fat genesis and its modulation by drugs might be useful for improving the treatments of cardiovascular disease.