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Anticoagulation for a flutter

Stefan Reers, Tolga Agdirlioglu, Michael Kellner, Matthias Borowski, Holger Thiele, Johannes Waltenberger, Michael Reppel
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown...
October 21, 2016: European Journal of Medical Research
Nebojša Mujović, Milan Marinković, Nebojša Marković, Aleksandar Kocijančić, Vladan Kovačević, Dragan Simić, Arsen Ristić, Goran Stanković, Biljana Miličić, Svetozar Putnik, Bosiljka Vujisić-Tešić, Tatjana S Potpara
INTRODUCTION: Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported. METHODS: We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011-2016. RESULTS: Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41-63), 569 were left-sided procedures (n = 406 with transseptal access)...
October 2016: Advances in Therapy
Kanako Ito, Yu-Ki Iwasaki, Yuhi Fujimoto, Eiichiro Oka, Kenta Takahashi, Ippei Tsuboi, Kenji Yodogawa, Meiso Hayashi, Yasushi Miyauchi, Wataru Shimizu
A 46-year-old man was admitted to our hospital for near syncope and palpitations. An electrocardiogram showed a common type of atrial flutter (AFL) with 1:1 atrioventricular conduction. Transthoracic echocardiography revealed a massive right atrial (RA) thrombus with a huge RA and right ventricle. The patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy. It was difficult to control the heart rate with beta-blockers during AFL, which resulted in the deterioration of right-sided heart failure...
2016: Internal Medicine
Gregory Y H Lip, Christoph Hammerstingl, Francisco Marin, Riccardo Cappato, Isabelle Ling Meng, Bodo Kirsch, Martin van Eickels, Ariel Cohen
BACKGROUND: Data on left atrial/left atrial appendage (LA/LAA) thrombus resolution after non-vitamin K antagonist (VKA) oral anticoagulant treatment are scarce. The primary objective of X-TRA was to explore the use of rivaroxaban for the resolution of LA/LAA thrombi in patients with nonvalvular atrial fibrillation (AF) or atrial flutter, with the CLOT-AF registry providing retrospective data after standard-of-care therapy in this setting. METHODS: X-TRA was a prospective, single-arm, open-label, multicenter study that investigated rivaroxaban treatment for 6 weeks for LA/LAA thrombus resolution in patients with nonvalvular AF or atrial flutter and LA/LAA thrombus confirmed at baseline on a transesophageal echocardiogram (TEE)...
August 2016: American Heart Journal
Ryuta Henmi, Koichiro Ejima, Morio Shoda, Daigo Yagishita, Nobuhisa Hagiwara
INTRODUCTION: Many patients with successful atrial flutter (AFL) ablation will develop atrial fibrillation (AF) during follow-up. This study aimed to determine whether prolonged interatrial conduction time (IACT) is associated with risk for new-onset AF after ablation of isolated, typical AFL. METHODS: Participants were 80 consecutive patients who underwent successful radiofrequency ablation of isolated, typical AFL from 2004 to 2012. Patients with any history of AF prior to AFL ablation were excluded...
July 16, 2016: Journal of Cardiovascular Electrophysiology
Jiuann-Huey I Lin, Adam C Kean, Timothy M Cordes
Atrial flutter or fibrillation (AFF) remains a major chronic complication of the Fontan procedure. This complication further predisposes this patient population to thromboembolic events. However, the incidence of thromboembolic complications in Fontan patients with AFF prior to or acutely after electrical cardioversion is unknown. This study aimed to characterize the risk of post-cardioversion thromboembolic events in this population. We performed a retrospective medical record review of all patients with a history of Fontan operation treated with direct current cardioversion for AFF at Riley Children's Hospital between June 1992 and March 2014...
October 2016: Pediatric Cardiology
Alanna M Chamberlain, Robert D Brown, Alvaro Alonso, Bernard J Gersh, Jill M Killian, Susan A Weston, Véronique L Roger
BACKGROUND: While atrial fibrillation is a recognized risk factor for stroke, contemporary data on trends in stroke incidence after the diagnosis of atrial fibrillation are scarce. METHODS AND RESULTS: Olmsted County, MN residents with incident atrial fibrillation or atrial flutter (collectively referred to as AF) from 2000 to 2010 were identified. Cox regression determined associations of year of AF diagnosis with ischemic stroke and transient ischemic attack (TIA) occurring through 2013...
June 2016: Journal of the American Heart Association
Guan Sen Kew, Mabel Tan, Toon Wei Lim
INTRODUCTION: Atrial fibrillation (AF) is a well-known cause of strokes and all major society guidelines recommend oral anticoagulants (OAC) such as vitamin K antagonists (VKA) for patients with concomitant risk factors to prevent them. However, compliance with these guidelines is historically poor. This study aims to evaluate the adherence to CHADS2 (congestive heart failure, hypertension,age ≥75 years, diabetes mellitus and prior stroke or transient ischaemic attack) guidelines, explore reasons and evaluate outcomes for non-adherence in a tertiary cardiology unit...
2015: Heart Asia
Sajid Ali, Justin Ugwu, Yousuf Kanjwal
BACKGROUND: Left atrial appendage thrombus formation is a known major complication of atrial fibrillation and atrial flutter which increases the risk of embolism and stroke. This risk of thrombosis is greatly increased with a lack of anticoagulation. After conversion to a normal sinus rhythm in these arrhythmias, the risk of thrombus formation in the left atrium persists through a phenomenon termed atrial myocardial stunning. CASE: We present the case of a patient who previously underwent successful pulmonary vein isolation and was found to be in typical isthmus-dependent atrial flutter with a questionable recurrence of atrial fibrillation...
2016: Cardiology
Craig B Clark, Nelson A Telles Garcia, Catherine Hackett Renner, Sarah M Ryan
BACKGROUND: In patients with atrial fibrillation or flutter, a left atrial appendage ejection velocity measured via transesophageal echocardiography equal to or less than 40 cm/sec has been shown to correlate with an increased risk of developing left atrial appendage thrombus while velocities greater than 40 cm/sec are at lower risk. The CHADS2 and CHA2DS2-VASc scores calculated from clinical variables have been developed to risk stratify patients with atrial fibrillation/flutter in regard to the need for anticoagulation...
August 2016: Echocardiography
D Baker, B Wilsmore, S Narasimhan
BACKGROUND: Direct oral anticoagulants (DOAC) are being increasingly utilised for stroke prevention in atrial fibrillation (AF) and atrial flutter. AIMS: To analyse the adoption and application of these drugs in a regional hospital inpatient cohort and compare with national prescribing data. METHODS: Digital medical records identified prescribed anticoagulants for patients admitted with AF and atrial flutter during 2013-2014. Analysis of patient demographics and stroke risk identified trends in prescribing DOAC versus warfarin...
July 2016: Internal Medicine Journal
Robert O Roswell, Brian Greet, Sunny Shah, Samuel Bernard, Alexandra Milin, Iryna Lobach, Yu Guo, Martha J Radford, Jeffrey S Berger
Patients with non-valvular atrial fibrillation (AF) have an elevated stroke risk that is 2-7 times greater than in those without AF. Intravenous unfractionated heparin (UFH) is commonly used for hospitalized patients with atrial fibrillation and atrial flutter (AFL) to prevent stroke. Dosing strategies exist for intravenous anticoagulation in patients with acute coronary syndromes and venous thromboembolic diseases, but there are no data to guide providers on a dosing strategy for intravenous anticoagulation in patients with AF/AFL...
August 2016: Journal of Thrombosis and Thrombolysis
Damian P Redfearn, Muhammad Ali Furqan, Andres Enriquez, David Barber, Cathy Shaw, Christopher Simpson, Adrian Baranchuk, Kevin Michael, Hoshiar Abdollah, Robert J Brison
BACKGROUND: Identification and appropriate management of patients with atrial fibrillation (AF) is critical to mitigate the consequences of the disease. We sought to assess the frequency and pattern of the emergency department (ED) use by patients who presented with AF and/or atrial flutter (AFL) in a midsized Canadian hospital. METHODS: We conducted a retrospective cohort analysis of patients who presented to the ED with AF and/or AFL during the calendar years 2010-2012...
March 2016: Canadian Journal of Cardiology
Jaya Chandrasekhar, Ioannis Mastoris, Usman Baber, Samantha Sartori, Mikkel Schoos, Sameer Bansilal, George Dangas, Roxana Mehran
BACKGROUND: In the era of novel antithrombotic therapy, the optimal treatment for patients with nonvalvular atrial fibrillation (AF) or flutter undergoing percutaneous coronary intervention (PCI) is undetermined. STUDY DESIGN: The AVIATOR 2 study is a multicenter prospective observational registry that will enroll approximately 2,500 patients with nonvalvular AF or flutter undergoing PCI starting March 2015 over an 18-month enrollment period. Antithrombotic therapy selection will be at the discretion of the treating physician...
December 2015: American Heart Journal
Celina Yong, Farnaz Azarbal, Freddy Abnousi, Paul A Heidenreich, Susan Schmitt, Jun Fan, Claire T Than, Aditya J Ullal, Felix Yang, Ciaran S Phibbs, Susan M Frayne, P Michael Ho, Supriya Shore, Kenneth W Mahaffey, Mintu P Turakhia
The influence of race on quality of anticoagulation control is not well described. We examined the association between race, international normalized ratio (INR) monitoring intensity, and INR control in warfarin-treated patients with atrial fibrillation (AF). Using data from the Veterans Health Administration (VHA), we performed a retrospective cohort study of 184,161 patients with a new diagnosis of AF/flutter from 2004 to 2012 who received any VHA prescription within 90 days of diagnosis. The primary predictor was race, ascertained from multiple VHA and linked Medicare demographic files...
January 1, 2016: American Journal of Cardiology
Irina Y Sazonova, Roja Pondicherry-Harish, Nikhil Kadle, Gyanendra K Sharma, Ramon E Figueroa, Vincent J B Robinson
We report a case of cerebrovascular accident with thromboembolic stroke etiology in a patient who had atrial flutter and negative transesophageal echocardiography (TEE) results. The increased D-dimer levels (1877 ng/mL) initiated referral for magnetic resonance imaging and magnetic resonance angiography of the brain that showed classic recanalization of an embolic thrombus in the angular branch of the left middle cerebral distribution. The D-dimer level of this patient was normalized after 3 months of anticoagulation therapy...
October 2014: Journal of Investigative Medicine High Impact Case Reports
M Djukic, D Bergmann, C Jacobshagen, R Nau
INTRODUCTION: Anticoagulation for the prevention of cardioembolic events is highly effective, but largely underused in frail older patients with atrial fibrillation or flutter (AF). This study aimed at identifying characteristics associated with anticoagulation use or non-use and the most frequent complications of this therapy. METHODS: Hospitalized geriatric patients treated in a one-year interval were retrospectively studied for the presence of AF and use or non-use of anticoagulation...
September 2015: Deutsche Medizinische Wochenschrift
Brian Marino, Abhishek Jaiswal, Seth Goldbarg, Gary L Bernardini, Todd Kerwin
BACKGROUND: The utility of transesophageal echocardiography (TEE) subsequent to a normal transthoracic echocardiogram (TTE) in older patients with an unexplained stroke is uncertain. METHODS: Two hundred sixty-three consecutive patients over the age of 50 years hospitalized with a clinical stroke confirmed with brain magnetic resonance imaging and a normal TTE were retrospectively analyzed. Patients with atrial fibrillation, atrial flutter, or any other causative reason for stroke were excluded...
February 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Ajay Yadlapati, Christopher Groh, S Chris Malaisrie, Mark Gajjar, Jane Kruse, Sheridan Meyers, Rod Passman
PURPOSE: Prosthetic valve replacement is performed in several hundred thousand patients worldwide annually, and many of these patients have or will ultimately develop atrial fibrillation or flutter (AF). Novel oral anticoagulants (NOACs) are not recommended in patients with AF and mechanical valves but have not been evaluated in patients with bioprosthetic valves. This study sought to evaluate the efficacy and safety of NOACs in patients with AF and bioprosthetic valves. METHODS: A retrospective single-center cohort study was performed on all patients with bioprosthetic valve implantation, for whom a NOAC was prescribed for the indication of AF...
March 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Dragos Vinereanu, Susanna R Stevens, John H Alexander, Sana M Al-Khatib, Alvaro Avezum, Marıa Cecilia Bahit, Christopher B Granger, Renato D Lopes, Sigrun Halvorsen, Michael Hanna, Steen Husted, Elaine M Hylek, Andrei D Mărgulescu, Lars Wallentin, Dan Atar
AIM: To assess clinical outcomes, efficacy, and safety according to sex during anticoagulation with apixaban compared with warfarin in patients with atrial fibrillation. METHODS AND RESULTS: Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) was a randomized, double-blind, placebo-controlled, multicentre trial that included 11 785 (64.7%) men and 6416 (35.3%) women with atrial fibrillation or flutter randomized to receive either warfarin or apixaban...
December 7, 2015: European Heart Journal
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