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https://www.readbyqxmd.com/read/28514878/anticoagulant-cessation-following-atrial-fibrillation-ablation-limits-of-the-ecg-guided-approach
#1
Matteo Anselmino, Chiara Rovera, Giovanni Marchetto, Federico Ferraris, Davide Castagno, Fiorenzo Gaita
Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management. Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation...
May 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28497899/replacing-warfarin-with-a-novel-oral-anticoagulant-risk-of-recurrent-bleeding-and-stroke-in-patients-with-warfarin-ineligible-or-failure-in-patients-with-atrial-fibrillation-the-roar-study
#2
Mohit K Turagam, Valay Parikh, Muhammad R Afzal, Rakesh Gopinnathanair, Madhav Lavu, Arun Kanmanthareddy, Jayasree Pillarisetti, Madhu Reddy, Donita Atkins, Sudharani Bommana, Melissa Jaeger, Courtney Jeffery, Sanghamitra Mohanty, Pasquale Santangeli, Jie Cheng, Luigi Dibiase, Calambur Narasimhan, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: A significant proportion of patients treated with warfarin for atrial fibrillation (AF) become warfarin ineligible (WI) due to major bleeding events (MBE) or systemic thromboembolism (STE). We report a large multicenter real-world experience of the use of DOACs in these WI patients. METHODS: We report the outcomes of 263 WI patients treated with DOACs. The primary objective was to evaluate clinical outcomes of STE and MBE with DOACs. Secondary objective was to assess clinical predictors of repeat MBE and STE on DOACs...
May 12, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28485276/left-atrial-appendage-occlusion-versus-standard-medical-care-in-patients-with-atrial-fibrillation-and-intracerebral-hemorrhage-a-propensity-score-matched-follow-up-study
#3
Jens Erik Nielsen-Kudsk, Søren Paaske Johnsen, Per Wester, Dorte Damgaard, Juhani Airaksinen, Juha Lund, Ole De Backer, Sami Pakarinen, Jacob Odenstedt, Saila Vikman, Magnus Settergren, Ole Kongstad, Mårten Rosenqvist, Derk W Krieger
AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral hemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nordic countries with AF and previous ICH who underwent LAAO using the Amplatzer Cardiac Plug or the Amplatzer Amulet were compared to a propensity score matched group of 151 patients receiving standard medical therapy...
May 9, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28466408/incidence-and-predictors-of-silent-cerebral-thromboembolic-lesions-after-catheter-ablation-for-atrial-fibrillation-in-patients-treated-with-direct-oral-anticoagulants
#4
Atsushi Doi, Masahiko Takagi, Jun Kakihara, Yusuke Hayashi, Hiroaki Tatsumi, Kohei Fujimoto, Kenichi Sugioka, Minoru Yoshiyama
There are few reports about the incidence and predictors of silent cerebral thromboembolic lesions (SCLs) after atrial fibrillation (AF) ablation in patients treated with direct oral anticoagulants (DOACs). The purpose of this study is to evaluate the incidence and predictors of SCLs after AF ablation with cerebral magnetic resonance imaging (C-MRI) in patients treated with DOACs. We enrolled 117 consecutive patients who underwent first AF ablation and received DOACs, including apixaban, dabigatran, edoxaban, and rivaroxaban...
May 2, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28454807/clinical-decision-support-for-stroke-prevention-in-atrial-fibrillation-cds-af-rationale-and-design-of-a-cluster-randomized-trial-in-the-primary-care-setting
#5
Lars O Karlsson, Staffan Nilsson, Emmanouil Charitakis, Magnus Bång, Gustav Johansson, Lennart Nilsson, Magnus Janzon
BACKGROUND: Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains a significant undertreatment. The main aim of the current study is to investigate whether a clinical decision support tool for stroke prevention (CDS) integrated in the electronic health record can improve adherence to guidelines for stroke prevention in patients with AF. METHODS: We will conduct a cluster randomized trial where 43 primary care clinics in the county of Östergötland, Sweden (population 444,347), will be randomized to be part of the CDS intervention or serve as controls...
May 2017: American Heart Journal
https://www.readbyqxmd.com/read/28438308/cardiovascular-outcomes-with-surgical-left-atrial-appendage-exclusion-in-patients-with-atrial-fibrillation-who-underwent-valvular-heart-surgery-from-the-national-inpatient-sample-database
#6
Ayman Elbadawi, Odunayo Olorunfemi, Gbolahan O Ogunbayo, Marwan Saad, Islam Y Elgendy, Zainab Arif, Haytham Badran, Deola Saheed, Hamdy M A Ahmed, Mohan Rao
Left atrial appendage (LAA) exclusion is a commonly performed procedure to reduce the embolic events in patients with atrial fibrillation (AF) who underwent cardiac surgeries. Our study aimed to evaluate the in-hospital outcomes of LAA exclusion in patients with AF who underwent valvular heart surgeries. We queried the Nationwide Inpatient Sample Database from 1998 to 2013 for patients with the International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis codes for AF and underwent any valvular heart surgery...
March 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28402476/silent-atrial-fibrillation-in-pacemaker-early-post-implantation-period-an-unintentionally-provoked-situation
#7
Juan Benezet-Mazuecos, José Antonio Iglesias, Marcelino Cortés, José Manuel Rubio, Juan José de la Vieja, Ana Del Río, Pepa Sanchez-Borque, Ángel Miracle, Jerónimo Farré
Aims: Atrial high-rate episodes (AHREs) compatible with silent AF detected in pacemakers (PM) are related to an increased risk of stroke and silent ischaemic brain lesions (IBL) on CT scan. AHREs soon after PM implantation could be related with the procedure itself and the prognosis might be different. Methods and results: We analysed the incidence of AHREs >5 min and the presence of silent IBL in 110 patients (56% men, aged 75 ± 9 year-old) with PM and no history of AF, in relation to time from implantation (≤3 months vs...
April 10, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28274576/long-term-follow-up-of-probands-with-brugada-syndrome
#8
Carlo de Asmundis, Giacomo Mugnai, Gian-Battista Chierchia, Juan Sieira, Giulio Conte, Moises Rodriguez-Mañero, Gudrun Pappaert, Jens Czapla, Jan Nijs, Mark La Meir, Ruben Casado, Erwin Ströker, Valentina De Regibus, Pedro Brugada
This study analyzes the natural history of a large cohort of probands with Brugada syndrome (BrS) to assess the predictive value of different clinical and electrocardiographic parameters for the development of ventricular fibrillation (VF) or sudden cardiac death (SCD) during a long-term follow-up. Baseline characteristics of 289 consecutive probands (203 men; mean age 45 ± 16 years) with a Brugada type 1 electrocardiogram were analyzed. After a mean follow-up of 10.1 ± 4.6 years, 29 malignant arrhythmias occurred...
May 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28245798/left-atrial-appendage-morphology-and-risk-of-stroke-following-pulmonary-vein-isolation-for-drug-refractory-atrial-fibrillation-in-low-cha2ds2vasc-risk-patients
#9
Faith R Kelly, Robert A Hull, Takor B Arrey-Mbi, Michael U Williams, Joshua S Lee, Ahmad M Slim, Dustin M Thomas
BACKGROUND: Cardiac CT angiography (CCTA) has become an important adjunct in the structural assessment of the pulmonary veins (PV) prior to pulmonary vein isolation (PVI). Published data is conflicting regarding a relationship between left atrial appendage (LAA) and the risk of ischemic stroke (CVA) following PVI. We investigated the associations of volumetric and morphologic left atrial (LA) and LAA measurements for CVA following PVI. METHODS: We retrospectively reviewed 332 consecutive patients with drug refractory atrial fibrillation who obtained cardiac CT angiogram (CCTA) prior to PVI...
February 28, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28238569/guideline-adherent-therapy-for-stroke-prevention-in-atrial-fibrillation-in-different-health-care-settings-results-from-ramses-study
#10
Özcan Başaran, Volkan Dogan, Murat Biteker, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet Ballı, Mehmet Hayri Alıcı, Serdar Bozyel, Cevat Kırma
OBJECTIVE: No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies. METHODS: Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared...
May 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28237286/comparison-of-has-bled-and-has-bed-versus-chads2-and-cha2ds2vasc-stroke-and-bleeding-scores-in-patients-with-atrial-fibrillation
#11
MULTICENTER STUDY
Daniela Poli, Emilia Antonucci, Vittorio Pengo, Sophie Testa, Gualtiero Palareti
Anticoagulation is recommended in patients with atrial fibrillation (AF) for stroke prevention, and the bleeding risk associated suggests the need for a bleeding risk stratification. HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly >65 years, drugs/alcohol concomitantly) score includes "labile INR" referred to quality of anticoagulation. However, in naïve patients, this item is not available. In addition, stroke and bleeding risk prediction scores shared several risk factors...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28135707/changes-in-oral-anticoagulant-treatment-rates-in-atrial-fibrillation-before-and-after-the-introduction-of-direct-oral-anticoagulants
#12
Rashmee U Shah, Austin B Rupp, Danielle Mowery, Mingyuan Zhang, Greg Stoddard, Vikrant Deshmukh, Bruce E Bray, Rachel Hess, Matthew T Rondina
BACKGROUND: Direct oral anticoagulants (DOACs) have the potential to improve stroke prevention among atrial fibrillation (AF) patients. We sought to determine if oral anticoagulation (OAC) treatment rates have increased since the approval of DOACs. METHODS: We identified 6,688 patients with AF at an academic medical center from January 2008 to June 2015. We examined OAC prescription rates over time and according to CHA2DS2VASc score using multivariable Poisson regression models, with an interaction term between risk score and year of AF diagnosis...
2016: Neuroepidemiology
https://www.readbyqxmd.com/read/28129663/risk-stratification-models-in-atrial-fibrillation
#13
Farhan Shahid, Gregory Y H Lip
Atrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. AF-related stroke confers a higher mortality and morbidity risk, and thus, early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation are crucial. Simple and practical risk assessment tools are essential to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision making. At present, the CHA2DS2VASc score is recommended by guidelines as the most simple and practical method of assessing stroke risk in AF patients...
January 27, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28129318/initial-experience-with-minimally-invasive-surgical-exclusion-of-the-left-atrial-appendage-with-an-epicardial-clip
#14
Nathan E Smith, Jeevan Joseph, John Morgan, Saqib Masroor
OBJECTIVE: Atrial fibrillation (AF) is the primary cardiac abnormality associated with ischemic stroke. Atrial fibrillation affects 2.7 million people with a stroke rate of 3.5% per year. Most of the emboli in patients with nonvalvular AF originate in the left atrial appendage (LAA). Surgical exclusion of the LAA decreases the yearly risk of stroke to 0.7% when combined with a Maze procedure. Traditional oversewing the LAA from inside the left atrium is associated with a significant number of recanalizations of LAA...
January 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28106147/prediction-of-very-late-arrhythmia-recurrence-after-radiofrequency-catheter-ablation-of-atrial-fibrillation-the-mb-later-clinical-score
#15
Nebojša Mujović, Milan Marinković, Nebojša Marković, Alena Shantsila, Gregory Y H Lip, Tatjana S Potpara
Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), 20 patients expirienced a VLRAF during a 29...
January 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28025766/safety-of-cardioversion-in-atrial-fibrillation-lasting-less-than-48%C3%A2-h-without-post-procedural-anticoagulation-in-patients-at-low-cardioembolic-risk
#16
Andrea Tampieri, Valentina Cipriano, Fabrizio Mucci, Anna Maria Rusconi, Tiziano Lenzi, Patrizia Cenni
Currently, there is no unified consensus on short-term anticoagulation after cardioversion of atrial fibrillation lasting less than 48 h in low-cardioembolic-risk patients. The aim of this study is to evaluate the rate of transient ischemic attacks, stroke and death in this subset of patients after cardioversion without post-procedural anticoagulation. In a prospective observational study, patients with recent-onset AF undergoing cardioversion attempts in the Emergency Department were evaluated over the past 3 years...
December 26, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27979034/interventional-left-atrial-appendage-closure-vs-novel-anticoagulation-agents-in-patients-with-atrial-fibrillation-indicated-for-long-term-anticoagulation-prague-17-study
#17
Pavel Osmancik, Petr Tousek, Dalibor Herman, Petr Neuzil, Pavel Hala, Josef Stasek, Ludek Haman, Petr Kala, Martin Poloczek, Marian Branny, Jan Chovancik, Pavel Cervinka, Jiri Holy, Vlastimil Vancura, Richard Rokyta, Milos Taborsky, Tomas Kovarnik, David Zemanek, Petr Peichl, Sarka Haskova, Jiri Jarkovsky, Petr Widimsky
Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA...
January 2017: American Heart Journal
https://www.readbyqxmd.com/read/27907893/factors-impacting-complication-rates-for-catheter-ablation-of-atrial-fibrillation-from-2003-to-2015
#18
Eunice Yang, Esra Gucuk Ipek, Muhammad Balouch, Yuliya Mints, Jonathan Chrispin, Joseph E Marine, Ronald D Berger, Hiroshi Ashikaga, Jack Rickard, Hugh Calkins, Saman Nazarian, David D Spragg
AIMS: Complications from catheter ablation for atrial fibrillation (AF) are well described. Changing aspects of AF ablation including patient populations referred, institutional experience, and emerging catheter and pharmacological options may impact complication rates. We assessed procedural complication trends in AF ablation patients from 2003-2015 to identify what factors affect adverse event rates. METHODS AND RESULTS: We evaluated consecutively enrolled patients undergoing initial AF ablation from 2003 through 2015...
October 6, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27903938/post-noac-portuguese-observational-study-of-intracranial-hemorrhage-on-non-vitamin-k-antagonist-oral-anticoagulants
#19
Cláudia Marques-Matos, José Nuno Alves, João Pedro Marto, Joana Afonso Ribeiro, Ana Monteiro, José Araújo, Fernando Silva, Fátima Grenho, Miguel Viana-Baptista, João Sargento-Freitas, João Pinho, Elsa Azevedo
BACKGROUND: There is a lower reported incidence of intracranial hemorrhage with non-vitamin K antagonist oral anticoagulants compared with vitamin K antagonist. However, the functional outcome and mortality of intracranial hemorrhage patients were not assessed. AIMS: To compare the outcome of vitamin K antagonists- and non-vitamin K antagonist oral anticoagulants-related intracranial hemorrhage. METHODS: We included consecutive patients with acute non-traumatic intracranial hemorrhage on oral anticoagulation therapy admitted between January 2013 and June 2015 at four university hospitals...
November 30, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27892885/vitamin-k-antagonists-for-stroke-prevention-in-hemodialysis-patients-with-atrial-fibrillation-a-systematic-review-and-meta-analysis
#20
Hans Van Der Meersch, Dirk De Bacquer, An S De Vriese
BACKGROUND: The use of vitamin K antagonists (VKAs) in hemodialysis patients with atrial fibrillation (AF) is controversial. No randomized trials are available and observational studies have yielded conflicting results, engendering a large clinical practice variability and physician uncertainty. An unresolved but highly relevant question is whether AF poses a true risk of ischemic stroke in hemodialysis and whether any form of oral anticoagulation is therefore warranted. METHODS: We conducted a systematic review of studies that compared the incidence of ischemic stroke and bleeding in hemodialysis patients with AF taking VKA and those not taking VKA...
October 4, 2016: American Heart Journal
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