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Maurizio Galderisi, Erwan Donal, Julien Magne, Francesco Lo Iudice, Eustachio Agricola, Leyla Elif Sade, Matteo Cameli, Ehud Schwammenthal, Nuno Cardim, Bernard Cosyns, Andreas Hagendorff, Alexandar N Neskovic, Josè Luis Zamorano, Patrizio Lancellotti, Gilbert Habib, Thor Edvardsen, Bogdan A Popescu
The European Society of Cardiology (ESC) guidelines for management of atrial fibrillation (AF) recommend the use of CHA2DS2VASc risk score for assessment of thromboembolic (TE) risk, whereas the stratification of bleeding risk should be obtained by HAS-Bleed to balance the most appropriate anticoagulation (OAC) therapy. However, men with CHA2DS2VASc score = 1 and women with CHA2DS2VASc = 2, who are at intermediate TE risk, represent a grey zone where guidelines do not provide a definite OAC indication...
March 1, 2018: European Heart Journal Cardiovascular Imaging
Mohinder Vindhyal, Shravani R Vindhyal, Travis Haneke, Paul M Ndunda, Freidy Eid, K James Kallail
Introduction Atrial fibrillation (AF), the most common cardiac arrhythmia, affects approximately 2.3 million patients in the United States, costing around $26 billion. Atrial fibrillation is associated with a two- to seven-fold increased risk of stroke, one of the most serious complications. Chronic kidney disease affects approximately 13% of the US population and has been associated with higher rates of AF than the general population. In patients with chronic kidney disease (CKD), the risk of stroke increases as the glomerular filtration rate (GFR) decreases, especially in CKD stages three and four...
December 11, 2017: Curēus
Clara Stegmann, Cosima Jahnke, Ingo Paetsch, Sebastian Hilbert, Arash Arya, Andreas Bollmann, Gerhard Hindricks, Philipp Sommer
Aims: Presence of late gadolinium enhancement (LGE) is related to adverse cardiovascular outcome. Many patients suffering from atrial fibrillation (AF) undergo cardiovascular magnetic resonance (CMR) imaging prior to ablation. Since quantification of atrial fibrosis still lacks reproducibility, we sought to investigate risk factors for the presence of left ventricular (LV)-LGE and a possible correlation between ventricular fibrosis as defined by positive LGE and pathological atrial voltage maps evaluated by 3D mapping systems...
February 6, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Hubert Cochet, Xavier Iriart, Soumaya Sridi, Claudia Camaioni, Olivier Corneloup, Michel Montaudon, François Laurent, Wieme Selmi, Pauline Renou, Zakaria Jalal, Jean-Benoît Thambo
Aims: Transoesophageal echocardiography studies have reported frequent peri-device leaks and device-related thrombi (DRT) after percutaneous left atrial appendage (LAA) occlusion. We assessed the prevalence, characteristics and correlates of leaks and DRT on cardiac computed tomography (CT) after LAA occlusion. Methods and results: Consecutive patients underwent cardiac CT before LAA occlusion to assess left atrial (LA) volume, LAA shape, and landing zone diameter...
February 2, 2018: European Heart Journal Cardiovascular Imaging
Ayman Elbadawi, Islam Y Elgendy, Le Dung Ha, Basarat Baig, Marwan Saad, Hussain Adly, Gbolahan O Ogunbayo, Odunayo Olorunfemi, Matthew S Mckillop, Scott A Maffett
Limited data are available regarding the impact of cancer on cerebrovascular accidents in patients with atrial fibrillation (AF). We queried the Nationwide Inpatient Survey Database to identify patients who have diagnostic code for AF. We performed a 1:1 propensity matching based on the CHA2DS2VASc score and other risk factors between patients with AF who had lung, breast, colon, and esophageal cancer, and those who did not (control). The final cohort included a total of 31,604 patients. The primary outcome of in-hospital cerebrovascular accidents (CVA) was lower in the cancer group than in the control group (4% vs 7%, p < 0...
December 20, 2017: American Journal of Cardiology
Paweł Balsam, Krzysztof Ozierański, Agata Tymińska, Katarzyna Żukowska, Martyna Zaleska, Katarzyna Szepietowska, Kacper Maciejewski, Michał Peller, Marcin Grabowski, Piotr Lodziński, Anna Praska-Ogińska, Inna Zaboyska, Łukasz Kołtowski, Anna Kowalczuk, Janusz Bednarski, Krzysztof J Filipiak, Grzegorz Opolski
BACKGROUND: The first line drugs for treatment of non-valvular atrial fibrillation (AF) are non-vitamin K oral anticoagulants (NOACs), which are preferred over vitamin K antagonists (VKAs). There is some evidence that an everyday clinical practice is distant from the guidelines. AIM: The study aimed to compare characteristics of patients on VKAs, dabigatran and rivaroxaban met in everyday practice (i.e. baseline characteristics, drugs' doses, risk factors of bleeding and thromboembolic events)...
January 19, 2018: Kardiologia Polska
Marise Gauci, Francesca Wirth, Liberato Camilleri, Lilian M Azzopardi, Anthony Serracino-Inglott
Background: Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs). Objective: To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons. Methods: Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a 'qualifying statement' followed by a 'standard'...
October 2017: Pharmacy Practice
Nijole Bernaitis, Chi Keong Ching, Tony Badrick, Shailendra Anoopkumar-Dukie
Warfarin decreases stroke risk in atrial fibrillation patients, with efficacy and safety impacted by the quality of warfarin control, as measured by time in therapeutic range (TTR). Stroke and bleed risk scores are calculated prior to commencing warfarin, so it would be beneficial if these scores also identified likely warfarin control. Some studies have investigated CHADS2, CHA2DS2VASc, and HASBLED individually for this purpose, but application of all scores to diverse ethnic populations and at sites with differing overall control has not been investigated...
November 28, 2017: Heart, Lung & Circulation
Devada Singh-Franco, Genevieve Hale, Robin J Jacobs
OBJECTIVES: Availability of direct oral anticoagulants and CHA2 DS2 VASc/HAS-BLED scoring tools underscore the importance of appropriate and safe use of oral anticoagulation therapy (OACT). The purpose of this study was to evaluate stroke prevention pharmacotherapy in adult patients with nonvalvular atrial fibrillation (NVAF) discharged from a large, community-based hospital. METHODS: A retrospective cohort study was conducted using a de-identified data collection sheet for data extraction (demographics, admitting diagnosis, OACT prior to admission and at discharge, concomitant medications that could increase bleed risk and/or acid-suppressive therapies)...
February 2018: Hospital Practice (Minneapolis)
Maria Perticone, Angela Sciacqua, Giovanni Tripepi, Sofia Miceli, Salvatore Corrao, Giorgio Sesti, Francesco Perticone
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and an emerging risk factor for atrial fibrillation (AF). CHADS2 and CHA2 DS2 -VASc scores are significantly associated with incident AF independently of other risk factors. The aim of this study was to demonstrate a possible interaction between COPD and CHA2 DS2 -VASc in predicting incident AF. METHODS: This observational prospective cohort study included 4322 Caucasians with cardiovascular risk factors, stratified by CHA2DS2-VASc score (>2 vs <2) and presence/absence of COPD...
March 15, 2018: International Journal of Cardiology
Kudret Keskin, Süleyman Sezai Yıldız, Gökhan Çetinkal, Gökhan Aksan, Hakan Kilci, Şükrü Çetin, Serhat Sığırcı, Kadriye Kılıçkesmez
Background: Acute coronary syndrome is the most common cause of cardiac morbidity and death. Various scoring systems have been developed in order to identify patients who are at risk for adverse outcome and may benefit from more aggressive and effective therapies. Objectives: This study was designed to evaluate the CHA2 DS2 VASC score as a predictor of mortality inpatients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (p-PCI)...
November 2017: Acta Cardiologica Sinica
Marcio José Montenegro da Costa, Esmeralci Ferreira, Edgard Freitas Quintella, Bernardo Amorim, Alexandre Fuchs, Ricardo Zajdenverg, Hugo Sabino, Denilson Campos de Albuquerque
BACKGROUND: Atrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke. OBJECTIVE: To assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF. METHODS: This study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex)...
November 13, 2017: Arquivos Brasileiros de Cardiologia
Onur Kaypakli, Hasan Koca, Durmuş Yıldıray Şahin, Sefa Okar, Fadime Karataş, Mevlüt Koç
AIM: We aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF. METHODS: We included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5±10,9years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 12‑lead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation...
October 9, 2017: Journal of Electrocardiology
Gregory Y H Lip, Jean Philippe Collet, Raffaele de Caterina, Laurent Fauchier, Deirdre A Lane, Torben B Larsen, Francisco Marin, Joao Morais, Calambur Narasimhan, Brian Olshansky, Luc Pierard, Tatjana Potpara, Nizal Sarrafzadegan, Karen Sliwa, Gonzalo Varela, Gemma Vilahur, Thomas Weiss, Giuseppe Boriani, Bianca Rocca
Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA2DS2VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD...
November 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Gentian Denas, Giacomo Zoppellaro, Seena Padayattil Jose, Emilia Antonucci, Francesco Marongiu, Daniela Poli, Sophie Testa, Armando Tripodi, Gualtiero Palareti, Vittorio Pengo
INTRODUCTION: The issue of anticoagulation in individuals with atrial fibrillation and 1 non-gender related risk factor is subject to debate. The reported risk of stroke in untreated individuals is not uniform, and the rate of haemorrhage associated with anticoagulation in this group of individuals is not well defined. To this end, we assessed the rate of stroke and major haemorrhage in individuals treated with warfarin. MATERIALS AND METHODS: individuals were extracted from the START register, an observational, multicentre, dynamic inception cohort study that collects data on AF individuals starting anticoagulation therapy...
October 27, 2017: Cardiovascular Therapeutics
Ênio Eduardo Guérios, Francisco Chamié, Márcio Montenegro, Eduardo Benchimol Saad, Fabio Sandoli de Brito, Paulo Avancini Caramori, Luiz Carlos Simões, Flávio Roberto Azevedo de Oliveira, Luiz Carlos Giuliano, Cláudio Munhoz da Fontoura Tavares
BACKGROUND: Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). OBJECTIVE: To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure. METHODS: 91 patients with NVAF, high stroke risk (CHA2DS2VASc score = 4...
October 19, 2017: Arquivos Brasileiros de Cardiologia
Micha Tobias Maeder, Tabea König, Sanja Bogdanovic, Irene Schneider, Werner Eugster, Peter Ammann, Marius König, Jürg Beer, Hans Rickli
AIM OF THE STUDY: To better appreciate the role of the non-vitamin K oral anticoagulants (NOACs) for patients with non-valvular atrial fibrillation in Switzerland we aimed to assess the quality of vitamin K antagonist (VKA) anticoagulation in daily practice. METHODS: In a cross-sectional study, clinically stable patients on VKA treatment for non-valvular atrial fibrillation for at least 6 months, documentation of international normalised ratio (INR) values for at least 3 months and with at least two INR values were included...
October 17, 2017: Swiss Medical Weekly
Matthew Hammond-Haley, Rui Providência, Pier D Lambiase
Atrial fibrillation (AF) is a clinically heterogeneous arrhythmia that is currently classified according to the variety of temporal rhythm based manifestations observed clinically, including 'first detected episode', 'paroxysmal', 'persistent', or 'permanent' AF. Despite being widely adopted by the most recent consensus guidelines, the utility of this classification system to stratify patients into distinct and clinically useful groups that have different outcomes including mortality, morbidity, specific cardiovascular outcomes, and quality of life (QoL), remains questionable...
July 11, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Hanen Ghazali, Jihen Essid, Anware Yahmadi, Moez Mougaida, Mahbouba Chkir, Sami Souissi
INTRODUCTION: The vitamin K antagonists (VKAs) are currently the most effective therapeutic class for the prevention of cerebrovascular eventsin atrial fibrillation (AF) patients. However, several studies showed an under-prescription of this therapy.The aim of the study was to assess the prescription of VKAs in non-valvular AF (NVAF) patients and factors influencing the non-prescription ofsuch treatment. METHODS: We conducted a prospective, observational study in an emergency department (ED)...
November 2016: La Tunisie Médicale
Jonggi Choi, Junhwan Kim, Ju Hyun Shim, Minsu Kim, Gi-Byoung Nam
BACKGROUND & AIMS: To evaluate the clinical benefits and risks of anticoagulation with warfarin in cirrhotic patients with atrial fibrillation (AF). METHODS: A total of 465 cirrhotic patients diagnosed with nonvalvular AF were retrospectively analyzed. We compared incidences of ischemic stroke and major bleeding events between the 2 groups and examined the factors predicting ischemic stroke or major bleeding events. RESULTS: Of 465 patients with AF, 113 (24...
October 2017: Journal of Cardiovascular Pharmacology
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