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Fibrilation atrial guidelines

Ali J Khiabani, Taylan Adademir, Richard B Schuessler, Spencer J Melby, Marc R Moon, Ralph J Damiano
Untreated atrial fibrillation is associated with an increased risk of all-cause mortality and morbidity. Despite the current guidelines recommending surgical ablation of atrial fibrillation at the time of coronary artery bypass surgery, most patients with concomitant atrial fibrillation and coronary artery disease do not receive surgical ablation for their atrial fibrillation. This review reports the efficacy of different surgical ablation techniques used for the treatment of atrial fibrillation during coronary artery bypass...
November 30, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Ammar M Killu, Christopher B Granger, Bernard J Gersh
Despite the demonstrable success of oral anticoagulants in reducing the rate of stroke in patients with atrial fibrillation, they continue to be seriously underutilized. Indications for their use as stated in the guidelines incorporate a number of risk score algorithms, the most widely used being the CHA2DS2-VASc score. Nonetheless there are several limitations to the various scores currently in clinical use and a critique of these is the focus of this review. In this review we discuss the pathophysiology of atrial fibrillation and its role in thromboembolic stroke risk...
December 1, 2018: European Heart Journal
Naja Emborg Vinding, Anders Nissen Bonde, Rasmus Rørth, Morten Lamberts, Jonas Bjerring Olesen, Gunnar Hilmar Gislason, Christian Torp-Pedersen, Lars Køber, Emil Loldrup Fosbøl
Aims: Patients with non-valvular atrial fibrillation (NVAF) receiving vitamin K antagonists (VKAs) with time in therapeutic international normalized ratio (INR) range (TTR) <70%, despite good adherence, are by guidelines recommended to switch to non-VKA oral anticoagulants (NOACs). The aim was to assess if patients are switched from VKA to NOAC when TTR is <70% in a real-world setting. Methods and results: Non-valvular atrial fibrillation patients receiving VKA (1 January 2010 to 31 December 2012) were identified in nationwide registries...
December 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Tess Fitzpatrick, Sophia Gocan, Chu Q Wang, Candyce Hamel, Aline Bourgoin, Dar Dowlatshahi, Grant Stotts, Michel Shamy
BACKGROUND: Identifying and treating patients with transient ischemic attack is an effective means of preventing stroke. However, making this diagnosis can be challenging, and over a third of patients referred to stroke prevention clinic are ultimately found to have alternate diagnoses. AIMS: We performed a systematic review to determine how neurologists diagnose transient ischemic attack. SUMMARY OF REVIEW: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE, Embase, and the Cochrane Library databases...
December 3, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
James A Reiffel
That clinically-documented atrial fibrillation (AF) in association with a variety of elevated clinical/laboratory risk markers is associated with an increased risk of stroke is well known -- regardless of whether the AF is paroxysmal, persistent, or permanent. Moreover, data is accumulating to suggest that the absolute rate of stroke should be expectedly higher with a greater burden of AF and greater degree of comorbid contributors. Relatedly, stroke prevention with chronic oral anticoagulation (OAC) is recommended for AF patients with appropriate risk markers by all major medical, cardiologic, and surgical guideline-writing organizations...
August 2018: Journal of Atrial Fibrillation
Enes E Gul, Usama Boles, Sohaib Haseeb, Wilma Hopman, Kevin A Michael, Chris Simpson, Hoshiar Abdollah, Adrian Baranchuk, Damian Redfearn, Benedict Glover
Background: Catheter ablation is a cornerstone treatment strategy in atrial fibrillation (AF). Left atrial (LA) size is one of the contributors in development of AF recurrences. The impact of contact-forced (CF) guided catheter ablation on the success rate of persistent AF patients with severe enlarged LA has not been investigated yet. Methods: Sixty-six patients with diagnosis of longstanding persistent AF undergoing catheter ablation were enrolled. All patients underwent a standard transthoracic echocardiography according to the guidelines...
August 2018: Journal of Atrial Fibrillation
Toyonobu Tsuda, Kenshi Hayashi, Noboru Fujino, Tetsuo Konno, Hayato Tada, Akihiro Nomura, Yoshihiro Tanaka, Kenji Sakata, Hiroshi Furusho, Masayuki Takamura, Masa-Aki Kawashiri, Masakazu Yamagishi
BACKGROUND: Anticoagulation is recommended in hypertrophic cardiomyopathy (HCM) with non-valvular atrial fibrillation (NVAF) according to European and American guidelines. However, it is unclear whether HCM is a risk factor for thromboembolism in NVAF in Japan, and the management for NVAF with HCM is not established. OBJECTIVES: We studied the impact of concomitant HCM on predicting thromboembolism in NVAF. METHODS: We retrospectively studied consecutive 2374 Japanese NVAF patients (1682 men, 71±10 years)...
November 29, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Rebecca M Jedwab, Alison M Hutchinson, Bernice Redley
OBJECTIVE: The objective of this review was to identify evidence to inform clinical practice guidelines for magnesium sulphate (MgSO4 ) replacement therapy for postoperative cardiac surgery patients. DATA SOURCES: Three databases were systematically searched: CINAHL Complete, MEDLINE Complete, and EmBase. REVIEW METHOD USED: A systematic literature review method was used to locate, appraise, and synthesise available evidence for each step of the medication management cycle (indication, prescription, preparation, administration, and monitoring) for MgSO4 replacement therapy...
November 27, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
John Erwin Iii, Bernard Iung
No abstract text is available yet for this article.
December 2018: Heart: Official Journal of the British Cardiac Society
Shaun Giancaterino, Florentino Lupercio, Marin Nishimura, Jonathan C Hsu
Insertable cardiac monitors (ICMs) are small, subcutaneously implanted devices offering continuous ambulatory electrocardiogram monitoring with a lifespan up to 3 years. ICMs have been studied and proven useful in selected cases of unexplained syncope and palpitations, as well as in atrial fibrillation (AF) management. The use of ICMs has greatly improved our ability to detect subclinical AF after cryptogenic stroke, and application of this technology is growing. Despite this, current stroke and cardiology society guidelines are lacking in recommendations for monitoring of subclinical AF following cryptogenic stroke, including the optimal timing from stroke event, duration, and method of electrocardiogram monitoring...
November 2018: JACC. Clinical Electrophysiology
David H Birnie, Jeff S Healey, George A Wells, Felix Ayala-Paredes, Benoit Coutu, Glen L Sumner, Giuliano Becker, Atul Verma, François Philippon, Eli Kalfon, John Eikelboom, Roopinder K Sandhu, Pablo B Nery, Nicholas Lellouche, Stuart J Connolly, John Sapp, Vidal Essebag
Aims: Guidelines recommend warfarin continuation rather than heparin bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL trial demonstrated an 80% reduction in device pocket haematoma with this approach. However, direct oral anticoagulants (DOACs) are now used to treat the majority of patients with atrial fibrillation. We sought to understand the best strategy to manage the DOACs at the time of device surgery and specifically hypothesized that performing device surgery without DOAC interruption would result in a reduced haematoma rate...
November 21, 2018: European Heart Journal
Jorge Romero, Ricardo Avendano, Juan Carlos Diaz, Jose Taveras, Florentino Lupercio, Luigi Di Biase
Atrial fibrillation is the most common arrhythmia worldwide. Its increasing prevalence has made the use of oral anticoagulants for stroke prevention routine, however the use of them after the blanking period of catheter ablation remains uncertain. Areas covered: This review outlines the pros and cons of stopping oral anticoagulation after catheter ablation. Major databases such as Pubmed or Embase were used. The most relevant articles published were used along with major recommendations of society guidelines...
November 21, 2018: Expert Review of Cardiovascular Therapy
Barry Burstein, Rodrigo Barbosa, Maude Peretz- Larochelle, Michelle Samuel, Vidal Essebag, Martin L Bernier
A 43-year-old man presented after ventricular fibrillation cardiac arrest with evidence of pre-excited atrial fibrillation. Electrophysiology study with guideline-directed testing demonstrated a low risk accessory pathway effective refractory period, which became high-risk with isoproterenol infusion. This case represents a challenging scenario wherein a high-risk pathway may be misclassified using the currently indicated methods of risk stratification.
June 2018: Journal of Atrial Fibrillation
Justin L Vandermolen, Murrium I Sadaf, Anil K Gehi
Introduction: Management of atrial fibrillation (AF) and atrial flutter (AFL) in the emergency department (ED) varies greatly, and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment. The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED, and assess potential outcomes associated with different management strategies in the ED. Methods and Results: A systematic review was done using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, combining the search terms "Atrial Fibrillation", "Atrial Flutter", "Emergency Medicine", "Emergency Service", and "Emergency Treatment"...
June 2018: Journal of Atrial Fibrillation
Noelle M Cocoros, Sean D Pokorney, Kevin Haynes, Crystal Garcia, Hussein R Al-Khalidi, Sana M Al-Khatib, Patrick Archdeacon, Jennifer C Goldsack, Thomas Harkins, Nancy D Lin, David Martin, Debbe McCall, Vinit Nair, Lauren Parlett, Robert Temple, Cheryl McMahill-Walraven, Christopher B Granger, Richard Platt
BACKGROUND: The US Food and Drug Administration's Sentinel Initiative is well positioned to support pragmatic clinical trials. FDA-Catalyst combines direct contact with health plan members and/or providers with data in the Sentinel infrastructure. Here, we describe the rationale, feasibility analyses, and lessons learned from the planning phase of the first large pragmatic trial conducted using the Sentinel Initiative's delivery system capabilities-IMplementation of a randomized controlled trial to imProve treatment with oral AntiCoagulanTs in patients with Atrial Fibrillation (the IMPACT-AFib trial)...
November 16, 2018: Clinical Trials: Journal of the Society for Clinical Trials
Sean D Pokorney, Diane Bloom, Christopher B Granger, Kevin L Thomas, Sana M Al-Khatib, Mayme L Roettig, John Anderson, Mitchell T Heflin, Bradi B Granger
BACKGROUND: Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs). AIMS: Given that the etiology of this gap in care is not well understood, we explored decision-making by patients and physicians regarding OAC use for stroke prevention in atrial fibrillation. METHODS AND RESULTS: We conducted a descriptive qualitative study among providers ( N=28) and their patients with atrial fibrillation for whom OACs were indicated ( N=25)...
November 12, 2018: European Journal of Cardiovascular Nursing
Nicolae Done, Amanda M Roy, Yingzhe Yuan, Steven D Pizer, Adam J Rose, Julia C Prentice
OBJECTIVE: To characterize the rate of guideline-concordant initiation of oral anticoagulation (OAC) among elderly Veterans with atrial fibrillation (AF) and high stroke risk. DATA SOURCES/STUDY SETTING: Veterans Health Administration (VHA) Corporate Data Warehouse (CDW) linked with Medicare claims 2011-2015. STUDY DESIGN: We identified 6619 elderly, high stroke-risk patients with a new episode of AF initially diagnosed in the VHA during fiscal years 2012-2015...
November 11, 2018: Health Services Research
David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo Norrving
BACKGROUND: About 13-26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population, early oral anticoagulation is suspected to increase the risk of potentially harmful intracranial haemorrhage, including haemorrhagic transformation of the infarct...
November 8, 2018: Lancet Neurology
David J Slotwiner, Merritt H Raitt, Freddy Del-Carpio Munoz, Naseer Nasser, Siva K Mulpuru, Pamela N Peterson
BACKGROUND: It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His-bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). AIM: Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent adverse remodeling and be associated with structural, functional, and clinical advantages compared with RVP among patients without severe left ventricular dysfunction (>35%) who required permanent pacing because of heart block...
October 31, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
David J Slotwiner, Merritt H Raitt, Freddy Del-Carpio Munoz, Siva K Mulpuru, Naseer Nasser, Pamela N Peterson
BACKGROUND: It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His-bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). AIM: Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent adverse remodeling and be associated with structural, functional, and clinical advantages compared with RVP among patients without severe left ventricular dysfunction (>35%) who required permanent pacing because of heart block...
October 31, 2018: Journal of the American College of Cardiology
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