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https://www.readbyqxmd.com/read/28811871/do-all-patients-with-atrial-fibrillation-need-long-term-anticoagulation
#1
Munish Sharma, Rohit Masih, Daniel A N Mascarenhas
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide with an estimated number of 2.7-6.1 million cases in the United States (US) alone. The incidence of AF is expected to increase 2.5 fold over the next 50 years in the US. The management of AF is complex and includes mainly three aspects; restoration of sinus rhythm, control of ventricular rate and prevention of systemic thromboembolism. AF as a cause of systemic embolization has been well known for many years, and majority of patients are on oral anticoagulants (OACs) to prevent this...
June 7, 2017: Clinics and Practice
https://www.readbyqxmd.com/read/28802808/novel-oral-anticoagulants-in-direct-current-cardioversion-for-atrial-fibrillation
#2
Giuseppe Femia, Taufik Fetahovic, Pratap Shetty, Astin Lee
BACKGROUND: For some patients with atrial fibrillation, direct current cardioversion (DCCV) is one strategy that can be used to establish sinus rhythm but appropriate anticoagulation is mandatory to prevent thromboembolic events. Historically, patients were anticoagulated with warfarin with bridging with unfractionated or low molecular weight heparin, however, recently novel oral anticoagulants (NOACs), apixaban, dabigatran and rivaroxaban have become more popular. Despite the increase in use, real world data on safety and efficacy is limited...
July 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28798015/morbidity-and-mortality-conference-for-percutaneous-coronary-intervention
#3
Jacob A Doll, Robert Overton, Manesh R Patel, Sunil V Rao, Michael H Sketch, J Kevin Harrison, James E Tcheng
BACKGROUND: Morbidity and mortality conference is a common educational and quality improvement activity performed in cardiac catheterization laboratories, but best practices for case selection and for maximizing the effectiveness of peer review have not been determined. METHODS AND RESULTS: We reviewed the 10-year percutaneous coronary intervention morbidity and mortality conference experience of an academic medical center. Cases were triggered for review by the occurrence of prespecified procedural events...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28790169/disease-understanding-in-patients-newly-diagnosed-with-atrial-fibrillation
#4
Brystana G Kaufman, Sunghee Kim, Karen Pieper, Larry A Allen, Bernard J Gersh, Gerald V Naccarelli, Michael D Ezekowitz, Gregg C Fonarow, Kenneth W Mahaffey, Daniel E Singer, Paul S Chan, James V Freeman, Jack Ansell, Peter R Kowey, James A Rieffel, Jonathan Piccini, Eric Peterson, Emily C O'Brien
OBJECTIVE: To describe self-reported disease understanding for newly diagnosed patients with atrial fibrillation (AF) and assess (1) how disease understanding changes over the first 6 months after diagnosis and (2) the relationship between patient understanding of therapies at baseline and treatment receipt at 6 months among treatment-naïve patients. METHODS: We analysed survey data from SATELLITE (Survey of Patient Knowledge and Personal Priorities for Treatment), a substudy of patients with new-onset AF enrolled in the national Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT) II registry across 56 US sites...
August 8, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28790101/splenic-rupture-following-synchronised-direct-current-cardioversion
#5
Nicholas Kaufman, David Ferraro
Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or minor medical procedures not involving the spleen. A 65-year-old man who was hospitalised for eosinophilic pneumonia developed haemodynamically unstable atrial flutter that necessitated urgent synchronised direct current cardioversion (DCCV). Two hours after successful cardioversion, he developed signs of an acute abdomen with free intraperitoneal fluid identified on bedside ultrasonography...
August 7, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28752145/increased-levels-of-red-cell-distribution-width-is-correlated-with-presence-of-left-atrial-stasis-in-patients-with-non-valvular-atrial-fibrillation
#6
Adnan Kaya, Ceyhan Tukkan, Ahmet Taha Alper, Baris Gungor, Kazim Serhan Ozcan, Mustafa Adem Tatlisu, Ahmet Ilker Tekkesin, Fatma Ozpamuk Karadeniz, Gulay Gok, Osman Kayapinar
OBJECTIVE: Red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) have been found to be associated with non-valvular atrial fibrillation (AF) and cardiovascular diseases. However, correlation of these parameters with presence of left atrial (LA) thrombus and/or spontaneous echo contrast (SEC) in patients with non-valvular AF has not been clarified. This study was an investigation of correlation of RDW, NLR, and clinical risk factors with LA thrombus and dense SEC in patients with non-valvular AF in the Turkish population...
2017: Northern Clinics of Istanbul
https://www.readbyqxmd.com/read/28751544/the-impact-of-cryoballoon-versus-radiofrequency-ablation-for-paroxysmal-atrial-fibrillation-on-healthcare-utilization-and-costs-an-economic-analysis-from-the-fire-and-ice-trial
#7
K R Julian Chun, Josep Brugada, Arif Elvan, Laszlo Gellér, Matthias Busch, Alberto Barrera, Richard J Schilling, Matthew R Reynolds, Robert B Hokanson, Reece Holbrook, Benedict Brown, Michael Schlüter, Karl-Heinz Kuck
BACKGROUND: This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. METHODS AND RESULTS: A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$])...
July 27, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28738693/the-accuracy-of-spacelabs-90207-in-blood-pressure-monitoring-in-patients-with-atrial-fibrillation
#8
Eliza Miszkowska-Nagórna, Jolanta Neubauer-Geryk, Jacek Wolf, Melanie Wielicka, Grzegorz Raczak, Krzysztof Narkiewicz, Leszek Bieniaszewski
PURPOSE: Irregular heart rhythm in the course of atrial fibrillation (AFib) results in lower blood pressure (BP) measurements reproducibility which is further limited by various BP-monitors used. Therefore the aim of our study was to estimate accuracy of oscillometric BP measurement (SpaceLabs 90207) with reference to mercury manometer-based readings. MATERIAL AND METHODS: Study was performed in 47 hemodynamically stable patients aged 63 ± 12 yo with paroxysmal or persistent AFib, at baseline...
July 24, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28709650/anticoagulation-control-in-warfarin-treated-patients-undergoing-cardioversion-of-atrial-fibrillation-from-the-edoxaban-versus-enoxaparin-warfarin-in-patients-undergoing-cardioversion-of-atrial-fibrillation-trial
#9
Gregory Y H Lip, Naab Al-Saady, James Jin, Ming Sun, Michael Melino, Shannon M Winters, Dmitry Zamoryakhin, Andreas Goette
In the Edoxaban Versus Enoxaparin-Warfarin in Patients Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF) study (NCT 02072434), edoxaban was compared with enoxaparin-warfarin in 2,199 patients undergoing electrical cardioversion of nonvalvular atrial fibrillation (AF). In this multicenter prospective randomized open blinded end-point trial, we analyzed patients randomized to enoxaparin-warfarin. We determined time to achieve therapeutic range (TtTR); time in therapeutic range (TiTR); their clinical determinants; relation to sex, age, medical history, treatment, tobacco use, race risk (SAMe-TT2R2) score; and impact on primary end points (composite of stroke, systemic embolic event[SEE], myocardial infarction [MI], and cardiovascular death [CVD] and composite of major + clinically relevant nonmajor bleeding)...
September 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28706585/atrial-tachyarrhythmia-in-adult-congenital-heart-disease
#10
REVIEW
Arsha Karbassi, Krishnakumar Nair, Louise Harris, Rachel M Wald, S Lucy Roche
The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues...
June 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/28701602/to-evaluate-dexmedetomidine-as-an-additive-to-propofol-for-sedation-for-elective-cardioversion-in-a-cardiac-intensive-care-unit-a-double-blind-randomized-controlled-trial
#11
Tanveer Singh Kundra, Parminder Kaur, P S Nagaraja, N Manjunatha
INTRODUCTION: Propofol may lead to patient recall and discomfort when used for sedation in elective cardioversion. The aim of the present study was to evaluate dexmedetomidine as an additive to propofol for sedation in elective cardioversion. MATERIALS AND METHODS: A total of 500 patients undergoing elective cardioversion were randomized into Group 1 (n = 250) and Group 2 (n = 250) on the basis of computer-generated randomization table. Patients in Group 1 were given dexmedetomidine (1 mcg/kg) over 10 min before giving propofol (1 mg/kg), while patients in Group 2 were given only propofol (1 mg/kg)...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28698191/manual-versus-semiautomatic-rhythm-analysis-and-defibrillation-for-out-of-hospital-cardiac-arrest
#12
Ziad Nehme, Emily Andrew, Resmi Nair, Stephen Bernard, Karen Smith
BACKGROUND: Although manual and semiautomatic external defibrillation (SAED) are commonly used in the management of out-of-hospital cardiac arrest, the optimal strategy is not known. We hypothesized that SAED would reduce the time to first shock and lead to higher rates of cardioversion and survival compared with a manual strategy. METHODS AND RESULTS: Between July 2005 and June 2015, we included adult out-of-hospital cardiac arrest of presumed cardiac pathogenesis...
July 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28692548/comparison-of-vernakalant-and-ranolazine-in-atrial-fibrillation
#13
Gerrit Frommeyer, Magdalena Sterneberg, Dirk G Dechering, Simon Kochhäuser, Nils Bögeholz, Michael Fehr, Lars Eckardt
BACKGROUND: Current guidelines recommend vernakalant for pharmacologic cardioversion of recent-onset atrial fibrillation. However, this drug is not established as chronic therapy. METHODS AND RESULTS: In total, 15 rabbit hearts were Langendorff-perfused. A burst pacing protocol-induced atrial fibrillation in 7 of 15 hearts at baseline (10 episodes). Subsequently, a combination of acetylcholine and isoproterenol (ACH/ISO) has been administered to increase occurrence of atrial fibrillation resulting in a reduction of atrial action potential duration (-25 ms, P < 0...
September 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28680511/emergency-department-procedural-sedation-for-primary-electrical-cardioversion-a-comparison-with-procedural-sedations-for-other-reasons
#14
Michael Butler, Patrick Froese, Peter Zed, George Kovacs, Robert MacKinley, Kirk Magee, Mary-Lynn Watson, Samuel G Campbell
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia treated in the emergency department (ED), with primary electrical cardioversion (PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation (EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital...
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28680466/atrial-fibrillation-with-a-structurally-normal-heart-in-pregnancy-an-international-survey-on-current-practice
#15
Annabelle Cumyn, Nadine Sauvé, Évelyne Rey
BACKGROUND: Little evidence exists for the optimal management of atrial fibrillation with a structurally normal heart in pregnancy. METHODS: A survey was sent to members of two associations to obtain input on optimal management of atrial fibrillation in pregnancy. The survey presented four cases with respect to (1) baseline investigations; (2) rate versus rhythm control; (3) chemical versus electrical cardioversion; and (4) anticoagulation. RESULTS: Sixty-one responders from 11 countries participated...
June 2017: Obstetric Medicine
https://www.readbyqxmd.com/read/28678147/efficacy-of-second-generation-cryoballoon-ablation-in-paroxysmal-and-persistent-atrial-fibrillation-patients
#16
Antonio Curnis, Francesca Salghetti, Manuel Cerini, Francesca Vassanelli, Lorenza Inama, Clara Villa, Daniele Giacopelli, Abdallah Raweh, Luca Bontempi
AIMS: In this study, we aimed to compare the efficacy of single pulmonary vein isolation with the second-generation cryoballoon (CB-Adv) and predictors of atrial fibrillation recurrences in patients with paroxysmal (PAF) and persistent atrial fibrillation (PersAF). METHODS: Consecutive PAF and PersAF patients undergoing CB-Adv for the first time were enrolled. Patients were followed with in-clinic visits including Holter ECG. Atrial arrhythmic episodes symptomatic or documented lasting more than 30 s were considered as recurrences...
September 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28675629/long-term-follow-up-after-left-atrial-appendage-occlusion-with-comparison-of-transesophageal-echocardiography-vs-computed-tomography-to-guide-medical-therapy-and-data-about-post-closure-cardioversion
#17
Benjamin Berte, Christine Attenhofer Jost, Dominik Maurer, Anja Fäh-Gunz, Xavier Pillois, Barbara Naegeli, Monica Pfyffer, Gabor Sütsch, Christoph Scharf
AIMS: The use of left atrial appendage (LAA)-occluders in atrial fibrillation is increasing. There are few data on the comparison between transesophageal echocardiography (TEE) and computed tomography (MDCT) assessing peridevice-flow and outcome of electrical cardioversion (ECV) in these patients. METHODS AND RESULTS: Single-center prospective registry from 2009 to 2015 including all LAA-occluders to analyze success and complications during implantation and follow-up...
July 4, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28667170/isolated-cardiac-sarcoidosis-masquerading-as-right-ventricular-outflow-tract-ventricular-tachycardia
#18
Auras R Atreya, Mitkumar Patel, Senthil K Sivalingam, Mathias L Stoenescu
A 67-year-old man with coronary artery disease (CAD) and left anterior descending artery (LAD) stent presented with symptomatic monomorphic ventricular tachycardia (VT) at a rate of 190 bpm requiring cardioversion. ECG showed left bundle branch block pattern and inferior axis, suggestive of a right ventricular outflow tract (RVOT) focus rather than left ventricular scar due to LAD territory myocardial infarction (MI). Echocardiography showed normal wall motion. Angiography revealed a patent mid-LAD stent. Cardiac MRI with delayed postcontrast sequence revealed several regions of hyperenhancement abnormality within the basal portion of the interventricular septum...
June 30, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28662483/intensity-of-anticoagulation-and-risk-of-thromboembolism-after-elective-cardioversion-of-atrial-fibrillation
#19
Tapio Hellman, Tuomas Kiviniemi, Ilpo Nuotio, Tuija Vasankari, Juha Hartikainen, Gregory Y H Lip, K E Juhani Airaksinen
BACKGROUND: Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0-2.4) vs. high (INR≥2.5) therapeutic range in a large retrospective cohort study. METHODS: This multi-centre "real world" study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV...
June 22, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28661896/vitamin-k-antagonists-versus-novel-oral-anticoagulants-for-elective-electrical-cardioversion-of-atrial-fibrillation
#20
Diana Ţînţ, Antoniu O Petriş, Ioana Pop, Rimma Melnic, Andreea-Mihaela Ignat, Liliana M Rogozea
BACKGROUND: The management strategy for patients with atrial fibrillation (AF) is often very complex, electrical cardioversion (EC) being often used to restore sinus rhythm in those patients. The increased risk of thromboembolic complications was lowered using anticoagulation therapy. Usually, the anticoagulation was achieved using vitamin K antagonists (VKAs), but over the last years we witnessed a wide implementation of the novel oral anticoagulants (NOACs). STUDY QUESTION: Study question was to compare the efficacy of NOACs versus VKAs in patients undergoing elective EC for persistent AF, by assessing the presence of left atrial spontaneous contrast and left atrial thrombi (LACS), as well as the occurrence of the thromboembolic events in the first month after the procedure...
April 26, 2017: American Journal of Therapeutics
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