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AF Stroke

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https://www.readbyqxmd.com/read/29772570/undertreatment-of-vascular-risk-factors-in-patients-with-monocular-ischaemic-visual-loss
#1
Angeliki Zarkali, Suk Fun Cheng, Agnes Dados, Robert Simister, Arvind Chandratheva
BACKGROUND AND PURPOSE: Ischaemic visual loss is often considered a lower risk factor than other transient ischaemic attacks (TIA). We aimed to determine the recurrence risk, prevalence and management of vascular risk factors in these patients. METHODS: The study took place in the University College Hospital London daily TIA clinic, main referral centre for North-Central London and Moorfields Eye Hospital. Consecutive records for patients with transient (< 24 h) or permanent (> 24 h) ischaemic visual loss were reviewed during the period January 2014-October 2016...
May 17, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29768672/catheter-ablation-for-atrial-fibrillation-on-uninterrupted-direct-oral-anticoagulants-a-safe-approach
#2
V Sawhney, M Shaukat, E Volkova, N Jones, R Providencia, S Honarbakhsh, G Dhillon, A Chow, M Lowe, P Lambiase, M Dhinoja, S Sporton, M J Earley, R J Schilling, R J Hunter
BACKGROUND: Current consensus guidelines suggest DOACs are interrupted peri-procedurally for catheter ablation (CA) of AF. However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. METHODS: Single centre, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinised prior to trans-septal puncture with a target activated clotting time (ACT) of 300-350 seconds...
May 16, 2018: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/29768161/-practical-aspects-of-anticoagulant-therapy-in-patients-with-atrial-fibrillation-and-arterial-hypertension
#3
Z D Kobalava, A A Shavarov
Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia, the prevalence of AF is 1-2 % in the general population and up to 6 % for population over 80 years. Arterial hypertension (AH) is the commonest background comorbidity in patients with AF. Patients with AF have 3-6‑fold increased risk of ischemic stroke in comparison to that in general population, additionally the presence of AH leads an 2-3‑fold increase in risk of subsequent stroke. Current clinical guidelines recommend long-time anticoagulant treatment for prevention of stroke and thromboembolic complications in majority of patients with confirmed AF...
2018: Kardiologiia
https://www.readbyqxmd.com/read/29764706/atrial-fibrillation-and-ischemic-events-with-rivaroxaban-in-patients-with-stable-coronary-artery-disease-afire-protocol-for-a-multicenter-prospective-randomized-open-label-parallel-group-study
#4
Satoshi Yasuda, Koichi Kaikita, Hisao Ogawa, Masaharu Akao, Junya Ako, Tetsuya Matoba, Masato Nakamura, Katsumi Miyauchi, Nobuhisa Hagiwara, Kazuo Kimura, Atsushi Hirayama, Kunihiko Matsui
BACKGROUND: In atrial fibrillation (AF) patients with coronary artery disease (CAD), anticoagulants are commonly used in combination with antiplatelet drugs. However, dual therapy can increase the risk of bleeding, and the potential therapeutic benefits must be weighed against this. Therefore, it is recommended that dual therapy is only used for a limited time, and that monotherapy with anticoagulants should start from 1 year after percutaneous coronary intervention (PCI). However, there is a lack of evidence on the use of monotherapy, in particular with direct oral anticoagulants, in this group of patients...
May 2, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29763917/relevance-of-dementia-in-atrial-fibrillation-patients-within-a-specific-european-health-care-area
#5
Moisés Rodríguez-Mañero, Estrella López-Pardo, Alberto Cordero, Omar Kreidieh, José Novo Platas, Luis Valdés, Adrian Cid-Menendez, Javier García-Seara, María Pereira-Vázquez, Jose-Luis Martínez-Sande, Alberto Ruano, Carlos Peña-Gil, Pilar Mazón, Jose María García-Acuña, José Ramón González-Juanatey
INTRODUCTION: Atrial fibrillation might increase the risk of dementia. We aim to test the hypothesis that dementia could reclassify the actual risk of stroke and death predicted by the CHA2DS2-VASc in patients with atrial fibrillation (AF). METHODS: A prospective study performed in a specific health care area. RESULTS: From our health care area (n = 348,985), throughout 2013, AF was codified in 7,990 (2.08%). Mean age was 76.83 ± 10.5, mean CHA2DS2-VASc = 3...
May 15, 2018: Neuroepidemiology
https://www.readbyqxmd.com/read/29759774/assessment-of-left-atrial-fibrosis-by-late-gadolinium-enhancement-magnetic-resonance-imaging-methodology-and-clinical-implications
#6
REVIEW
Johannes Siebermair, Eugene G Kholmovski, Nassir Marrouche
Recently, studies using late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) to identify structural changes of atrial tissue have contributed significantly to understanding the pathophysiology and progression of atrial fibrillation (AF). Moreover, imaging of atrial fibrosis using MRI has evolved to be a tool to improve clinical outcome of AF ablation procedures by allowing a patient-specific individualized management approach. LGE-MRI has been shown to predict AF ablation outcome based on pre-procedural imaging to define the extent of atrial fibrosis...
August 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29759716/atrial-fibrillation-in-athletes-a-lesson-in-the-virtue-of-moderation
#7
REVIEW
N A Mark Estes, Christopher Madias
Although the cardiovascular benefits of moderate exercise are well established, there is growing epidemiological support for the notion that high-intensity endurance athletics increases the risk of atrial fibrillation (AF). There are many gaps in evidence related to epidemiology and mechanisms of AF in endurance athletes. The proposed pathophysiological mechanisms include alterations of autonomic tone, electrical remodeling, anatomical remodeling, fibrosis, and inflammation. Clinical management of the athlete with AF often includes a period of decreased frequency, intensity, and duration of exercise with assessment for improvement in AF recurrence...
September 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29759670/systemic-octreotide-therapy-in-prevention-of-gastrointestinal-bleeds-related-to-arteriovenous-malformations-and-obscure-etiology-in-atrial-fibrillation
#8
Venkat Vuddanda, Mohammad-Ali Jazayeri, Mohit K Turagam, Madhav Lavu, Valay Parikh, Donita Atkins, Sudharani Bommana, Madhu Reddy Yeruva, Luigi Di Biase, Jie Cheng, Vijay Swarup, Rakesh Gopinathannair, Mojtaba Olyaee, Vijay Ivaturi, Andrea Natale, Dhanunjaya Lakkireddy
OBJECTIVES: The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. BACKGROUND: AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs...
December 11, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29759668/incidence-characteristics-and-clinical-course-of-device-related-thrombus-after-watchman-left-atrial-appendage-occlusion-device-implantation-in-atrial-fibrillation-patients
#9
Shunsuke Kubo, Yukiko Mizutani, Krissada Meemook, Yoshifumi Nakajima, Asma Hussaini, Saibal Kar
OBJECTIVES: This study investigated characteristics and clinical impact of device-related thrombus formation after Watchman device implantation in atrial fibrillation (AF) patients. BACKGROUND: Left atrial appendage occlusion using the Watchman device is an effective alternative to anticoagulation for stroke prevention in AF patients. However, device-related thrombus formation remains an important concern after Watchman implantation. METHODS: From 2006 to 2014, 119 consecutive AF patients underwent Watchman implantation...
December 11, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29759666/patients-with-atrial-fibrillation-who-are-not-on-anticoagulant-treatment-due-to-increased-bleeding-risk-are-common-and-have-a-high-risk-of-stroke
#10
Björn Redfors, William A Gray, Randall J Lee, Kenneth A Ellenbogen, Machaon Bonafede, Ori Ben-Yehuda
OBJECTIVES: This study sought to determine how many patients with atrial fibrillation (AF) are not treated with oral anticoagulants (OAC) due to a high risk of bleeding and to characterize their risk of ischemic stroke in a real-world setting. BACKGROUND: AF is associated with a 5-fold increased risk of ischemic stroke. OAC reduce the risk of stroke in patients with AF who do not have an increased bleeding risk, but no comparably effective treatment exists for patients with contraindications to OAC...
December 11, 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29759117/current-evidence-based-understanding-of-the-epidemiology-prevention-and-treatment-of-atrial-fibrillation
#11
Paul A Rogers, Michael L Bernard, Christopher Madias, Sudarone Thihalolipavan, N A Mark Estes, Daniel P Morin
Atrial fibrillation (AF) is the most common atrial arrhythmia in adults worldwide. As medical advancements continue to contribute to an ever-increasing aging population, the burden of atrial fibrillation on the modern health care system continues to increase. Therapies are also evolving, for treatment of the arrhythmia itself, and stroke risk mitigation. Internists and cardiologists alike are, in most instances, the frontline contact for AF patients, and would benefit from remaining facile in their understanding of care options...
June 2018: Current Problems in Cardiology
https://www.readbyqxmd.com/read/29756640/aortic-valve-hemodynamics-in-atrial-fibrillation-should-the-highest-doppler-signal-be-used-to-estimate-severity-of-aortic-stenosis
#12
Said Alsidawi, Sana Khan, Sorin V Pislaru, Vuyisile T Nkomo
Grading severity of AS in AF is complicated by varying stroke volumes associated with fluctuating maximum velocities and pressure gradients across the aortic valve. Current guidelines recommend averaging five continuous-wave peak velocity and mean gradient (MG) Doppler signals across the aortic valve when estimating severity of AS in AF. However, it is unknown when grading severity of AS how the average of multiple Doppler signals vs the highest Doppler signal in AF compares to the Doppler signals when the patient is in normal sinus rhythm...
May 14, 2018: Echocardiography
https://www.readbyqxmd.com/read/29754921/global-longitudinal-strain-corrected-by-rr-interval-is-a-superior-echocardiographic-predictor-of-outcome-in-patients-with-atrial-fibrillation
#13
Maria Dons, Jan Skov Jensen, Flemming Javier Olsen, Martina Chantal de Knegt, Thomas Fritz-Hansen, Ali Vazir, Tor Biering-Sørensen
BACKGROUND: Echocardiographic assessment of systolic and diastolic function during atrial fibrillation (AF) is challenging. This study evaluates the prognostic value of strain in patients with AF and suggests a novel approach on how to take into account the varying heart cycle lengths in AF. METHODS: Echocardiograms from 204 patients with AF during examination were analyzed offline. Patients with known heart failure (HF) were excluded. Peak global longitudinal strain (GLS) was averaged from 18 myocardial segments...
July 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29754661/catheter-ablation-versus-antiarrhythmic-drug-therapy-for-atrial-fibrillation-cabana-trial-study-rationale-and-design
#14
Douglas L Packer, Daniel B Mark, Richard A Robb, Kristi H Monahan, Tristram D Bahnson, Kathleen Moretz, Jeanne E Poole, Alice Mascette, Yves Rosenberg, Neal Jeffries, Hussein R Al-Khalidi, Kerry L Lee
The Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA,NCT00911508)(1) trial is testing the hypothesis that the treatment strategy of percutaneous left atrial catheter ablation for the purpose of eliminating atrial fibrillation (AF) is superior to current state-of-the-art pharmacologic therapy. This international 140-center clinical trial was designed to randomize 2200 patients to a strategy of catheter ablation versus state-of-the-art rate or rhythm control drug therapy. Inclusion criteria include: 1) age> 65, or ≤65 with≥ 1 risk factor for stroke, 2) documented AF warranting treatment, and 3) eligibility for both catheter ablation and≥ 2 anti-arrhythmic or≥ 2 rate control drugs...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754652/risk-of-cardiovascular-events-and-incident-atrial-fibrillation-in-patients-without-prior-atrial-fibrillation-implications-for-expanding-the-indications-for-anticoagulation
#15
Xiaoxi Yao, Bernard J Gersh, Lindsey R Sangaralingham, Nilay D Shah, Peter A Noseworthy
BACKGROUND: There is growing interest in the role for non-vitamin K antagonist oral anticoagulants (NOACs) in patients without atrial fibrillation (AF). We aimed to provide a comprehensive assessment of the risks of ischemic stroke, myocardial infarction (MI), AF, and major bleeding in patients without previously diagnosed AF. METHODS: Using a large US administrative database, we identified 6,495,875 patients ≥50 years between January 1, 2011, and September 30, 2016, who were not diagnosed with AF and were not treated with oral anticoagulants or nonaspirin antiplatelet agents...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754650/shared-decision-making-tool-for-thromboprophylaxis-in-atrial-fibrillation-a-feasibility-study
#16
Mark H Eckman, Alexandru Costea, Mehran Attari, Jitender Munjal, Ruth E Wise, Carol Knochelmann, Matthew L Flaherty, Pete Baker, Robert Ireton, Brett M Harnett, Anthony C Leonard, Dylan Steen, Adam Rose, John Kues
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. METHODS: We hypothesized that a shared decision-making interaction facilitated by an Atrial Fibrillation Shared Decision Making Tool (AFSDM) would improve patient knowledge about atrial fibrillation, and the risks and benefits of various treatment options for stroke prevention; increase satisfaction with the decision-making process; improve the therapeutic alliance between patient and the clinical care team; and increase medication adherence...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29754512/-stroke-prevention-in-the-elderly-effectiveness-and-safety-of-edoxaban-in-elderly-patients-according-to-the-results-of-the-engage-af-study
#17
László Márk
Atrial fibrillation is the most common clinically relevant arrhythmia frequently causing systemic thromboembolic events. Traditionally vitamin K antagonists had been used for decades to prevent these events. The emerging of the new direct anticoagulants has revolutionized this treatment and a gradual growth and extensive spread of usage is expected. The latest one approved in Hungary, edoxaban, is a factor Xa inhibitor. Once-daily administration and favourable safety profile are major benefits of this drug...
May 2018: Orvosi Hetilap
https://www.readbyqxmd.com/read/29753377/antithrombotic-therapy-in-nonvalvular-atrial-fibrillation-consensus-and-challenges
#18
REVIEW
Furqan Khattak, Mian B Alam, Timir K Paul, Shasank Rijal, Shoaib Wazir, Carl J Lavie, Samir Saba
Atrial fibrillation (AF) is associated with high risk of systemic thromboembolism leading to significant morbidity and mortality. Warfarin, previously the mainstay for stroke prevention in AF, requires close monitoring because of multiple food and drug interactions. In recent years, food and drug administration has approved several direct oral anticoagulants (DOACs) for use in patients with nonvalvular AF. These agents have not been studied in patients with valvular AF who are at an even higher risk of systemic thromboembolism...
May 2018: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29753312/impact-of-aspirin-on-warfarin-control-as-measured-by-time-in-therapeutic-range
#19
Michelle L Boyce, Alexa Zayac, Arie Davis, Tony Badrick, Shailendra Anoopkumar-Dukie, Nijole Bernaitis
Warfarin is an oral anticoagulant widely prescribed for a variety of thromboembolic indications including venous thromboembolism (VTE) deep vein thrombosis (DVT) and the prevention of stroke associated for atrial fibrillation (AF).1 Warfarin requires ongoing monitoring of Internationalised Normalised Ratio (INR) due to a narrow therapeutic index and interactions with numerous drugs.2 The time in therapeutic range (TTR) is often used to indicate the quality of warfarin therapy due to the established correlation between higher mean TTR and reduced complications such as bleeding and thromboembolism...
May 12, 2018: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/29752398/device-related-thrombus-after-left-atrial-appendage-closure-incidence-predictors-and-outcomes
#20
Srinivas R Dukkipati, Saibal Kar, David R Holmes, Shephal K Doshi, Vijendra Swarup, Douglas N Gibson, Brijeshwar Maini, Nicole T Gordon, Michael L Main, Vivek Y Reddy
Background -In patients with atrial fibrillation (AF), left atrial appendage closure (LAAC) with the Watchman device prevents thromboembolism from the LAA; however, thrombus may form on the left atrial face of the device, and then potentially embolize. Herein, we studied the incidence, predictors and clinical outcome of device-related thrombus (DRT) using a large series of clinical trial cohorts of patients undergoing Watchman implantation. Methods -We studied the device arms of 4 prospective FDA trials: PROTECT-AF (n=463); PREVAIL (n=269); CAP (n=566); CAP2 (n=578)...
May 11, 2018: Circulation
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