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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
Susanne DeMeester, Rebecca A Hess, Bradley Hubbard, Kara LeClerc, Jane Ferraro, Jeremy J Albright
OBJECTIVES: Atrial fibrillation (AFib) is the most common dysrhythmia in the United States. Patients seen in the emergency department (ED) in rapid AFib are often started on intravenous rate controlling agents and admitted for several days. Although underlying and triggering illnesses must be addressed, AFib, intrinsically, is rarely life threatening and can often be safely managed in an outpatient setting. At our academic community hospital, we implemented an algorithm to decrease hospital admissions for individuals presenting with a primary diagnosis of AFib...
January 31, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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
Robert H Pass, Leonardo Liberman, Eric S Silver, Christopher M Janson, Andrew D Blaufox, Lynn Nappo, Scott R Ceresnak
BACKGROUND: Concealed left-sided accessory pathways (CLAP) are a cause of supraventricular tachycardia (SVT) in the young. Most are mapped with right ventricular (RV) apical/outflow pacing. Rarely, alternative means of mapping are required. We review our experience from three pediatric electrophysiology (EP) centers with a rare form of "hidden" CLAP. METHODS: All patients <21 years undergoing EP study from 2008 to 2014 with a "hidden" CLAP (defined as an accessory pathway [AP] for which RV pacing at cycle lengths [CL] stable for mapping did not demonstrate eccentric retrograde conduction) were included...
January 12, 2018: Pacing and Clinical Electrophysiology: PACE
Jelena Ivanovic, Fargol Mostofian, Caitlin Anstee, Sebastien Gilbert, Donna E Maziak, Farid M Shamji, Ramanadhan Sudhir Sundaresan, Patrick James Villeneuve, Andrew J E Seely
As an innovative approach to improve quality of surgical care, we combined surgeon self-assessment and anonymized peer comparison with continuous quality improvement seminars using positive deviance (CQI/PD) to identify surgeon(s) with the lowest rates of adverse events (AEs) to guide group practice recommendations. Our objective was to quantify the impact these interventions on postoperative AEs rates after major non-cardiac chest operations. All postoperative AEs after all thoracic operations (n = 1,084, March, 2013 to February, 2016, single-center) were prospectively collected using the thoracic morbidity and mortality system, based on Clavien-Dindo schema...
January 8, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
Ryota Sato, Michitaka Nasu
Dobutamine is commonly used worldwide and included in the protocol for early goal-directed therapy (EGDT). Since the use of dobutamine in EGDT was reported, it has been considered to be an important component, especially in the treatment of septic patients with myocardial dysfunction. However, it is questionable whether dobutamine improves the mortality of sepsis and septic shock. In three recent randomized controlled trials (ProCESS, ProMISe, and ARISE trials), the frequency of dobutamine use was significantly higher in the EGDT group than in the standard care group, but there were no significant differences in the mortality between the groups...
2017: Journal of Intensive Care
Bawer Jalal Tofig, Peter Lukac, Rune Borregaard, Jan Møller Nielsen, Henrik Kjærulf Jensen, Christian Gerdes, Jens Kristensen, Jens Cosedis Nielsen, Steen Buus Kristiansen
OBJECTIVES: Recurrent arrhythmia after pulmonary vein isolation (PVI) by radiofrequency (RF) ablation in patients with atrial fibrillation (AFIB) remains a significant challenge. Using contact force (CF) sensing ablation catheters, we aimed to identify procedure related parameters associated with recurrence after de-novo PVI in patients with AFIB. METHODS: Consecutive patients undergoing a de-novo PVI procedure (n = 120, 63% paroxysmal and 37% persistent AFIB) employing a force-sensing ablation catheter were included...
February 2018: Scandinavian Cardiovascular Journal: SCJ
Konstantinos E Iliodromitis, Marc Bonsels, Rolf Borchard, Anja Dorszewski
Ebstein's anomaly (EA) is a rare congenital heart disease characterized by "atrialization" of the right ventricle, due to apical displacement of the tricuspid leaflets into the right ventricle. Patients with EA may develop all kinds of supraventricular arrhythmias requiring radiofrequency ablation. Atrial fibrillation (Afib) is a common arrhythmia in EA patients, and results in debilitating symptoms that often require surgical treatment. This is a follow-up report of 2 patients with EA undergoing radiofrequency ablation for Afib...
2018: Cardiology
Susanne Rinné, Aytug K Kiper, Constanze Schmidt, Beatriz Ortiz-Bonnin, Simone Zwiener, Guiscard Seebohm, Niels Decher
BACKGROUND/AIMS: TASK channels belong to the two-pore-domain potassium (K2P) channel family. TASK-1 is discussed to contribute to chronic atrial fibrillation (AFib) and has been together with uncoupling protein 1 found as a marker protein of brown adipose tissue (BAT) fat. In addition, TASK-1 was linked in a genome-wide association study to an increased body mass index. A recent study showed that TASK-1 inhibition is causing obesity in mice by a BAT whitening and that these effects are linked to the mineralocorticoid receptor pathway, albeit the mechanism remained elusive...
2017: Cellular Physiology and Biochemistry
Antoine Da Costa, Clarisse Delolme, Jean Baptiste Guichard, Antoine Gerbay, Romain Pierrard, Cécile Romeyer-Bouchard, Karl Isaaz
BACKGROUND: The prevalence and management of left atrial appendage (LAA) thrombi associated with new anticoagulants remain to be elucidated, especially prior to atrial fibrillation (AFib) ablation. This study sought to (1) compare the prevalence of LAA thrombi and/or severe LAA contrast under vitamin K antagonist (VKA) agents and novel oral anticoagulants (NOACs), (2) evaluate the rate of LAA thrombus resolution after anticoagulation modification, and (3) determine the predictive factors of LAA thrombi and severe LAA contrast in patients prior to LA AFib ablation...
November 2017: American Heart Journal
Marijana Knezović, Sanja Pintarić, Marko Mornar Jelavić, Višnja Nesek, Goran Krstačić, Mislav Vrsalović, Aljoša Šikić, Ivan Zeljković, Hrvoje Pintarić
In this study, we investigated the correlation of air temperature, pressure and concentration of air pollutants with the rate of admissions for cardiac arrhythmias at two clinical centers in the area with a humid continental climate. This retrospective study included 3749 patients with arrhythmias admitted to emergency department (ED). They were classified into four groups: supraventricular tachycardia (SVT), ventricular tachycardia (VT), atrial fibrillation/undulation (Afib/Aund), and palpitations (with no ECG changes, or with sinus tachycardia and extrasystoles)...
March 2017: Acta Clinica Croatica
Philip Boehme, Peter Wienand, Maximilian Herrmann, Hubert Truebel, Thomas Mondritzki
The effectiveness and safety of a pharmacologic intervention is highly dependent on patient's capability to follow the recommended treatment regimen. Non-adherence to pharmacologic treatments is associated with worsening conditions including hospitalization and death. This is a significant burden to healthcare systems on a global scale with non-adherence rates being as high (or higher) as 50% in the first treatment year. The most common causes for non-adherence are forgetfulness, busy lifestyle or complexity and changes in therapeutic schedules...
October 2017: Medical Hypotheses
Diana Fischer, Patricia Orlando, Laura Shane-McWhorter
OBJECTIVE: To describe Mohs micrographic surgery and evaluate whether direct oral anticoagulants should be withheld in patients with atrial fibrillation (Afib) prior to the procedure and to consider what type of antibiotic prophylaxis should be used. SETTING: A community setting in which an elderly patient is living independently at home. PRACTICE DESCRIPTION: Academic-affiliated internal medicine clinic that cares for adult patients of all ages, including elderly patients living independently in their own home...
August 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Rupak Desai, Chintan Rupareliya, Upenkumar Patel, Syeda Naqvi, Smit Patel, Abhishek Lunagariya, Zabeen Mahuwala
Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes...
August 8, 2017: Curēus
Johanna Strotmann, Henrik Fox, Thomas Bitter, Odile Sauzet, Dieter Horstkotte, Olaf Oldenburg
BACKGROUND: Sleep-disordered breathing (SDB) represents a common and highly relevant co-morbidity in patients with atrial fibrillation (Afib). Obstructive sleep apnea (OSA) has been identified as an independent risk factor for developing Afib and for Afib recurrence after treatment, but the role of central sleep apnea (CSA) is less clear. This study investigated characteristics of SDB in Afib patients with preserved left ventricular ejection fraction (PEF). METHODS AND RESULTS: Consecutive patients (07/2007 to 03/2016) with documented Afib at hospital admission and PEF undergoing 6-channel cardiorespiratory polygraphy (PG) screening were retrospectively analyzed...
February 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Johanna Strotmann, Henrik Fox, Thomas Bitter, Florian Schindhelm, Klaus-Jürgen Gutleben, Dieter Horstkotte, Olaf Oldenburg
OBJECTIVE/BACKGROUND: Sleep-disordered breathing (SDB) is common in patients with atrial fibrillation (Afib). Although a high proportion of respiratory events are hypopneas, previous studies have only used apneas to differentiate obstructive (OSA) from central (CSA) sleep apnea. This study investigated the impact of using apneas and hypopneas versus apneas only to define the predominant type of SDB in Afib patients with preserved ejection fraction. PATIENTS/METHODS: This retrospective analysis was based on high-quality cardiorespiratory polygraphy (PG) recordings (07/2007-03/2016) that were re-analyzed using 2012 American Academy of Sleep Medicine criteria, with differentiation of apneas and hypopneas as obstructive or central...
September 2017: Sleep Medicine
Sanjeev Sethi, Jason D Theis
Renal amyloidosis is characterized by acellular Congo red positive deposits in the glomeruli, interstitium and/or arteries. Light chain restriction on immunofluorescence studies is present in AL-amyloidosis, the most common type of amyloidosis involving the kidney. The detection of Congo red positive deposits coupled with negative immunofluorescence studies is highly suggestive of non-AL amyloidosis. Some of the non-AL amyloidosis are common while others are relatively rare. The clinical features, laboratory and renal pathology findings are helpful in the diagnosis and typing of non-AL amyloidosis...
August 21, 2017: Journal of Nephrology
Torstein R Meling, Luis Romundstad, Geir Niemi, Jon Narum, Per Kristian Eide, Angelika G Sorteberg, Wilhelm A Sorteberg
Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative. We retrospectively reviewed our clinical database between September 2011 and July 2014. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. A total of 18 craniotomies were performed, and 18 aneurysms were clipped under adenosine-induced asystole (7 basilar arteries, 8 internal carotid arteries, 1 middle cerebral artery, and 1 anterior communicating artery) in 16 patients (10 females, 6 males)...
August 17, 2017: Neurosurgical Review
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...
February 2018: Blood Pressure
Nikolaos Michelakakis, Georgios J Neroutsos, Anastasia S Perpinia, Dimitrios Farmakis, Eugenia G Voukouti, Apostolos J Karavidas, John Parissis, Maria T Georgiakaki, Vlassios N Pyrgakis
BACKGROUND: The inflammatory glycoprotein chitinase-3-like protein 1 or YKL-40 has emerged as a potential biomarker of cardiovascular diseases, including atrial fibrillation (AFib). We sought to assess YKL-40 in a wide spectrum of supraventricular arrhythmias besides AFib in comparison with other inflammatory markers. METHODS: We determined serum levels of YKL-40, C-reactive protein (CRP) and IL-6 in 70 patients with AFib, atrial flutter, atrioventricular node reentry tachycardia or other supraventricular tachycardias before, immediately after therapy and 1 week after therapy; 20 healthy patients served as controls...
September 2017: Journal of Cardiovascular Medicine
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