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Paroxysmal atrial fibrillation oral anticoagulant

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https://www.readbyqxmd.com/read/28317415/uninterrupted-dabigatran-versus-warfarin-for-ablation-in-atrial-fibrillation
#1
Hugh Calkins, Stephan Willems, Edward P Gerstenfeld, Atul Verma, Richard Schilling, Stefan H Hohnloser, Ken Okumura, Harvey Serota, Matias Nordaby, Kelly Guiver, Branislav Biss, Marc A Brouwer, Massimo Grimaldi
Background Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation. Methods In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2...
April 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28243592/loop-recorder-detected-high-rate-of-atrial-fibrillation-recurrence-after-a-single-balloon-or-basket-based-ablation-of-paroxysmal-atrial-fibrillation-results-of-the-macpaf-study
#2
Alexander Schirdewan, Juliane Herm, Mattias Roser, Ulf Landmesser, Matthias Endres, Lydia Koch, Karl Georg Haeusler
PURPOSE: Pulmonary vein isolation (PVI) is an established approach to treat symptomatic non-permanent atrial fibrillation (AF). Detecting AF recurrence after PVI is important, if discontinuation of oral anticoagulation after ablation is considered. METHODS: Patients with symptomatic paroxysmal AF were enrolled in the prospective randomized mesh ablator vs. cryoballoon pulmonary vein (PV) ablation of symptomatic paroxysmal AF study, comparing efficacy and safety of the HD Mesh Ablator(®) (C...
2017: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28228305/clinical-presentation-management-and-outcomes-in-the-indian-heart-rhythm-society-atrial-fibrillation-ihrs-af-registry
#3
A Vora, A Kapoor, M Nair, Y Lokhandwala, C Narsimhan, A G Ravikishore, S K Dwivedi, N Namboodiri, R Hygriv, A Saxena, A Nabar, S Garg, N Bardoloi, R Yadav, A Nambiar, U Pandurangi, D Jhala, A Naik, Nagmallesh, S Rajagopal, R Selvaraj, V Arora, A Thachil, J Thomas, G Panicker
AIM: A national atrial fibrillation (AF) registry was conducted under the aegis of the Indian Heart Rhythm Society (IHRS), to capture epidemiological data-type of AF, clinical presentation and comorbidities, current treatment practices, and 1-year follow-up outcomes. METHODS: A total of 1537 patients were enrolled from 24 sites in India in the IHRS-AF registry from July 2011 to August 2012. Their baseline characteristics and follow-up data were recorded in case report forms and subsequently analyzed...
January 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28179613/left-atrial-appendage-thrombi-formation-in-japanese-non-valvular-atrial-fibrillation-patients-during-anticoagulation-therapy%C3%A3-warfarin-vs-direct-oral-anticoagulants
#4
Mihoko Kawabata, Masahiko Goya, Takeshi Sasaki, Shingo Maeda, Yasuhiro Shirai, Takuro Nishimura, Takakatsu Yoshitake, Shinya Shiohira, Mitsuaki Isobe, Kenzo Hirao
BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia, associated with increased cardiovascular morbidity and mortality including thromboembolic events. The aims of this study were to assess the prevalence of left atrial appendage (LAA) thrombi in Japanese non-valvular atrial fibrillation (NVAF) patients undergoing preprocedural transesophageal echocardiography (TEE) during anticoagulation therapy, and to compare the efficacy of warfarin and direct oral anticoagulants (DOAC)...
February 7, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28153345/usefulness-of-the-mrwallets-scoring-system-to-predict-first-diagnosed-atrial-fibrillation-in-patients-with-ischemic-stroke
#5
Antonio Muscari, Andrea Bonfiglioli, Luca Faccioli, Marco Ghinelli, Donatella Magalotti, Francesco Manzetto, Anna Pontarin, Giovanni M Puddu, Luca Spinardi, Eleonora Tubertini, Marco Zoli
Some cryptogenic strokes are caused by undetected paroxysmal atrial fibrillation (AF) and could benefit from oral anticoagulation. In this study, we searched for echocardiographic parameters associated with first diagnosed AF, to form a scoring system for the identification of patients with AF. We examined 571 patients with ischemic stroke (72.7 ± 13.5 years, 50.6% women), subdivided into 4 groups: documented cause without AF, first diagnosed AF, known paroxysmal AF, and permanent AF. All patients underwent transthoracic echocardiography, brain computed tomography scan, carotid/vertebral ultrasound, and continuous electrocardiographic monitoring...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28111055/oral-anticoagulant-use-in-octogenarian-european-patients-with-atrial-fibrillation-a-subanalysis-of-prefer-in-af
#6
Olivier Hanon, Jean-Sébastien Vidal, Jean-Yves Le Heuzey, Paulus Kirchhof, Raffaele De Caterina, Josef Schmitt, Petra Laeis, Pier Mannuccio Mannucci, Maura Marcucci
BACKGROUND: Few studies describe oral anticoagulant (OAC) prescription practices in very elderly patients with atrial fibrillation (AF). METHODS: In this sub-analysis of the PREFER in AF study, performed in 2012, patients were stratified according to age (<80 [n=5565] and ≥80years [n=1660]) and OAC treatment. Factors associated with OAC prescription were analyzed in a multivariate logistic regression model with backward elimination of variables least associated with OAC use...
April 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28106147/prediction-of-very-late-arrhythmia-recurrence-after-radiofrequency-catheter-ablation-of-atrial-fibrillation-the-mb-later-clinical-score
#7
Nebojša Mujović, Milan Marinković, Nebojša Marković, Alena Shantsila, Gregory Y H Lip, Tatjana S Potpara
Reliable prediction of very late recurrence of atrial fibrillation (VLRAF) occuring >12 months after catheter ablation (CA) in apparently "cured" patients could optimize long-term follow-up and modify decision-making regarding the discontinuation of oral anticoagulant therapy. In a single-centre cohort of consecutive patients post radiofrequency AFCA, we retrospectively derived a novel score for VLRAF prediction. Of 133 consecutive post AFCA patients (mean age 56.9 ± 11.8 years, 63.9% male, 69.2% with paroxysmal AF) who were arrhythmia-free at 12 months (excluding 3-month "blanking period"), 20 patients expirienced a VLRAF during a 29...
January 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28011798/stepwise-mass-screening-for-atrial-fibrillation-using-n-terminal-pro-b-type-natriuretic-peptide-the-strokestop-ii-study-design
#8
Johan Engdahl, Emma Svennberg, Leif Friberg, Faris Al-Khalili, Viveka Frykman, Katrin Kemp Gudmundsdottir, Tove Fredriksson, Mårten Rosenqvist
AIM: Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG...
December 23, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27984303/the-complexity-of-atrial-fibrillation-newly-diagnosed-after-ischemic-stroke-and-transient-ischemic-attack-advances-and-uncertainties
#9
Joshua O Cerasuolo, Lauren E Cipriano, Luciano A Sposato
PURPOSE OF REVIEW: Atrial fibrillation is being increasingly diagnosed after ischemic stroke and transient ischemic attack (TIA). Patient characteristics, frequency and duration of paroxysms, and the risk of recurrent ischemic stroke associated with atrial fibrillation detected after stroke and TIA (AFDAS) may differ from atrial fibrillation already known before stroke occurrence. We aim to summarize major recent advances in the field, in the context of prior evidence, and to identify areas of uncertainty to be addressed in future research...
February 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27888051/absence-of-oral-anticoagulation-and-subsequent-outcomes-among-outpatients-with-atrial-fibrillation
#10
Paul L Hess, Sunghee Kim, Gregg C Fonarow, Laine Thomas, Daniel E Singer, James V Freeman, Bernard J Gersh, Jack Ansell, Peter R Kowey, Kenneth W Mahaffey, Paul S Chan, Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini
BACKGROUND: Prior studies have shown a treatment gap in oral anticoagulation (OAC) use among patients with atrial fibrillation yet have incompletely characterized factors associated with failure to treat and subsequent outcomes in contemporary practice. METHODS: Using data collected between June 2010 and August 2011 from 174 ambulatory care sites in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we identified factors associated with absence of OAC via stratified logistic regression...
November 23, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27861421/current-and-emerging-uses-of-insertable-cardiac-monitors-evaluation-of-syncope-and-monitoring-for-atrial-fibrillation
#11
REVIEW
Todd T Tomson, Rod Passman
Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs...
January 2017: Cardiology in Review
https://www.readbyqxmd.com/read/27847992/-esc-guidelines-on-atrial-fibrillation-2016-summary-of-the-most-relevant-recommendations-and-modifications
#12
L Eckardt, K G Häusler, U Ravens, M Borggrefe, P Kirchhof
The first European Society of Cardiology (ESC) guidelines on atrial fibrillation (AF) developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) were published in August 2016. These guidelines replace the revised guidelines from 2012 and contain some interesting new aspects. The topics range from the pathophysiology through diagnostics, therapy and stroke prevention up to special clinical situations, such as atrial fibrillation in cardiopathy, sport and pregnancy. Early screening, patient informed consent, individualized therapy and the modification of factors promoting atrial fibrillation are of particular importance...
December 2016: Herz
https://www.readbyqxmd.com/read/27824417/-anticoagulation-and-new-therapeutic-options-in-atrial-fibrillation
#13
REVIEW
Karl Mischke
Oral anticoagulation plays an essential role in the treatment of patients with atrial fibrillation as it is indicated for most patients to reduce the risk of stroke. It is prudent to assess the risks of stroke and bleeding using the CHA2DS2-VASc and HAS-BLED scores. Oral anticoagulation is indicated in general for all patients with valvular atrial fibrillation (atrial fibrillation in moderate to severe mitral stenosis or mechanical prosthetic valve) as well as for patients with a CHA2DS2-VASc-Score of 1 - 2 points or higher...
October 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27818480/rivaroxaban-for-periprocedural-anticoagulation-therapy-in-japanese-patients-undergoing-catheter-ablation-of-paroxysmal-non-valvular-atrial-fibrillation
#14
MULTICENTER STUDY
Mihoko Kawabata, Takeshi Sasaki, Shingo Maeda, Yasuhiro Shirai, Yasuteru Yamauchi, Junichi Nitta, Masahiko Goya, Kenzo Hirao
Direct oral anticoagulants (DOACs) have been shown to be safe and effective for the prevention of stroke in nonvalvular atrial fibrillation (NVAF) patients, however, experience with peri-AF ablation management of DOACs is scarce. This study aimed to investigate the safety and feasibility of periprocedural anticoagulation therapy with rivaroxaban in Japanese patients undergoing paroxysmal non-valvular AF (NVAF) ablation using radiofrequency energy.This study was a multicenter, prospective pilot study. In paroxysmal NVAF patients, rivaroxaban (15 mg or 10 mg once-daily) was started at least 4 weeks prior to AF ablation, discontinued on the day of the procedure, resumed within 24 hours after ablation, and continued at least 3 months afterwards...
December 2, 2016: International Heart Journal
https://www.readbyqxmd.com/read/27730663/severe-spontaneous-echo-contrast-auricolar-thrombosis-in-nonvalvular-af-value-of-thromboembolic-risk-scores
#15
Giosuè Mascioli, Elena Lucca, Federica Michelotti, Giusy Alioto, Franco Santoro, Guido Belli, Cristina Rota, Ombretta Ornago, Giovanni Sirianni, Emanuela Pulcini, Matteo Pennesi, Carlo Savasta, Rosario Russo, Antonino Pitì
BACKGROUND: Patients with atrial fibrillation (AF) have an increased thromboembolic risk that can be estimated with risk scores and sometimes require oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (R2 CHADS2 , CHADS2 , and CHA2 DS2 -VASc) in predicting such events remains controversial. METHODS AND RESULTS: The aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients...
January 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/27696012/intermittent-vs-continuous-anticoagulation-therapy-in-patients-with-atrial-fibrillation-icare-af-a-randomized-pilot-study
#16
Stavros Stavrakis, Julie A Stoner, Joel Kardokus, Paul J Garabelli, Sunny S Po, Ralph Lazzara
PURPOSE: We hypothesized that intermittent anticoagulation based on daily rhythm monitoring using the novel oral anticoagulants (NOACs) is feasible and safe among patients with paroxysmal atrial fibrillation (AF). METHODS: Patients with paroxysmal AF and ≥1 risk factors for stroke were randomized to either intermittent or continuous anticoagulation. Those in the intermittent group were instructed to transmit a daily ECG using an iPhone-based rhythm monitoring device...
January 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/27619976/st-segment-elevation-following-cardioversion-of-atrial-fibrillation-in-the-emergency-department-unmasked-myocardial-infarction-due-to-left-main-coronary-artery-plaque-rupture-or-unspecific-finding
#17
Dirk Prochnau, Ralf Surber, Matthias Hoyme, Sylvia Otto, Anna Selle, Tudor C Poerner
Atrial fibrillation (AF) is a frequent reason for emergency department visits. According to current guidelines either rate- or rhythm-control are acceptable therapeutic options in such situations. In this report, we present the complicated clinical course of a patient with AF and a rapid ventricular response. Because of paroxysmal AF, the patient was on chronic oral anticoagulation therapy with warfarin. Pharmacological treatment was ineffective to control ventricular rate, and immediate synchronized electrical cardioversion was performed...
September 13, 2016: CJEM
https://www.readbyqxmd.com/read/27492943/left-atrial-appendage-occlusion-in-high-risk-patients-with-non-valvular-atrial-fibrillation
#18
Sergio Berti, Luigi Emilio Pastormerlo, Marco Rezzaghi, Giuseppe Trianni, Umberto Paradossi, Elisa Cerone, Marcello Ravani, Alberto Ranieri De Caterina, Antonio Rizza, Cataldo Palmieri
OBJECTIVE: Percutaneous left atrial appendage (LAA) occlusion has been developed as a viable option for stroke and thromboembolism prevention in patients with non-valvular atrial fibrillation (NVAF) and at high risk for cerebral cardioembolic events. Data on device implantation and long-term follow-up from large cohorts are limited. METHODS: 110 consecutive patients with NVAF and contraindications to oral anticoagulants (OACs) underwent LAA occlusion procedures and achieved a longer than 1 year follow-up...
August 4, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27485817/left-atrial-enlargement-is-an-independent-predictor-of-stroke-and-systemic-embolism-in-patients-with-non-valvular-atrial-fibrillation
#19
Yasuhiro Hamatani, Hisashi Ogawa, Kensuke Takabayashi, Yugo Yamashita, Daisuke Takagi, Masahiro Esato, Yeong-Hwa Chun, Hikari Tsuji, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Gregory Y H Lip, Masaharu Akao
Controversy exists regarding whether left atrial enlargement (LAE) is a predictor of stroke/systemic embolism (SE) in atrial fibrillation (AF) patients. The Fushimi AF Registry, a community-based prospective survey, enrolled all AF patients in Fushmi-ku, Japan, from March 2011. Follow-up data and baseline echocardiographic data were available for 2,713 patients by August 2015. We compared backgrounds and incidence of events over a median follow-up of 976.5 days between patients with LAE (left atrial diameter > 45 mm; LAE group) and those without in the Fushimi AF Registry...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27382087/long-term-persistence-of-newly-initiated-warfarin-therapy-in-chinese-patients-with-nonvalvular-atrial-fibrillation
#20
Zhi-Zun Wang, Xin Du, Wei Wang, Ri-Bo Tang, Jing-Guang Luo, Chao Li, San-Shuai Chang, Xiao-Hui Liu, Cai-Hua Sang, Rong-Hui Yu, De-Yong Long, Jia-Hui Wu, Rong Bai, Nian Liu, Yan-Fei Ruan, Jian-Zeng Dong, Chang-Sheng Ma
BACKGROUND: Despite its therapeutic efficacy, warfarin is extremely underused in Chinese patients with nonvalvular atrial fibrillation (AF). Whether the nonpersistence of warfarin treatment contributes to its underuse is not known. The aims of this study were to determine nonpersistence rates of newly started warfarin treatment in Chinese patients with nonvalvular AF and to identify the factors associated with discontinuation of the treatment. METHODS AND RESULTS: We identified 1461 patients with nonvalvular AF enrolled in the Chinese Atrial Fibrillation Registry (CAFR) who newly started on warfarin therapy in the period between August 1, 2011, and June 30, 2014...
July 2016: Circulation. Cardiovascular Quality and Outcomes
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