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Paroxysmal atrial fibrillation oral anticoagulant

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https://www.readbyqxmd.com/read/28709762/prevalence-of-paroxysmal-atrial-fibrillation-in-a-population-assessed-by-continuous-24-hour-monitoring
#1
João Primo, Helena Gonçalves, Ana Macedo, Paula Russo, Telma Monteiro, João Guimarães, Ovídio Costa
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and a major cause of morbidity, due to the associated risk of stroke. However, since it is often paroxysmal, it is commonly underdiagnosed and undertreated. OBJECTIVES: The primary objective of this prospective study was to determine the prevalence of paroxysmal atrial fibrillation (PAF) in patients aged 40 and above in a population who underwent continuous 24-hour electrocardiographic monitoring...
July 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28682320/management-of-atrial-high-rate-episodes-detected-by-cardiac-implanted-electronic-devices
#2
REVIEW
Ben Freedman, Giuseppe Boriani, Taya V Glotzer, Jeff S Healey, Paulus Kirchhof, Tatjana S Potpara
Cardiac implanted electronic devices (CIEDs), including pacemakers and implantable defibrillators that perform atrial sensing typically using an atrial electrode, frequently detect subclinical atrial high-rate episodes (AHREs). When the intracardiac electrograms are carefully examined, the majority of AHREs are atrial fibrillation (AF) or other atrial tachyarrhythmias, which have been shown to be associated with both an increased risk of stroke, and subsequent development of clinical AF. However, the absolute risk of stroke among patients with AHREs is less than might be expected for clinically diagnosed paroxysmal AF...
July 6, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28662693/transesophageal-vs-intracardiac-echocardiographic-screening-in-patients-undergoing-atrial-fibrillation-ablation-with-uninterrupted-rivaroxaban
#3
A Tsyganov, A Shapieva, V Sandrikov, S Fedulova, S Mironovich, A Dzeranova, E Lyan
BACKGROUND: Patients with atrial fibrillation (AF) routinely undergo different imaging modalities for the evaluation of the left atrial (LA) appendage to rule out thrombus prior to the AF ablation procedure. Recently, uninterrupted novel oral anticoagulants were introduced for patients undergoing atrial fibrillation (AF) ablation to minimize the peri-procedural thromboembolism risk. We performed a retrospective analysis to evaluate the safety of uninterrupted rivaroxaban and whether transesophageal (TEE) or intracardiac echocardiography (ICE) is necessary for patients undergoing AF ablation...
June 29, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28635023/risk-stratification-of-patients-with-left-atrial-appendage-thrombus-prior-to-catheter-ablation-of-atrial-fibrillation-an-approach-towards-an-individualized-use-of-transesophageal-echocardiography
#4
Melanie A Gunawardene, Jannis Dickow, Benjamin N Schaeffer, Ruken Ö Akbulak, Marc Lemoine, Jana M Nührich, Mario Jularic, Christoph Sinning, Christian Eickholt, Christian Meyer, Julia M Moser, Boris A Hoffmann, Stephan Willems
INTRODUCTION: The need for transesophageal echocardiography (TEE) before catheter ablation of atrial fibrillation (CA-AF) is still being questioned. The aim of this study is to analyze patients' (pts) risk factors of left atrial appendage thrombus (LAAT) prior to CA-AF in daily clinical practice, according to oral anticoagulation (OAC) strategies recommended by current guidelines. METHODS AND RESULTS: All pts scheduled for CA-AF from 01/2015-12/2016 in our center were included and either treated with NOACs (novel-OAC; paused 24-hours pre-ablation) or continuous vitamin K-antagonists (INR 2...
June 21, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28622606/dementia-correlates-with-anticoagulation-underuse-in-older-patients-with-atrial-fibrillation
#5
Giovanni Viscogliosi, Evaristo Ettorre, Iulia Maria Chiriac
OBJECTIVES: Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. METHODS: Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed...
September 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28614214/a-rare-case-of-multiple-thrombi-in-a-giant-left-atrium
#6
Alfredo Intorcia, Marco A Perrone, Riccardo Morgagni, Domenico Sergi, Massimo Marchei, Mauro Borzi, Francesco Romeo
: Giant left atrium is frequently associated with rheumatic mitral valve disease. The incidence of left atrial thrombus among patients with mitral stenosis and atrial fibrillation varies from 7 to 38%. Anticoagulation therapy achieves a high rate of resolution of left atrial appendage (LAA) and left atrial cavity thrombi, but in selected patients surgical therapy must be considered. An 81-year-old woman presented to our emergency department with repeated episodes of transient ischemic attack. She had a history of carotid artery stenosis, chronic lymphocytic leukemia, rheumatic heart disease, and paroxysmal atrial fibrillation...
June 12, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28471498/thromboembolic-risk-and-effect-of-oral-anticoagulation-according-to-atrial-fibrillation-patterns-a-systematic-review-and-meta-analysis
#7
REVIEW
Alessio Lilli, Andrea Di Cori, Valerio Zacà
Oral anticoagulation (OAC) is recommended in both paroxysmal atrial fibrillation (pxAF) and nonparoxysmal AF (non-pxAF), but disagreement exists in classes of recommendation. Data on incidence/rate of stroke in pxAF are conflicting, and OAC is often underused in this population. The objectives of the meta-analysis were to investigate different impact on outcomes of pxAF and non-pxAF, with and without OAC. Two reviewers searched for prospective studies on risk of stroke and systemic embolism (SE) in pxAF and non-pxAF, with and without OAC...
May 4, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28317415/uninterrupted-dabigatran-versus-warfarin-for-ablation-in-atrial-fibrillation
#8
RANDOMIZED CONTROLLED TRIAL
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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...
April 2017: 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
#18
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
#19
REVIEW
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
#20
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
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