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Paroxysmal atrial fibrillation oral anticoagulant

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 an require sometimes 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 MATERIAL AND RESULTS: 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...
October 12, 2016: Pacing and Clinical Electrophysiology: PACE
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...
October 1, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
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
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
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
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
Menno V Huisman, Chang Sheng Ma, Hans-Christoph Diener, Sergio J Dubner, Jonathan L Halperin, Kenneth J Rothman, Christine Teutsch, Nils Schoof, Eva Kleine, Dorothee B Bartels, Gregory Y H Lip
AIMS: The introduction of non-VKA oral anticoagulants (NOACs), which differ from the earlier vitamin K antagonist (VKA) treatments, has changed the approach to stroke prevention in atrial fibrillation (AF). GLORIA-AF is a prospective, global registry programme describing the selection of antithrombotic treatment in newly diagnosed AF patients at risk of stroke. It comprises three phases: Phase I, before the introduction of NOACs; Phase II, during the time of the introduction of dabigatran, the first NOAC; and Phase III, once NOACs have been established in clinical practice...
September 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Kazuo Kitagawa
Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. ESUS was proposed for unifying embolic stroke of undetermined sources by Hart et al. in 2014. The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Scott B Silverman
In cryptogenic stroke, prolonged cardiac monitoring is often employed to search for and diagnose atrial fibrillation (AF). Multiple monitoring modalities with multiple durations of monitoring exist. Finding atrial fibrillation after an ischemic stroke is extremely important as anticoagulation is the standard of care and results in the lowest stroke recurrence rate. The protocol at our institution is to carry out 30-day mobile cardiac outpatient telemetry (MCOT) in all patients with cryptogenic stroke. If this MCOT fails to reveal AF, yet the suspicion is high based on the presence of clinical, biochemical, electrocardiographic, and echocardiographic factors, we may proceed to use an implantable cardiac monitor...
August 2016: Current Treatment Options in Cardiovascular Medicine
Oliver Klein-Wiele, Markus Faghih, Stefan Dreesen, Rhyan Urbien, Marwan Abdelghafor, Kaffer Kara, Michael Schulte-Hermes, Marietta Garmer, Dietrich Grönemeyer, Birgit Hailer
BACKGROUND: Patient-activated event recorders (ER) can facilitate diagnosis in unclear palpi-tations, however impact of ER screening on further treatment in clinical routine is unknown. We investigated the feasibility and clinical value of a network-based telemetric monitoring using a patient activated ER. METHODS: The network consisted of 12 general practitioners (GP) and a department of car-diology (DC). GP-patients sent electrocardiograms (ECGs) twice daily and in case of palpitations...
2016: Cardiology Journal
Claudia Stöllberger, Josef Finsterer
BACKGROUND: Apixaban, a factor-Xa-inhibitor, is one of the non-vitamin-K-antagonist oral anticoagulants (NOACs) which are increasingly used in atrial fibrillation (AF). In real life even patients with contraindications to vitamin K antagonists (VKAs) receive NOAC because NOAC are considered as "safer" than VKAs. CASE DESCRIPTION: In a 61-years-old man with hypertension, heart failure and paroxysmal AF apixaban was started. Despite advices from his physicians, he continued alcohol abuse and suffered from recurrent falls...
2016: Neurologia i Neurochirurgia Polska
R Sankaranarayanan, D J Fox
Left atrial ablation strategies are being increasingly performed as a Class 1 therapeutic indication for drug refractory paroxysmal atrial fibrillation (AF). Traditionally AF ablation has been performed with patients on uninterrupted warfarin therapy, however over the last few years, novel oral anticoagulants (NOACs) have emerged as attractive alternatives to warfarin in order to reduce stroke risk due to AF. NOACs are therefore increasingly being used instead of warfarin in the management of AF. There is also mounting evidence mainly in the form of small randomised studies and meta-analysis that have demonstrated that the use of NOACs for AF ablation is efficacious, safe and convenient...
May 5, 2016: Current Cardiology Reviews
Akino Yoshimura, Yasuhisa Iriki, Hitoshi Ichiki, Naoya Oketani, Hideki Okui, Ryuichi Maenosono, Fuminori Namino, Masaaki Miyata, Mitsuru Ohishi
BACKGROUND: We previously reported that dabigatran increased the risk of microthromboembolism and hemopericardium compared with warfarin. The safety of non-vitamin-K-antagonist oral anticoagulants (NOACs) in the periprocedural use of atrial fibrillation (AF) ablation is controversial. This study aimed to compare the incidence of asymptomatic cerebral microthromboembolism and hemopericardium in AF ablation among periprocedural use of rivaroxaban, apixaban, and warfarin. METHODS AND RESULTS: This study was a prospective, randomized registry...
April 27, 2016: Journal of Cardiology
Patrick Müller, Philipp Halbfass, Attila Szöllösi, Johannes-Wolfgang Dietrich, Franziska Fochler, Karin Nentwich, Markus Roos, Joachim Krug, Rainer Schmitt, Andreas Mügge, Thomas Deneke
BACKGROUND: Silent cerebral events (SCEs) have been observed on diffusion-weighted cerebral magnetic resonance imaging (MRI) in a substantial number of asymptomatic patients after atrial fibrillation (AF) ablation procedures. The purpose of this study was to investigate if periprocedural oral anticoagulation (OAC) management affects the incidence of new-onset SCE after radiofrequency catheter ablation (RFCA) of AF. METHODS AND RESULTS: One hundred ninety-two consecutive patients (64 ± 10...
September 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Luigi Di Biase, David F Briceno, Chintan Trivedi, Sanghamitra Mohanty, Carola Gianni, J David Burkhardt, Prasant Mohanty, Rong Bai, Sampath Gunda, Rodney Horton, Shane Bailey, Javier E Sanchez, Amin Al-Ahmad, Patrick Hranitzky, G Joseph Gallinghouse, Yaruva Madhu Reddy, Jason Zagrodzky, Richard Hongo, Salwa Beheiry, Dhanunjaya Lakkireddy, Andrea Natale
BACKGROUND: Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. OBJECTIVE: To evaluate whether TEE is necessary before AF ablation in patients treated with novel oral anticoagulants (NOACs). METHODS: We performed a prospective multicenter registry of AF patients undergoing radiofrequency catheter ablation on uninterrupted NOACs (apixaban and rivaroxaban)...
June 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Pier Luigi Pellegrino, Gaetano Fassini, Matteo DI Biase, Claudio Tondo
INTRODUCTION: Percutaneous left atrial appendage (LAA) occlusion has emerged as an alternative therapeutic approach to medical therapy for stroke prevention in patients with atrial fibrillation. 3D printing is a novel technology able to create a patient specific model of any given anatomical portion of the heart. RESULTS: Herein we report the first 2 cases of LAA occlusion procedure with 2 different systems, the Wave Crest device (Coherex Medical, Inc., USA) and the Amplatzer Amulet device (St...
June 2016: Journal of Cardiovascular Electrophysiology
Kohki Nakamura, Shigeto Naito, Takehito Sasaki, Kentaro Minami, Yutaka Take, Eri Goto, Satoru Shimizu, Yoshiaki Yamaguchi, Naoko Suzuki, Toshiaki Yano, Michiharu Senga, Koji Kumagai, Kenichi Kaseno, Nobusada Funabashi, Shigeru Oshima
BACKGROUND: The aim of this study was to identify the predictors of silent cerebral ischemic lesions (SCIL) after catheter ablation of atrial fibrillation (AF) and to determine whether SCIL develop into cerebral infarcts in patients with 5 types of oral anticoagulants (OAC). METHODS AND RESULTS: We retrospectively studied 286 consecutive patients (median, 67 years; 208 male; paroxysmal/persistent/long-standing persistent AF [LSP-AF], 147/90/49) who received periprocedural OAC and underwent MRI after the procedure...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Anand N Ganesan, Derek P Chew, Trent Hartshorne, Joseph B Selvanayagam, Philip E Aylward, Prashanthan Sanders, Andrew D McGavigan
AIMS: Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation (AF) regard risk as independent of classification into paroxysmal (PAF) and non-paroxysmal atrial fibrillation (NPAF). The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism, bleeding, and mortality. METHODS AND RESULTS: PubMed was searched through 27 November 2014 for randomized controlled trials, cohort studies, and case series reporting prospectively collected clinical outcomes stratified by AF type...
May 21, 2016: European Heart Journal
Tatjana S Potpara, Gheorghe-Andrei Dan, Elina Trendafilova, Artan Goda, Zumreta Kusljugic, Sime Manola, Ljilja Music, Rodica Musetescu, Elisabeta Badila, Gorana Mitic, Vilma Paparisto, Elena S Dimitrova, Marija M Polovina, Stanislav L Petranov, Hortensia Djergo, Daniela Loncar, Amira Bijedic, Sandro Brusich, Gregory Y H Lip
Data on the management of atrial fibrillation (AF) in the Balkan Region are limited. The Serbian AF Association (SAFA) prospectively investigated contemporary 'real-world' AF management in clinical practice in Albania, Bosnia&Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia through a 14-week (December 2014-February 2015) prospective, multicentre survey of consecutive AF patients. We report the results pertinent to stroke prevention strategies. Of 2712 enrolled patients, 2663 (98.2%) with complete data were included in this analysis (mean age 69...
2016: Scientific Reports
Hans-Christoph Diener, James Aisenberg, Jack Ansell, Dan Atar, Günter Breithardt, John Eikelboom, Michael D Ezekowitz, Christopher B Granger, Jonathan L Halperin, Stefan H Hohnloser, Elaine M Hylek, Paulus Kirchhof, Deirdre A Lane, Freek W A Verheugt, Roland Veltkamp, Gregory Y H Lip
Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs...
February 4, 2016: European Heart Journal
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