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Medicine › Cardiology and Cardiovascular Medicine

Atrial Fibrillation Management and Outcomes

Works Count: 120718

Description

This cluster of papers focuses on the management, treatment, and risk assessment of atrial fibrillation (AF). It covers topics such as anticoagulant therapy, catheter ablation, stroke prevention, risk stratification, and guidelines for managing AF. The papers also compare different medications such as warfarin, rivaroxaban, and dabigatran for the treatment of AF.

Keywords

Atrial Fibrillation; Anticoagulant Therapy; Catheter Ablation; Stroke Prevention; Risk Stratification; Guidelines; Thromboembolism; Warfarin; Rivaroxaban; Dabigatran

Approaches to Catheter Ablation for Persistent Atrial Fibrillation

2015-05-06
Atul Verma , Chenyang Jiang , Timothy R. Betts +7 more
Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial … Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation.We randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (263 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (259 patients). The duration of follow-up was 18 months. The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than 30 seconds after a single ablation procedure.Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures (P<0.001). After 18 months, 59% of patients assigned to pulmonary-vein isolation alone were free from recurrent atrial fibrillation, as compared with 49% of patients assigned to pulmonary-vein isolation plus complex electrogram ablation and 46% of patients assigned to pulmonary-vein isolation plus linear ablation (P=0.15). There were also no significant differences among the three groups for the secondary end points, including freedom from atrial fibrillation after two ablation procedures and freedom from any atrial arrhythmia. Complications included tamponade (three patients), stroke or transient ischemic attack (three patients), and atrioesophageal fistula (one patient).Among patients with persistent atrial fibrillation, we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01203748.).
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A Method to Determine the Optimal Intensity of Oral Anticoagulant Therapy

1993-01-01
F.R. Rosendaal , Suzanne C. Cannegieter , F.J.M. van der Meer +1 more
Oral anticoagulant therapy has been shown to be effective for several indications. The optimal intensity of anticoagulation for each indication, however, is largely unknown. To determine this optimal intensity, randomised … Oral anticoagulant therapy has been shown to be effective for several indications. The optimal intensity of anticoagulation for each indication, however, is largely unknown. To determine this optimal intensity, randomised clinical trials are conducted in which two target levels of anticoagulation are compared. This approach is inefficient, since the choice of the target levels will be arbitrary. Moreover, the achieved intensity is not taken into account. We propose a method to determine the optimal achieved intensity of anticoagulation. This method can be applied within a clinical trial as an "efficacy-analysis", but also on data gathered in day-to-day patient care. In this method, INR-specific incidence rates of events, either thromboembolic or hemorrhagic, are calculated. The numerator of the incidence rate is based on data on the INR at the time of the event. The denominator consists of the person-time at each INR value, summed over all patients, and is calculated from all INR measurements of all patients during the follow-up interval. This INR-specific person-time is calculated with the assumption of a linear increase or decrease between two consecutive INR determinations. Since the incidence rates may be substratified on covariates, efficient assessment of the effects of other factors (e.g. age, sex, comedication) by multivariate regression analysis becomes possible. This method allows the determination of the optimal pharmacological effects of anticoagulation, which can form a rational starting point for choosing the target levels in subsequent clinical trials.
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Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study

1994-03-16
Emelia J. Benjamin
To determine the independent risk factors for atrial fibrillation.Cohort study.The Framingham Heart Study.A total of 2090 men and 2641 women members of the original cohort, free of a history of … To determine the independent risk factors for atrial fibrillation.Cohort study.The Framingham Heart Study.A total of 2090 men and 2641 women members of the original cohort, free of a history of atrial fibrillation, between the ages of 55 and 94 years.Sex-specific multiple logistic regression models to identify independent risk factors for atrial fibrillation, including age, smoking, diabetes, electrocardiographic left ventricular hypertrophy, hypertension, myocardial infarction, congestive heart failure, and valve disease.During up to 38 years of follow-up, 264 men and 298 women developed atrial fibrillation. After adjusting for age and other risk factors for atrial fibrillation, men had a 1.5 times greater risk of developing atrial fibrillation than women. In the full multivariable model, the odds ratio (OR) of atrial fibrillation for each decade of advancing age was 2.1 for men and 2.2 for women (P < .0001). In addition, after multivariable adjustment, diabetes (OR, 1.4 for men and 1.6 for women), hypertension (OR, 1.5 for men and 1.4 for women), congestive heart failure (OR, 4.5 for men and 5.9 for women), and valve disease (OR, 1.8 for men and 3.4 for women) were significantly associated with risk for atrial fibrillation in both sexes. Myocardial infarction (OR, 1.4) was significantly associated with the development of atrial fibrillation in men. Women were significantly more likely than men to have valvular heart disease as a risk factor for atrial fibrillation. The multivariable models were largely unchanged after eliminating subjects with valvular heart disease.In addition to intrinsic cardiac causes such as valve disease and congestive heart failure, risk factors for cardiovascular disease also predispose to atrial fibrillation. Modification of risk factors for cardiovascular disease may have the added benefit of diminishing the incidence of atrial fibrillation.

A Comparison of Rate Control and Rhythm Control in Patients with Recurrent Persistent Atrial Fibrillation

2002-12-05
Isabelle C. Van Gelder , Vincent E. Hagens , Hans A. Bosker +7 more
Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation. However, recurrences of atrial fibrillation and side effects of antiarrhythmic drugs offset the benefits of sinus … Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation. However, recurrences of atrial fibrillation and side effects of antiarrhythmic drugs offset the benefits of sinus rhythm. We hypothesized that ventricular rate control is not inferior to the maintenance of sinus rhythm for the treatment of atrial fibrillation.
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Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation

2007-06-19
Robert G. Hart , Lesly A. Pearce , Maria I. Aguilar
Background: Atrial fibrillation is a strong independent risk factor for stroke. Purpose: To characterize the efficacy and safety of antithrombotic agents for stroke prevention in patients who have atrial fibrillation, … Background: Atrial fibrillation is a strong independent risk factor for stroke. Purpose: To characterize the efficacy and safety of antithrombotic agents for stroke prevention in patients who have atrial fibrillation, adding 13 recent randomized trials to a previous meta-analysis. Data Sources: Randomized trials identified by using the Cochrane Stroke Group search strategy, 1966 to March 2007, unrestricted by language. Study Selection: All published randomized trials with a mean follow-up of 3 months or longer that tested antithrombotic agents in patients who have nonvalvular atrial fibrillation. Data Extraction: Two coauthors independently extracted information regarding interventions; participants; and occurrences of ischemic and hemorrhagic stroke, major extracranial bleeding, and death. Data Synthesis: Twenty-nine trials included 28 044 participants (mean age, 71 years; mean follow-up, 1.5 years). Compared with the control, adjusted-dose warfarin (6 trials, 2900 participants) and antiplatelet agents (8 trials, 4876 participants) reduced stroke by 64% (95% CI, 49% to 74%) and 22% (CI, 6% to 35%), respectively. Adjusted-dose warfarin was substantially more efficacious than antiplatelet therapy (relative risk reduction, 39% [CI, 22% to 52%]) (12 trials, 12 963 participants). Other randomized comparisons were inconclusive. Absolute increases in major extracranial hemorrhage were small (≤0.3% per year) on the basis of meta-analysis. Limitation: Methodological features and quality varied substantially and often were incompletely reported. Conclusions: Adjusted-dose warfarin and antiplatelet agents reduce stroke by approximately 60% and by approximately 20%, respectively, in patients who have atrial fibrillation. Warfarin is substantially more efficacious (by approximately 40%) than antiplatelet therapy. Absolute increases in major extracranial hemorrhage associated with antithrombotic therapy in participants from the trials included in this meta-analysis were less than the absolute reductions in stroke. Judicious use of antithrombotic therapy importantly reduces stroke for most patients who have atrial fibrillation.

2012 focused update of the ESC Guidelines for the management of atrial fibrillation

2012-08-24
A. John Camm , Gregory Y.H. Lip , Raffaele De Caterina +7 more
2012 focused update of the ESC Guidelines for the management of atrial fibrillation : an update of the 2010 ESC Guidelines for the management of atrial fibrillation: developed with the … 2012 focused update of the ESC Guidelines for the management of atrial fibrillation : an update of the 2010 ESC Guidelines for the management of atrial fibrillation: developed with the special contribution of the European Heart Rhythm Association
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Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates 11Reprints are not available.

1998-10-01
William B. Kannel , Philip A. Wolf , Emelia J. Benjamin +1 more

Validation of Clinical Classification Schemes for Predicting Stroke

2001-06-13
Brian F. Gage , Amy D. Waterman , William D. Shannon +3 more
ContextPatients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.ObjectiveTo assess the predictive value of classification … ContextPatients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.ObjectiveTo assess the predictive value of classification schemes that estimate stroke risk in patients with AF.Design, Setting, and PatientsTwo existing classification schemes were combined into a new stroke-risk scheme, the CHADS2 index, and all 3 classification schemes were validated. The CHADS2 was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge.Main Outcome MeasureHospitalization for ischemic stroke, determined by Medicare claims data.ResultsDuring 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS2 index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS2 score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6.ConclusionThe 2 existing classification schemes and especially a new stroke risk index, CHADS2, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.

Cryptogenic Stroke and Underlying Atrial Fibrillation

2014-06-25
Tommaso Sanna , Hans‐Christoph Diener , Rod Passman +7 more
Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have … Current guidelines recommend at least 24 hours of electrocardiographic (ECG) monitoring after an ischemic stroke to rule out atrial fibrillation. However, the most effective duration and type of monitoring have not been established, and the cause of ischemic stroke remains uncertain despite a complete diagnostic evaluation in 20 to 40% of cases (cryptogenic stroke). Detection of atrial fibrillation after cryptogenic stroke has therapeutic implications.We conducted a randomized, controlled study of 441 patients to assess whether long-term monitoring with an insertable cardiac monitor (ICM) is more effective than conventional follow-up (control) for detecting atrial fibrillation in patients with cryptogenic stroke. Patients 40 years of age or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring underwent randomization within 90 days after the index event. The primary end point was the time to first detection of atrial fibrillation (lasting >30 seconds) within 6 months. Among the secondary end points was the time to first detection of atrial fibrillation within 12 months. Data were analyzed according to the intention-to-treat principle.By 6 months, atrial fibrillation had been detected in 8.9% of patients in the ICM group (19 patients) versus 1.4% of patients in the control group (3 patients) (hazard ratio, 6.4; 95% confidence interval [CI], 1.9 to 21.7; P<0.001). By 12 months, atrial fibrillation had been detected in 12.4% of patients in the ICM group (29 patients) versus 2.0% of patients in the control group (4 patients) (hazard ratio, 7.3; 95% CI, 2.6 to 20.8; P<0.001).ECG monitoring with an ICM was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. (Funded by Medtronic; CRYSTAL AF ClinicalTrials.gov number, NCT00924638.).
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Prevalence, Age Distribution, and Gender of Patients With Atrial Fibrillation

1995-03-13
William M. Feinberg
The prevalence of atrial fibrillation (AF) is related to age. Anticoagulation is highly effective in preventing stroke in patients with AF, but the risk of hemorrhage may be increased in … The prevalence of atrial fibrillation (AF) is related to age. Anticoagulation is highly effective in preventing stroke in patients with AF, but the risk of hemorrhage may be increased in older patients. We reviewed the available epidemiologic data to define the age and sex distribution of people with AF. From four large recent population-based surveys, we estimated the overall age- and gender-specific prevalence of AF. These estimates were applied to the recent US census data to calculate the number of men and women with AF in each age group. There are an estimated 2.2 million people in the United States with AF, with a median age of about 75 years. The prevalence of AF is 2.3% in people older than 40 years and 5.9% in those older than 65 years. Approximately 70% of individuals with AF are between 65 and 85 years of age. The absolute number of men and women with AF is about equal. After age 75 years, about 60% of the people with AF are women. In contrast to people with AF in the general population, patients with AF in recent anticoagulation trials had a mean age of 69 years, and only 20% were older than 75 years. The risks and benefits of antithrombotic therapy in older individuals are important considerations in stroke prevention in AF.

Edoxaban versus Warfarin in Patients with Atrial Fibrillation

2013-11-19
Robert P. Giugliano , Christian T. Ruff , Eugene Braunwald +7 more
Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not … Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known.We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding.The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32).Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.).
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Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation

2011-08-10
Manesh R. Patel , Kenneth W. Mahaffey , Jyotsna Garg +7 more
The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide … The use of warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulation than warfarin.
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Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial

2009-08-01
David R. Holmes , Vivek Y. Reddy , Zoltan G. Turi +5 more

A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation

2002-12-05
D G Wyse , A.L. Waldo , John Dimarco +7 more
There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling … There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended.
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Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation

2009-04-01
Stuart J. Connolly , Janice Pogue , Robert G. Hart +4 more
Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that … Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation.
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Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.

1991-08-01
Philip A. Wolf , Robert D. Abbott , W B Kannel
The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. … The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (p less than 0.001) and more than trebled in the presence of hypertension (p less than 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p less than 0.001) and a near fivefold excess when atrial fibrillation was present (p less than 0.001). In persons with coronary heart disease or cardiac failure, atrial fibrillation doubled the stroke risk in men and trebled the risk in women. With increasing age the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker (p less than 0.05). Advancing age, however, did not reduce the significant impact of atrial fibrillation. For persons aged 80-89 years, atrial fibrillation was the sole cardiovascular condition to exert an independent effect on stroke incidence (p less than 0.001). The attributable risk of stroke for all cardiovascular contributors decreased with age except for atrial fibrillation, for which the attributable risk increased significantly (p less than 0.01), rising from 1.5% for those aged 50-59 years to 23.5% for those aged 80-89 years. While these findings highlight the impact of each cardiovascular condition on the risk of stroke, the data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present.(ABSTRACT TRUNCATED AT 250 WORDS)

Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism

2009-12-07
Sam Schulman , Clive Kearon , Ajay K. Kakkar +6 more
The direct oral thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative therapy to warfarin for patients who have acute venous thromboembolism.In a randomized, double-blind, noninferiority … The direct oral thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative therapy to warfarin for patients who have acute venous thromboembolism.In a randomized, double-blind, noninferiority trial involving patients with acute venous thromboembolism who were initially given parenteral anticoagulation therapy for a median of 9 days (interquartile range, 8 to 11), we compared oral dabigatran, administered at a dose of 150 mg twice daily, with warfarin that was dose-adjusted to achieve an international normalized ratio of 2.0 to 3.0. The primary outcome was the 6-month incidence of recurrent symptomatic, objectively confirmed venous thromboembolism and related deaths. Safety end points included bleeding events, acute coronary syndromes, other adverse events, and results of liver-function tests.A total of 30 of the 1274 patients randomly assigned to receive dabigatran (2.4%), as compared with 27 of the 1265 patients randomly assigned to warfarin (2.1%), had recurrent venous thromboembolism; the difference in risk was 0.4 percentage points (95% confidence interval [CI], -0.8 to 1.5; P<0.001 for the prespecified noninferiority margin). The hazard ratio with dabigatran was 1.10 (95% CI, 0.65 to 1.84). Major bleeding episodes occurred in 20 patients assigned to dabigatran (1.6%) and in 24 patients assigned to warfarin (1.9%) (hazard ratio with dabigatran, 0.82; 95% CI, 0.45 to 1.48), and episodes of any bleeding were observed in 205 patients assigned to dabigatran (16.1%) and 277 patients assigned to warfarin (21.9%; hazard ratio with dabigatran, 0.71; 95% CI, 0.59 to 0.85). The numbers of deaths, acute coronary syndromes, and abnormal liver-function tests were similar in the two groups. Adverse events leading to discontinuation of the study drug occurred in 9.0% of patients assigned to dabigatran and in 6.8% of patients assigned to warfarin (P=0.05).For the treatment of acute venous thromboembolism, a fixed dose of dabigatran is as effective as warfarin, has a safety profile that is similar to that of warfarin, and does not require laboratory monitoring. (ClinicalTrials.gov number, NCT00291330.)
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A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate

2004-06-01
Koonlawee Nademanee , John P. McKenzie , Erol M. Kosar +5 more

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2014-03-29
Craig T. January , L. Samüel Wann , Joseph S. Alpert +7 more
work of the writing committee, without commercial support.Writing committee members volunteered their time for this activity.Guidelines are official policy of both the ACC and AHA.In an effort to maintain relevance … work of the writing committee, without commercial support.Writing committee members volunteered their time for this activity.Guidelines are official policy of both the ACC and AHA.In an effort to maintain relevance at the point of care for clinicians, the Task Force continues to oversee an ongoing process improvement initiative.As a result, in response to pilot projects, several changes to this guideline will be apparent
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A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk of Major Bleeding in Patients With Atrial Fibrillation

2010-03-19
Ron Pisters , Deirdre A. Lane , Robby Nieuwlaat +3 more

Prevalence of Diagnosed Atrial Fibrillation in Adults

2001-05-09
Alan S. Go , Elaine M. Hylek , Kathleen A. Phillips +4 more
TRIAL FIBRILLATION IS THE most common clinically significant cardiac arrhythmia.It is also a potent risk factor for ischemic stroke, increasing the risk of stroke 5-fold and accounting for approximately 15% … TRIAL FIBRILLATION IS THE most common clinically significant cardiac arrhythmia.It is also a potent risk factor for ischemic stroke, increasing the risk of stroke 5-fold and accounting for approximately 15% of all strokes nationally. 1 Symptomatic atrial fibrillation may also reduce quality of life, functional status, and cardiac performance. 2It is associated with higher medical costs as well as an increased risk of death. 3Specifying the prevalence of atrial fibrillation in the United States has important implications for understanding the population burden of disability and medical costs associated with this arrhythmia.][8] Overall, these limitations may reduce the generalizability of prior studies' results to current populations.We assembled a contemporary cohort of patients with atrial fibrillation to provide age-, sex-, and race-specific

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary

2014-03-29
Craig T. January , L. Samüel Wann , Joseph S. Alpert +7 more
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Dabigatran versus Warfarin in Patients with Atrial Fibrillation

2009-08-31
Stuart J. Connolly , Michael D. Ezekowitz , Salim Yusuf +7 more
Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor. Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor.
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Lifetime Risk for Development of Atrial Fibrillation

2004-08-17
Donald M. Lloyd‐Jones , Thomas J. Wang , Eric Leip +7 more
Background— Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a source of considerable morbidity and mortality, but lifetime risk for AF has not been estimated. Methods and Results— … Background— Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a source of considerable morbidity and mortality, but lifetime risk for AF has not been estimated. Methods and Results— We included all participants in the Framingham Heart Study who were free of AF at index ages of 40 years and older. We estimated lifetime risks for AF (including atrial flutter) to age 95 years, with death free of AF as a competing event. We followed 3999 men and 4726 women from 1968 to 1999 (176 166 person-years); 936 participants had development of AF and 2621 died without prior AF. At age 40 years, lifetime risks for AF were 26.0% (95% CI, 24.0% to 27.0%) for men and 23.0% (21.0% to 24.0%) for women. Lifetime risks did not change substantially with increasing index age despite decreasing remaining years of life because AF incidence rose rapidly with advancing age. At age 80 years, lifetime risks for AF were 22.7% (20.1% to 24.1%) in men and 21.6% (19.3% to 22.7%) in women. In further analyses, counting only those who had development of AF without prior or concurrent congestive heart failure or myocardial infarction, lifetime risks for AF were approximately 16%. Conclusions— Lifetime risks for development of AF are 1 in 4 for men and women 40 years of age and older. Lifetime risks for AF are high (1 in 6), even in the absence of antecedent congestive heart failure or myocardial infarction. These substantial lifetime risks underscore the major public health burden posed by AF and the need for further investigation into predisposing conditions, preventive strategies, and more effective therapies.

Secular Trends in Incidence of Atrial Fibrillation in Olmsted County, Minnesota, 1980 to 2000, and Implications on the Projections for Future Prevalence

2006-07-05
Yoko Miyasaka , Marion E. Barnes , Bernard J. Gersh +5 more
Background— Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. … Background— Limited data exist on trends in incidence of atrial fibrillation (AF). We assessed the community-based trends in AF incidence for 1980 to 2000 and provided prevalence projections to 2050. Methods and Results— The adult residents of Olmsted County, Minnesota, who had ECG-confirmed first AF in the period 1980 to 2000 (n=4618) were identified. Trends in age-adjusted incidence were determined and used to construct model-based prevalence estimates. The age- and sex-adjusted incidence of AF per 1000 person-years was 3.04 (95% CI, 2.78 to 3.31) in 1980 and 3.68 (95% CI, 3.42 to 3.95) in 2000. According to Poisson regression with adjustment for age and sex, incidence of AF increased significantly ( P =0.014), with a relative increase of 12.6% (95% CI, 2.1 to 23.1) over 21 years. The increase in age-adjusted AF incidence did not differ between men and women ( P =0.84). According to the US population projections by the US Census Bureau, the number of persons with AF is projected to be 12.1 million by 2050, assuming no further increase in age-adjusted incidence of AF, but 15.9 million if the increase in incidence continues. Conclusions— The age-adjusted incidence of AF increased significantly in Olmsted County during 1980 to 2000. Whether or not this rate of increase continues, the projected number of persons with AF for the United States will exceed 10 million by 2050, underscoring the urgent need for primary prevention strategies against AF development.
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Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation

2009-12-08
Riccardo Cappato , Hugh Calkins , Shih‐Ann Chen +7 more
The purpose of this study was to provide an updated worldwide report on the methods, efficacy, and safety of catheter ablation of atrial fibrillation (AF).A questionnaire with 46 questions was … The purpose of this study was to provide an updated worldwide report on the methods, efficacy, and safety of catheter ablation of atrial fibrillation (AF).A questionnaire with 46 questions was sent to 521 centers from 24 countries in 4 continents. Complete interviews were collected from 182 centers, of which 85 reported to have performed 20,825 catheter ablation procedures on 16,309 patients with AF between 2003 and 2006. The median number of procedures per center was 245 (range, 2 to 2715). All centers included paroxysmal AF, 85.9% also included persistent and 47.1% also included long-lasting AF. Carto-guided left atrial circumferential ablation (48.2% of patients) and Lasso-guided ostial electric disconnection (27.4%) were the most commonly used techniques. Efficacy data were analyzed with centers representing the unit of analysis. Of 16,309 patients with full disclosure of outcome data, 10 488 (median, 70.0%; interquartile range, 57.7% to 75.4%) became asymptomatic without antiarrhythmic drugs and another 2047 (10.0%; 0.5% to 17.1%) became asymptomatic in the presence of previously ineffective antiarrhythmic drugs over 18 (range, 3 to 24) months of follow-up. Success rates free of antiarrhythmic drugs and overall success rates were significantly larger in 9590 patients with paroxysmal AF (74.9% and 83.2%) than in 2800 patients with persistent AF (64.8% and 75.0%) and 1108 patients with long-lasting AF (63.1% and 72.3%) (P<0.0001). Major complications were reported in 741 patients (4.5%).When analyzed in a large number of electrophysiology laboratories worldwide, catheter ablation of AF shows to be effective in approximately 80% of patients after 1.3 procedures per patient, with approximately 70% of them not requiring further antiarrhythmic drugs during intermediate follow-up.

Worldwide Epidemiology of Atrial Fibrillation

2013-12-18
Sumeet S. Chugh , Rasmus Havmoeller , Kumar Narayanan +7 more
Background— The global burden of atrial fibrillation (AF) is unknown. Methods and Results— We systematically reviewed population-based studies of AF published from 1980 to 2010 from the 21 Global Burden … Background— The global burden of atrial fibrillation (AF) is unknown. Methods and Results— We systematically reviewed population-based studies of AF published from 1980 to 2010 from the 21 Global Burden of Disease regions to estimate global/regional prevalence, incidence, and morbidity and mortality related to AF (DisModMR software). Of 377 potential studies identified, 184 met prespecified eligibility criteria. The estimated number of individuals with AF globally in 2010 was 33.5 million (20.9 million men [95% uncertainty interval (UI), 19.5–22.2 million] and 12.6 million women [95% UI, 12.0–13.7 million]). Burden associated with AF, measured as disability-adjusted life-years, increased by 18.8% (95% UI, 15.8–19.3) in men and 18.9% (95% UI, 15.8–23.5) in women from 1990 to 2010. In 1990, the estimated age-adjusted prevalence rates of AF (per 100 000 population) were 569.5 in men (95% UI, 532.8–612.7) and 359.9 in women (95% UI, 334.7–392.6); the estimated age-adjusted incidence rates were 60.7 per 100 000 person-years in men (95% UI, 49.2–78.5) and 43.8 in women (95% UI, 35.9–55.0). In 2010, the prevalence rates increased to 596.2 (95% UI, 558.4–636.7) in men and 373.1 (95% UI, 347.9–402.2) in women; the incidence rates increased to 77.5 (95% UI, 65.2–95.4) in men and 59.5 (95% UI, 49.9–74.9) in women. Mortality associated with AF was higher in women and increased by 2-fold (95% UI, 2.0–2.2) and 1.9-fold (95% UI, 1.8–2.0) in men and women, respectively, from 1990 to 2010. There was evidence of significant regional heterogeneity in AF estimations and availability of population-based data. Conclusions— These findings provide evidence of progressive increases in overall burden, incidence, prevalence, and AF-associated mortality between 1990 and 2010, with significant public health implications. Systematic, regional surveillance of AF is required to better direct prevention and treatment strategies.
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Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study

2006-03-09
Jan Heeringa , Deirdre A.M. van der Kuip , Albert Hofman +6 more
Aims We aimed to investigate the prevalence and incidence of atrial fibrillation (AF) in a large European population-based study. Methods and results The study is part of the Rotterdam study, … Aims We aimed to investigate the prevalence and incidence of atrial fibrillation (AF) in a large European population-based study. Methods and results The study is part of the Rotterdam study, a population-based prospective cohort study among subjects aged 55 years and above. The prevalence at baseline was assessed in 6808 participants. Incidence of AF was investigated during a mean follow-up period of 6.9 years in 6432 persons. We identified 376 prevalent and 437 incident cases. Overall prevalence was 5.5%, rising from 0.7% in the age group 55–59 years to 17.8% in those aged 85 years and above. The overall incidence rate was 9.9/1000 person–years. The incidence rate in the age group 55–59 years was 1.1/1000 person–years, rose to 20.7/1000 person–years in the age group 80–84 years and stabilized in those aged 85 years and above. Prevalence and incidence were higher in men than in women. The lifetime risk to develop AF at the age of 55 years was 23.8% in men and 22.2% in women. Conclusion In this prospective study in a European population, the prevalence and incidence of AF increased with age and were higher in men than in women. The high lifetime risk to develop AF was similar to North American epidemiological data.
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Apixaban in Patients with Atrial Fibrillation

2011-02-10
Stuart J. Connolly , John W. Eikelboom , Campbell Joyner +7 more
Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist … Vitamin K antagonists have been shown to prevent stroke in patients with atrial fibrillation. However, many patients are not suitable candidates for or are unwilling to receive vitamin K antagonist therapy, and these patients have a high risk of stroke. Apixaban, a novel factor Xa inhibitor, may be an alternative treatment for such patients.In a double-blind study, we randomly assigned 5599 patients with atrial fibrillation who were at increased risk for stroke and for whom vitamin K antagonist therapy was unsuitable to receive apixaban (at a dose of 5 mg twice daily) or aspirin (81 to 324 mg per day), to determine whether apixaban was superior. The mean follow up period was 1.1 years. The primary outcome was the occurrence of stroke or systemic embolism.Before enrollment, 40% of the patients had used a vitamin K antagonist. The data and safety monitoring board recommended early termination of the study because of a clear benefit in favor of apixaban. There were 51 primary outcome events (1.6% per year) among patients assigned to apixaban and 113 (3.7% per year) among those assigned to aspirin (hazard ratio with apixaban, 0.45; 95% confidence interval [CI], 0.32 to 0.62; P<0.001). The rates of death were 3.5% per year in the apixaban group and 4.4% per year in the aspirin group (hazard ratio, 0.79; 95% CI, 0.62 to 1.02; P=0.07). There were 44 cases of major bleeding (1.4% per year) in the apixaban group and 39 (1.2% per year) in the aspirin group (hazard ratio with apixaban, 1.13; 95% CI, 0.74 to 1.75; P=0.57); there were 11 cases of intracranial bleeding with apixaban and 13 with aspirin. The risk of a first hospitalization for cardiovascular causes was reduced with apixaban as compared with aspirin (12.6% per year vs. 15.9% per year, P<0.001). The treatment effects were consistent among important subgroups.In patients with atrial fibrillation for whom vitamin K antagonist therapy was unsuitable, apixaban reduced the risk of stroke or systemic embolism without significantly increasing the risk of major bleeding or intracranial hemorrhage. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00496769.).
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Impact of Atrial Fibrillation on the Risk of Death

1998-09-08
Emelia J. Benjamin , Philip A. Wolf , Ralph B. D’Agostino +3 more
Background —Atrial fibrillation (AF) causes substantial morbidity. It is uncertain whether AF is associated with excess mortality independent of associated cardiac conditions and risk factors. Methods and Results —We examined … Background —Atrial fibrillation (AF) causes substantial morbidity. It is uncertain whether AF is associated with excess mortality independent of associated cardiac conditions and risk factors. Methods and Results —We examined the mortality of subjects 55 to 94 years of age who developed AF during 40 years of follow-up of the original Framingham Heart Study cohort. Of the original 5209 subjects, 296 men and 325 women (mean ages, 74 and 76 years, respectively) developed AF and met eligibility criteria. By pooled logistic regression, after adjustment for age, hypertension, smoking, diabetes, left ventricular hypertrophy, myocardial infarction, congestive heart failure, valvular heart disease, and stroke or transient ischemic attack, AF was associated with an OR for death of 1.5 (95% CI, 1.2 to 1.8) in men and 1.9 (95% CI, 1.5 to 2.2) in women. The risk of mortality conferred by AF did not significantly vary by age. However, there was a significant AF-sex interaction: AF diminished the female advantage in survival. In secondary multivariate analyses, in subjects free of valvular heart disease and preexisting cardiovascular disease, AF remained significantly associated with excess mortality, with about a doubling of mortality in both sexes. Conclusions —In subjects from the original cohort of the Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. The decreased survival seen with AF was present in men and women and across a wide range of ages.

Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials

2013-12-04
Christian T. Ruff , Robert P. Giugliano , Eugene Braunwald +7 more

Subclinical Atrial Fibrillation and the Risk of Stroke

2012-01-11
Jeff S. Healey , Stuart J. Connolly , Michael R. Gold +7 more
One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with … One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinical episodes of rapid atrial rate detected by implanted devices were associated with an increased risk of ischemic stroke in patients who did not have other evidence of atrial fibrillation.We enrolled 2580 patients, 65 years of age or older, with hypertension and no history of atrial fibrillation, in whom a pacemaker or defibrillator had recently been implanted. We monitored the patients for 3 months to detect subclinical atrial tachyarrhythmias (episodes of atrial rate >190 beats per minute for more than 6 minutes) and followed them for a mean of 2.5 years for the primary outcome of ischemic stroke or systemic embolism. Patients with pacemakers were randomly assigned to receive or not to receive continuous atrial overdrive pacing.By 3 months, subclinical atrial tachyarrhythmias detected by implanted devices had occurred in 261 patients (10.1%). Subclinical atrial tachyarrhythmias were associated with an increased risk of clinical atrial fibrillation (hazard ratio, 5.56; 95% confidence interval [CI], 3.78 to 8.17; P<0.001) and of ischemic stroke or systemic embolism (hazard ratio, 2.49; 95% CI, 1.28 to 4.85; P=0.007). Of 51 patients who had a primary outcome event, 11 had had subclinical atrial tachyarrhythmias detected by 3 months, and none had had clinical atrial fibrillation by 3 months. The population attributable risk of stroke or systemic embolism associated with subclinical atrial tachyarrhythmias was 13%. Subclinical atrial tachyarrhythmias remained predictive of the primary outcome after adjustment for predictors of stroke (hazard ratio, 2.50; 95% CI, 1.28 to 4.89; P=0.008). Continuous atrial overdrive pacing did not prevent atrial fibrillation.Subclinical atrial tachyarrhythmias, without clinical atrial fibrillation, occurred frequently in patients with pacemakers and were associated with a significantly increased risk of ischemic stroke or systemic embolism. (Funded by St. Jude Medical; ASSERT ClinicalTrials.gov number, NCT00256152.).
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Apixaban versus Warfarin in Patients with Atrial Fibrillation

2011-08-28
Christopher B. Granger , John H. Alexander , John J.V. McMurray +7 more
Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been … Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin.In this randomized, double-blind trial, we compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause.The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio with apixaban, 0.79; 95% confidence interval [CI], 0.66 to 0.95; P<0.001 for noninferiority; P=0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; 95% CI, 0.60 to 0.80; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; 95% CI, 0.80 to 0.99; P=0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; 95% CI, 0.74 to 1.13; P=0.42).In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. (Funded by Bristol-Myers Squibb and Pfizer; ARISTOTLE ClinicalTrials.gov number, NCT00412984.).
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Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach

2009-09-18
Gregory Y.H. Lip , Robby Nieuwlaat , Ron Pisters +2 more

Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)

2010-08-29
A. John Camm , Paulus Kirchhof , Gregory Y.H. Lip +7 more
The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to … The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written.Health professionals are encouraged to take them fully into account when exercising their clinical judgement.The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer.It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.
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2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (…

2012-03-01
Hugh Calkins , Karl Heinz Kuck , Riccardo Cappato +7 more
During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major … During the past decade, catheter ablation of atrial fibrillation (AF) has evolved rapidly from an investigational procedure to its current status as a commonly performed ablation procedure in many major hospitals throughout the world. Surgical ablation of AF, using either standard or minimally invasive techniques, is also performed in many major hospitals throughout the world. In 2007, an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society.1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons and the American College of Cardiology. Since the publication of the 2007 document, there has been much learned about AF ablation, and the indications for these procedures have changed. Therefore the purpose of this 2012 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a Task Force, convened by the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society and charged with defining the indications, techniques, and outcomes of this procedure. Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation, including definitions relevant to this topic. This statement summarizes the opinion of the Task Force members based on an extensive literature review as well as their own experience. It is directed to all health care professionals who are involved in the care of patients with AF, particularly those who are undergoing, or are being considered for, catheter or surgical ablation procedures for AF. This statement is not intended to recommend or promote catheter ablation of AF. Rather the ultimate judgment regarding care of a particular patient …

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

2006-08-14
Valentı́n Fuster , Lars Rydén , David S. Cannom +7 more
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Epidemiologic Features of Chronic Atrial Fibrillation

1982-04-29
William B. Kannel , Robert D. Abbott , Daniel D. Savage +1 more
In the Framingham Study 2325 men and 2866 women 30 to 62 years old at entry were followed biennially over 22 years for the development of chronic atrial fibrillation in … In the Framingham Study 2325 men and 2866 women 30 to 62 years old at entry were followed biennially over 22 years for the development of chronic atrial fibrillation in relation to antecedent cardiovascular disease and risk factors. During surveillance, atrial fibrillation developed in 49 men and 49 women. The incidence rose sharply with age but did not differ significantly between the sexes. Overall, there was a 2.0 per cent chance that the disorder would develop in two decades. Atrial fibrillation usually followed the development of overt cardiovascular disease. Only 18 men and 12 women (31 per cent) had chronic atrial fibrillation in the absence of cardiovascular disease. Cardiac failure and rheumatic heart disease were the most powerful predictive precursors, with relative risks in excess of sixfold. Hypertensive cardiovascular disease was the most common antecedent disease, largely because of its frequency in the general population. Among the risk factors for cardiovascular disease, diabetes and electrocardiographic evidence of left ventricular hypertrophy were related to the occurrence of atrial fibrillation. The development of chronic atrial fibrillation was associated with a doubling of overall mortality and of mortality from cardiovascular disease.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016-08-27
Paulus Kirchhof , Stefano Benussi , Dipak Kotecha +7 more
The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation

2017-05-13
Hugh Calkins , Gerhard Hindricks , Riccardo Cappato +7 more
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Catheter Ablation for Atrial Fibrillation with Heart Failure

2018-01-31
Nassir Marrouche , Johannes Brachmann , Dietrich Andresen +7 more
Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a … Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment.We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure.After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009).Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188 .).
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The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation

2018-03-01
Jan Steffel , Peter Verhamme , Tatjana Potpara +7 more
The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral … The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug-drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of NOACs; (8) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu).
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2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2019-01-29
Craig T. January , L. Samüel Wann , Hugh Calkins +7 more

2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons

2019-01-28
Craig T. January , L. Samüel Wann , Hugh Calkins +7 more

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016-08-27
Paulus Kirchhof , Stefano Benussi , Dipak Kotecha +7 more
The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
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2012 focused update of the ESC Guidelines for the management of atrial fibrillation

2012-08-24
A. John Camm , Gregory Y.H. Lip , Raffaele De Caterina +7 more
The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at
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2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

2020-07-17
Gerhard Hindricks , Tatjana Potpara , Nikolaos Dagres +7 more
Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read mginstead of mg (use with … Supplementary Table 9, column 'Edoxaban', row 'eGFR category', '95 mL/min' (page 15). The cell should be coloured green instead of yellow. It should also read mginstead of mg (use with caution in 'supranormal' renal function).In the above-indicated cell, a footnote has also been added to state: Edoxaban should be used in patients with high creatinine clearance only after a careful evaluation of the individual thromboembolic and bleeding risk.Supplementary Table 9, column 'Edoxaban', row 'Dose reduction in selected patients' (page 16). The cell should read Edoxaban 60 mg reduced to 30 mg once daily if any of the following: creatinine clearance 15-50 mL/min, body weight <60 kg, concomitant use of dronedarone, erythromycin, ciclosporine or ketokonazoleinstead of Edoxaban 60 mg reduced to 30 mg once daily, and edoxaban 30 mg reduced to 15mg once daily, if any of the following: creatinine clearance of 30-50 mL/min, body weight <60 kg, concomitant us of verapamil or quinidine or dronedarone.
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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2014-03-28
Craig T. January , L. Samüel Wann , Joseph S. Alpert +7 more

Risk Factors for Stroke and Efficacy of Antithrombotic Therapy in Atrial Fibrillation

1994-07-11
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Independent Risk Factors for Atrial Fibrillation in a Population-Based Cohort

1994-03-16
Emelia J. Benjamin
<h3>Objective.</h3> —To determine the independent risk factors for atrial fibrillation. <h3>Design.</h3> —Cohort study. <h3>Setting.</h3> —The Framingham Heart Study. <h3>Subjects.</h3> —A total of 2090 men and 2641 women members of the … <h3>Objective.</h3> —To determine the independent risk factors for atrial fibrillation. <h3>Design.</h3> —Cohort study. <h3>Setting.</h3> —The Framingham Heart Study. <h3>Subjects.</h3> —A total of 2090 men and 2641 women members of the original cohort, free of a history of atrial fibrillation, between the ages of 55 and 94 years. <h3>Main Outcome Measures.</h3> —Sex-specific multiple logistic regression models to identify independent risk factors for atrial fibrillation, including age, smoking, diabetes, electrocardiographic left ventricular hypertrophy, hypertension, myocardial infarction, congestive heart failure, and valve disease. <h3>Results.</h3> —During up to 38 years of follow-up, 264 men and 298 women developed atrial fibrillation. After adjusting for age and other risk factors for atrial fibrillation, men had a 1.5 times greater risk of developing atrial fibrillation than women. In the full multivariable model, the odds ratio (OR) of atrial fibrillation for each decade of advancing age was 2.1 for men and 2.2 for women (<i>P</i>&lt;.0001). In addition, after multivariable adjustment, diabetes (OR, 1.4 for men and 1.6 for women), hypertension (OR, 1.5 for men and 1.4 for women), congestive heart failure (OR, 4.5 for men and 5.9 for women), and valve disease (OR, 1.8 for men and 3.4 for women) were significantly associated with risk for atrial fibrillation in both sexes. Myocardial infarction (OR, 1.4) was significantly associated with the development of atrial fibrillation in men. Women were significantly more likely than men to have valvular heart disease as a risk factor for atrial fibrillation. The multivariable models were largely unchanged after eliminating subjects with valvular heart disease. <h3>Conclusion.</h3> —In addition to intrinsic cardiac causes such as valve disease and congestive heart failure, risk factors for cardiovascular disease also predispose to atrial fibrillation. Modification of risk factors for cardiovascular disease may have the added benefit of diminishing the incidence of atrial fibrillation. (<i>JAMA</i>. 1994;271:840-844)

Preventive Measures and Treatment Options for Atrial Fibrillation.

2025-08-08
Stephan Willems , Felix K. Wegner , Lars Eckardt | PubMed
With approximately 1.6 million people affected in Germany, atrial fibrillation (AF) is the most common arrhythmia. The management of AF, from prevention to treatment, including anticoagulation, is therefore of major … With approximately 1.6 million people affected in Germany, atrial fibrillation (AF) is the most common arrhythmia. The management of AF, from prevention to treatment, including anticoagulation, is therefore of major clinical importance in terms of these patients' quality of life and their mortality. This first German clinical practice guideline on AF was developed in accordance with the Regelwerk Leitlinien (rules for guidelines) of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., AWMF). The available evidence on all relevant issues was retrieved by a systematic literature search and evaluated with the participation of many medical specialty societies. AF is classified on clinical grounds as paroxysmal, persistent, longstanding persistent, or permanent. It is associated with a 1.5- to 2-fold increase in mortality and a 4- to 5-fold increase in the risk of stroke. Nonetheless, general screening for AF is not currently recommended, as the data on this question are conflicting. Lifestyle interventions and the reduction of risk factors lessen the frequency of AF. Female sex is only a minor risk factor; the CHA2DS2-VA score is recommended to assess the risk of thromboembolic events. If it is 2 or higher, oral anticoagulation (OAC) is indicated, of a type that should be decided on an individual basis. In patients with cardiovascular risk factors, early rhythm control has been shown to reduce prognostically relevant cardiovascular endpoints (3.9 versus 5.0 per 100 patient-years). Multiple studies have shown that catheter ablation is superior to drug-based antiarrhythmic therapy in patients with paroxysmal symptomatic AF as well as in those with heart failure and AF. It is hoped that the recommendations contained in this guideline will lead to intensified measures for the prevention of AF, resulting in a lower prevalence of AF and its adverse sequelae. The available evidence supports the evaluation of the indications for OAC, early rhythm control, and the use of catheter ablation, especially in patients with paroxysmal AF or heart failure.

Effectiveness of Immediate Pharmacological Versus Electrical Cardioversion on Hemodynamic Stability and Rhythm Restoration in Patients With Refractory Atrial Fibrillation: A Systematic Review

2025-06-25
Paulina Elizabeth Cisneros Clavijo , Montserrat Milà , Carlos Alberto Ruíz +6 more | Cureus

Wearable Irregular Heart Rhythm Detection Recurrences and Electrocardiographic Atrial Fibrillation Confirmation: The Fitbit Heart Study

2025-06-25
Steven A. Lubitz , Michael V. McConnell , Caitlin Selvaggi +7 more | Circulation Arrhythmia and Electrophysiology
BACKGROUND: Wrist-worn wearables can detect irregular heart rhythms using photoplethysmography, but ECGs are required to confirm atrial fibrillation (AF). We sought to determine the frequency of a recurrent irregular heart … BACKGROUND: Wrist-worn wearables can detect irregular heart rhythms using photoplethysmography, but ECGs are required to confirm atrial fibrillation (AF). We sought to determine the frequency of a recurrent irregular heart rhythm detection (IHRD; ≥30 minutes of an irregular rhythm), estimate the potential diagnostic yield of different electrocardiographic monitoring strategies for confirming AF, and identify predictors of recurrent IHRDs. METHODS: The Fitbit Heart Study enrolled wrist-worn photoplethysmography device users without diagnosed AF. Of 455 699 participants, 1057 who wore and returned a 1-week ECG patch monitor after receiving an IHRD were analyzed. Baseline clinical data, device-derived metrics, IHRDs during follow-up, and electrocardiographic patch data were used for analysis. RESULTS: A total of 570 (53.9%) participants were aged 40 to 64 years, 422 (39.9%) were aged ≥65 years, and 510 (48.2%) were female. Median follow-up after ECG patch initiation was 80 days (interquartile range, 45–122 days). The frequency of another IHRD was 57.2% (95% CI, 53.1%–60.9%) at 3 months. After an initial IHRD, the estimated diagnostic yield for AF with a 10-second ECG was 7.6% (95% CI, 6.2%–9.0%), twice-daily 30-second ECGs over 1 week 19.0% (95% CI, 16.7%–21.2%), 24-hour monitor 17.4% (95% CI, 15.5%–19.3%), 1-week monitor 32.2% (95% CI, 29.4%–35.0%), 2-week monitor 46.8% (95% CI, 42.7%–50.8%), and 4-week monitor 60.8% (95% CI, 56.5%–65.1%). The risk of a recurrent IHRD was greater with older age ( P &lt;0.001), male sex ( P =0.001), vascular disease ( P =0.03), longer initial runs of consecutive IHRDs at detection ( P =0.02), and less nightly sleep ( P =0.03). CONCLUSIONS: Irregular heart rhythms are common after initial detection using a wrist-worn wearable device. Longer electrocardiographic monitoring periods increase the likelihood of confirming AF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04380415.

Silent atrial fibrillation and cognitive dysfunction: not so silent after all

2025-06-24
David Conen , Pascal Meyre | Polskie Archiwum Medycyny Wewnętrznej

Comparison of Flow Dynamics After Left Atrial Appendage Occlusion With the Watchman FLX Versus Amulet Devices: Implications for Device‐Related Thrombosis

2025-06-24
Ahmad Bshennaty , Brennan Vogl , Ghasaq Saleh +7 more | Catheterization and Cardiovascular Interventions
ABSTRACT Background This study aims to assess how Watchman FLX (Boston Scientific) and Amplatzer Amulet (Abbott) devices for left atrial appendage occlusion (LAAO) impact the flow dynamics in the LA … ABSTRACT Background This study aims to assess how Watchman FLX (Boston Scientific) and Amplatzer Amulet (Abbott) devices for left atrial appendage occlusion (LAAO) impact the flow dynamics in the LA and the risk of device‐related thrombosis (DRT). Methods Flow simulations were carried out for 12 AF patients before and after undergoing LAAO. Six patients had Watchman FLX while the other six had Amulet devices, of which three in each group had DRT. The flow parameters investigated included the LA velocities, pressure, time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). Low TAWSS and high OSI and RRT are generally associated with flow stasis and thrombosis. Results LA flow dynamics differed significantly between the two groups. On average, after LAAO, the Amulet patients exhibited a 25% increase in TAWSS and 24% decrease in RRT while the Watchman FLX patients exhibited, on average, a 24% decrease in TAWSS and a 23% increase in RRT. Both populations experienced an increase in LA pressure (~10% for Amulet patients and 16% for Watchman FLX patients). Increased DRT volume seems to be correlated with low TAWSS and elevated RRT. Conclusion This preliminary study suggests that the Amulet device might be associated with improved LA flow dynamics and a potentially lower incidence of DRT compared with the Watchman. However, a larger clinical study is needed to confirm these findings.

HOCM: Remission durch Myosin-Inhibiton

2025-06-24
Roland Fath | CardioVasc

ida-TAVId: Neuer Score für präzisere Risikobewertung bei TAVI

2025-06-24
Veronika Schlimpert | CardioVasc

Long-term adherence to flecainide as a rhythm control therapy in recurrent atrial fibrillation – a retrospective cohort study

2025-06-24
Alexander Siotis , Samuel Johansson , Claus Graff +2 more | Scandinavian Cardiovascular Journal
Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. To investigate associations of electro- (ECG) and echocardiographic indices with safety … Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34-3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36-9.75]), DTNP-V1 > 0.1mV (HR 3.78, [1.15-12.4]), LAVI >48 ml/m2 (HR 4.43, [2.02-9.70]), moderate mitral regurgitation (HR 4.40, [1.57-12.4]), and RV-FAC <35% (HR 2.30, [1.03-5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF.

Navigating Complexity: Precision Assessment Paves the Way for Minimal Intervention in Ludwig's Angina

2025-06-24
Sahaja Acharya | International Journal of Oral and Maxillofacial Surgery

Dealing with oral anticoagulants in stroke patients: A narrative review based on current practice guidelines

2025-06-24
Deepak Goel , Priya Singh | Brain Circulation
Abstract: A significant subgroup of stroke patients require oral anticoagulants (OACs) for the prevention of recurrence of thromboembolic events. For a long time, clinicians have been using conventional warfarin as … Abstract: A significant subgroup of stroke patients require oral anticoagulants (OACs) for the prevention of recurrence of thromboembolic events. For a long time, clinicians have been using conventional warfarin as OAC in stroke prevention. However, the discovery of newer OACs that do not require strict monitoring with an international normalized ratio (INR) has resulted in changes in guidelines for stroke prevention. For the last 10 years, there has been a flood of literature on the use of Vitamin K antagonist (VKA) versus non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention. More than 100 meta-analyses, randomized trials, and more than six new guidelines or comparisons of guidelines are available in the medical literature. Hence, we have planned to write a review on this topic to compile all new findings and recommendations. Therefore, now, clinicians have to use currently available knowledge and guidelines for choosing appropriate OAC in stroke settings. The current review is divided into 6 segments: 1) general information and protocol for VKA use; 2) current definition to describe “valvular” versus “non-valvular” AF; 3) to describe current recommendations for uses of VKA and NOACs for recurrent stroke prevention; 4) how to use VKA/NOACs in special populations; 5) perioperative management of patients on OAC; and 6) OAC recommendations for Asian population. This narrative review can help for the better understanding and clear clinical decision making for selection of OAC in stroke patients. Further, it will highlight the gray areas with no clearcut guidance for the selection of OAC.

Iatrogenic laceration of the atrial septum during catheter ablation for atrial fibrillation in a patient with multiple atrial septal defects

2025-06-24
Koji Nakagawa , Yoichi Takaya , Teiji Akagi +3 more | Cardiovascular Intervention and Therapeutics

Artificial intelligence in atrial fibrillation: emerging applications, research directions and ethical considerations

2025-06-24
Ibrahim Antoun , Ahmed Abdelrazik , Mahmoud S. Eldesouky +5 more | Frontiers in Cardiovascular Medicine
Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and a major contributor to stroke and heart failure. Despite progress in management, challenges persist in early detection, risk stratification, and … Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and a major contributor to stroke and heart failure. Despite progress in management, challenges persist in early detection, risk stratification, and personalised treatment. Artificial intelligence (AI), especially machine learning (ML) and deep learning (DL), has emerged as a transformative tool in AF care. This scoping review examines the applications of AI across key domains: detection, risk prediction, treatment optimisation, and remote monitoring. AI-driven models enhance AF detection by analysing ECGs and wearable device data with high accuracy, enabling early identification of asymptomatic cases. By incorporating diverse clinical, imaging, and genomic data, predictive models outperform conventional risk scores in estimating stroke risk and disease progression. In treatment, AI assists in personalised anticoagulation decisions, catheter ablation planning, and optimising antiarrhythmic drug selection. Furthermore, AI-powered remote monitoring integrates wearable-derived insights with real-time decision support, improving patient engagement and adherence. Despite these advances, significant challenges persist, including algorithm transparency, bias, data integration, and regulatory hurdles. Explainable AI (XAI) is crucial to ensure clinician trust and facilitate implementation into clinical workflows. Future research should focus on large-scale validation, multi-modal data integration, and real-world AI deployment in AF management. AI has the potential to revolutionise AF care, shifting from reactive treatment to proactive, personalised management. Addressing current limitations through interdisciplinary collaboration will be key to realising AI's full potential in clinical practice and improving patient outcomes.

Temporary Restoration of Sinus Rhythm Improves Outcomes of Catheter Ablation for Longstanding Persistent Atrial Fibrillation

2025-06-23
Mohamad Raad , Justice Oranefo , Haran Yogasundaram +7 more | Journal of Cardiovascular Electrophysiology
Long-standing persistent atrial fibrillation (LSPAF) is associated with adverse atrial structural and electrical remodeling, limiting the success of catheter ablation (CA). To determine whether temporary restoration of sinus rhythm (TRSR) … Long-standing persistent atrial fibrillation (LSPAF) is associated with adverse atrial structural and electrical remodeling, limiting the success of catheter ablation (CA). To determine whether temporary restoration of sinus rhythm (TRSR) can improve the single procedure efficacy of CA in patients with LSPAF. Patients with LSPAF undergoing their first CA between 2016 and 2022 were included. TRSR was attempted using cardioversion, with or without antiarrhythmic drugs (AAD), no later than 6 months before CA. The ablation strategy included pulmonary vein isolation (PVI), non-PV trigger ablation, and linear lesions for organized atrial tachyarrhythmias (OAT). The primary study outcome was freedom from atrial arrhythmias (AA: AF and/or OAT) on/off AAD at 12 months, and the secondary outcome was freedom from AA off AAD at 12 months. One hundred eighty patients (median age 66 years, 24% female) were included. TRSR was attempted in 67 (37%) patients, and 17 (25%) of these presented in SR at the time of CA. Patients undergoing TRSR had more comorbidities (CHA2DS2-VASc score 3.1 vs. 2.7, p = 0.012) than those who did not. The primary and secondary outcomes were significantly better in the TRSR than the no TRSR group: AA-free survival (73% vs. 51%, p = 0.004) and AA-free survival off AAD (69% vs. 45%, p = 0.002). The primary outcome was better in the TRSR group, whether the presenting rhythm at CA was SR or AF (75% and 72%, respectively). TRSR within 6 months of CA was associated with improved arrhythmia-free survival in LSPAF patients undergoing CA regardless of the presenting rhythm at ablation.

Delivery of Telemedicine to Manage Cardiac Palpitations with Herbal Medicine in a Patient with Premature Ventricular Complexes Following Catheter Ablation for Atrial Fibrillation

2025-06-23
J Y Kim , Hyungsun Jun , Jungtae Leem +3 more | Perspectives on Integrative Medicine
A patient living abroad who underwent catheter ablation for atrial fibrillation 3 years ago experienced recurrent arrhythmia symptoms 3 months ago and was diagnosed with premature ventricular complexes (PVCs) confirmed … A patient living abroad who underwent catheter ablation for atrial fibrillation 3 years ago experienced recurrent arrhythmia symptoms 3 months ago and was diagnosed with premature ventricular complexes (PVCs) confirmed by Holter monitoring. He was advised to undergo repeat catheter ablation, however, he sought traditional Korean medicine (TKM) treatment advised via telemedicine. He reported continuous irregular heartbeats [numeric rating scale (NRS) score 10]. He was started on Yixin Tang, and by the 3rd day of administration his symptoms of irregular heartbeats had disappeared (NRS 0) and did not return during the subsequent 320-day observation period. Pain caused by tightness in the chest and throat (NRS 8) did not show improvement despite various prescriptions; a noncardiac etiology, likely gastrointestinal, was suspected. Heart failure as measured by NT-pro BNP levels, was consistently elevated borderline, around 130 pg/mL, (possible heart failure), and on Day 320 it was normal measuring 50 pg/mL (heart failure less likely). No serious adverse events were reported following TKM treatment. This case suggests the potential value of TKM remote treatment in meeting the unmet needs of arrhythmia patients. Further research, including controlled clinical trials and development of telemedicine-specific guidelines, is warranted.

<i>APOE</i> ε4 and Risk of Intracranial Hemorrhage in Patients With Atrial Fibrillation Taking Apixaban

2025-06-23
Santiago Clocchiatti‐Tuozzo , Cyprien Rivier , Daniela Renedo +7 more | JAMA Neurology
The APOE ε4 variant is causally linked to cerebral amyloid angiopathy and is a risk factor for intracranial hemorrhage (ICH) among warfarin-treated patients with atrial fibrillation. Nevertheless, its impact on … The APOE ε4 variant is causally linked to cerebral amyloid angiopathy and is a risk factor for intracranial hemorrhage (ICH) among warfarin-treated patients with atrial fibrillation. Nevertheless, its impact on those treated with apixaban remains unknown. To test the hypothesis that APOE ε4 allele carriership is associated with an increased risk of ICH in patients with atrial fibrillation taking apixaban. This cohort study involved data from the All of Us Research Program, a longitudinal, population-based study in the United States. Inclusion criteria were age older than 50 years, history of atrial fibrillation, and anticoagulation with apixaban. Participants with a history of ischemic stroke or ICH were excluded. Up to 3 years of follow-up data were available. Data were collected from 2017 to 2022 and analyzed from November 2023 to December 2024. APOE ε2, ε3, and ε4 were ascertained using variants rs429358 and rs7412. APOE ε4 was modeled dichotomously (noncarriers [no alleles] vs carriers [1 or 2 alleles]). Incident ICH, including any new intraparenchymal, subdural, or subarachnoid hemorrhage after initiation of apixaban therapy. Of 413 477 All of Us participants, 2038 were eligible. Their mean (SD) age was 71 (9) years; 918 (45%) were female, 1120 (55%) were male, and 1710 (83%) had European ancestry. Among these participants, 483 (23.7%) were carriers of at least 1 APOE ε4 allele. After a median follow-up of 2.9 years, 26 participants sustained an ICH (cumulative incidence, 1.5%; 95% CI, 1.0%-2.2%), of whom 12 (cumulative incidence, 3.1%; 95% CI, 1.7%-5.3%) were carriers and 14 (cumulative incidence, 1%; 95% CI, 0.6%-1.7%) were noncarriers (P = .007). Multivariable Cox proportional hazard models confirmed this association: compared with noncarriership, APOE ε4 carriership was associated with a 3-fold increase in the risk of ICH (hazard ratio, 3.07; 95% CI, 1.42-6.65). APOE information improved the discrimination of risk prediction scores (C statistic of 0.74 and 0.68 for models with and without APOE, respectively; P = .03). Further research is needed to evaluate whether cerebral amyloid angiopathy mediates the observed association and whether APOE e4 information improves clinical decision-making about anticoagulation therapy in patients with atrial fibrillation. The latter is important now that APOE information is used in clinical settings to guide antiamyloid treatment for Alzheimer disease and has been returned to millions of persons by direct-to-consumer genotyping companies.

Bleeding Events and Correlation with Anti-Xa Levels and Therapeutic Nadroparin Dose in Patients with Impaired Renal Function

2025-06-23
Adam Cox , Monique M. de Maat , Sabine J.G.M. Ahlers +2 more | Seminars in Thrombosis and Hemostasis
Dutch national guidelines for therapeutic treatment with low-molecular-weight heparins (LWMHs) in patients with renal insufficiency recommend dose adjustment based on observed anti-Xa levels. The literature on the relationship between anti-Xa … Dutch national guidelines for therapeutic treatment with low-molecular-weight heparins (LWMHs) in patients with renal insufficiency recommend dose adjustment based on observed anti-Xa levels. The literature on the relationship between anti-Xa levels and clinical outcome in terms of bleeding events is inconsistent. The primary aim of this study was to investigate the incidence and correlation of bleeding events in relation to anti-Xa levels in patients with impaired renal function, using therapeutic nadroparin according to the national guidelines. The secondary objective was to investigate the correlation between the LMWH dose and bleeding events. This was a retrospective study of patients with impaired renal function treated with therapeutic nadroparin for which anti-Xa levels were monitored. Bleeding and thrombotic events were assessed for each patient. This study included 243 patients, of whom 61 (25%) had a bleeding event. There was no correlation between anti-Xa levels and the occurrence of bleeding. Although there was no difference in renal function, weight, or body mass index (BMI) between patients with or without a bleeding event, the median dose of nadroparin was significantly higher (p < 0.005) in patients with a bleeding event. In conclusion, for this study population, there was a high incidence of bleeding. No correlation was found between anti-Xa levels and the occurrence of a bleeding event, with the majority of anti-Xa levels being subtherapeutic. However, a correlation was found between the dose and the occurrence of a bleeding event. Therefore, it is questionable whether the focus on monitoring anti-Xa levels is a justified method to reduce the risk of a bleeding event.

Bleeding risk assessment tools in patients with atrial fibrillation taking anticoagulants: a comparative review and clinical implications

2025-06-23
Chia Siang Kow , Feng Chen , Shawn Leong Kai Jie +5 more | Expert Review of Cardiovascular Therapy
Bleeding risk assessment plays a critical role in anticoagulation management for atrial fibrillation (AF), to balance stroke prevention with risk of major hemorrhage. Traditional bleeding risk models, such as HAS-BLED, … Bleeding risk assessment plays a critical role in anticoagulation management for atrial fibrillation (AF), to balance stroke prevention with risk of major hemorrhage. Traditional bleeding risk models, such as HAS-BLED, ORBIT, and ATRIA, offer valuable insights but have limitations in predictive accuracy and clinical applicability. Recent advances in risk stratification have introduced novel models integrating biomarkers, genetic data, and artificial intelligence (AI)-driven algorithms to improve precision and individualized patient care. This review evaluates strengths and limitations of established bleeding risk assessment tools and explores emerging trends in predictive modeling. It discusses novel risk stratification models- DOAC Score, GARFIELD-AF, and HEMORR₂HAGES, which incorporate renal function markers, hematologic parameters, and genetic polymorphisms to enhance predictive accuracy. Integration of machine learning and digital health tools, such as the Universal Clinician Device (UCD) and the mAFA-II mobile application, was also examined for their role in improving anticoagulation safety and adherence. The future of bleeding risk assessment lies in AI-driven, real-time risk prediction models adapting to dynamic patient profiles. Enhanced integration of digital health solutions and learning health systems will minimize adverse events while optimizing stroke prevention. Future research should prioritize the validation and standardization of these novel tools.

Temporal Trends in the Association Between Female Sex and Ischemic Stroke Among Patients With Atrial Fibrillation

2025-06-23
Mark T Mills , Tommaso Bucci , Peter Calvert +2 more | Journal of the American Heart Association
Female sex has historically been associated with higher risk of ischemic stroke in patients with atrial fibrillation. However, contemporary European studies suggest this association may have attenuated and become nonsignificant … Female sex has historically been associated with higher risk of ischemic stroke in patients with atrial fibrillation. However, contemporary European studies suggest this association may have attenuated and become nonsignificant over recent years. This study aims to characterize temporal trends in cardiovascular outcomes in a large, global cohort of patients with atrial fibrillation. Nonanticoagulated patients with newly diagnosed atrial fibrillation were identified from a global federated research network (TriNetX) between 2000 and 2019. One-year ischemic stroke risk and risk ratios were calculated for women versus men. Secondary outcomes included all-cause death, myocardial infarction, heart failure, and dementia. Cohorts were compared before and after adjustment for age and comorbidities. Overall, 1 204 852 patients were included (44% women). Unadjusted risk of ischemic stroke increased in women (1.75% to 4.24%) and men (1.13% to 3.55%) from 2000-2004 to 2015-2019, while all-cause death decreased over the same periods (women, 10.36% to 7.79%; males, 10.76% to 7.59%). After adjustment, female sex remained independently associated with higher risk of ischemic stroke, although the risk decreased over time (2000-2004: risk ratio, 1.54 [95% CI, 0.94-2.51]; 2015-2019: risk ratio, 1.09 [95% CI, 1.06-1.13]). After adjustment, male sex was associated with risk of all-cause death and myocardial infarction, while risk of dementia and heart failure was similar between sexes. Between 2000 and 2019, the risk of ischemic stroke increased among nonanticoagulated patients with atrial fibrillation. While the association between female sex and ischemic stroke decreased over time, female sex remained associated with a higher stroke risk in 2015 to 2019 after adjustment.

Impact of Additional Left Atrial Lines Beyond Pulmonary Vein Isolation: Analysis of the CABANA Trial

2025-06-23
Matthew W. Segar , Anish Badjatiya , Jordan Gales +3 more | Journal of the American Heart Association

Early Rhythm Control of Atrial Fibrillation in Cancer Survivors: A Nationwide Population‐Based Study

2025-06-23
Seokmoon Han , So‐Ryoung Lee , Eue‐Keun Choi +7 more | Journal of the American Heart Association
Although early rhythm control (ERC) is effective in reducing stroke in patients with atrial fibrillation (AF), its benefits have not been well elucidated in cancer survivors. This study aimed to … Although early rhythm control (ERC) is effective in reducing stroke in patients with atrial fibrillation (AF), its benefits have not been well elucidated in cancer survivors. This study aimed to compare the risk of ischemic stroke between ERC and usual care in cancer survivors with AF. This nationwide observational study was conducted using the Korean National Health Insurance Service database. Patients aged ≥20 years with newly diagnosed AF between 2009 and 2018 were included. Patients who received rhythm control therapy within 1 year of AF diagnosis were defined as the ERC group, while the remaining patients were defined as usual care group. The risk of ischemic stroke in the ERC group was compared with those of the usual care group in cancer survivors (cancer diagnosis ≥5 years) and the noncancer group. A total of 591 692 patients were included in the study (18 747 patients [3.2%] with cancer; mean age, 65.7±14.6 years; 53.7% men). During a mean 4-year follow-up, stroke occurred in 52 500 patients (1338 cancer survivors and 51 182 noncancer survivors). The ERC group showed a lower risk of stroke than the usual care group, regardless of the presence of a cancer history (adjusted hazard ratio, 0.67 [95% CI, 0.58-0.76] in cancer survivors versus 0.76 [95% CI, 0.74-0.78] in the noncancer group). ERC is associated with a lower risk of ischemic stroke among cancer survivors. An integrated approach that incorporates appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.

Type 1 diabetes mellitus patients had lower total vitamin K levels and increased sensitivity to direct anticoagulants

2025-06-23
Alejandro Carazo , Markéta Paclíková , Jaka Fadraersada +7 more | PLoS ONE
The abnormalities in blood coagulation in patients with diabetes can lead to a prothrombotic state and requirement for the administration of direct anticoagulants. However, no comparative studies have been conducted … The abnormalities in blood coagulation in patients with diabetes can lead to a prothrombotic state and requirement for the administration of direct anticoagulants. However, no comparative studies have been conducted on the effects of different direct anticoagulants. A head-to-head investigation of the impact of anticoagulants in 50 patients of type 1 diabetes mellitus (DMT1) was performed, and the data were compared to 50 generally healthy individuals. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured in plasma treated with vehicle, heparin, or four direct anticoagulants at 1 μM. In addition to common biochemical parameters, novel inflammatory markers (neopterin, kynurenine/tryptophan ratio) and major vitamin K forms were measured. Heparin and dabigatran treatments resulted in prolonged coagulation in DMT1 patients compared to healthy individuals in both tests (both p < 0.001). The same phenomenon was observed for rivaroxaban and apixaban-treated samples in PT (p < 0.001). Interestingly, healthy volunteers had higher total vitamin K levels than DMT1. Further analysis suggested that observed coagulation differences were not caused by differences in glycemia but were rather associated with an unexpected, better lipid profile of our DMT1 group. There were also correlations between prolongation of coagulation brought about by the most active anticoagulants and inflammatory markers, and hence inflammatory state probably also contributed to the differences, as well as the mentioned differences in vitamin K levels. Conclusively, this paper suggests the suitability for controlling the effects of direct anticoagulants in DMT1 patients.

Premature ventricular complexes and risk of atrial fibrillation and stroke in patients without structural heart disease

2025-06-23
Robin Bouleau , Natalie Glaser , Martin Jönsson +1 more | Heart
Prior studies have suggested that patients with premature ventricular complexes (PVCs) may have an increased risk for atrial fibrillation (AF) and stroke. It is unclear whether frequent PVCs are linked … Prior studies have suggested that patients with premature ventricular complexes (PVCs) may have an increased risk for atrial fibrillation (AF) and stroke. It is unclear whether frequent PVCs are linked to an increased risk of AF and stroke in patients where structural heart disease (SHD) has been excluded. We aimed to study if PVCs increase the risk of AF or stroke in patients without SHD. In this retrospective observational cohort study, we included patients who received a PVC diagnosis at three major hospitals in Stockholm, Sweden. The patients had no history of heart disease, normal results at stress test and echocardiography, and no previous diagnosis of AF or stroke. For each case, four matched controls were obtained from the general population. We used inverse probability weighting (IPW) to control for differences in baseline characteristics. A total of 751 PVC patients and 3041 controls were included. The median age was 59 years, and 2239 (59%) were women. The median follow-up time was 5.2 years. There was a higher risk of AF among patients in the PVC group compared with the control group in the unadjusted analysis (HR 2.08, 95% CI 1.35 to 3.20, p=0.0009). After IPW, there was no significant difference in the risk of AF (HR 1.44, 95% CI 0.88 to 2.37) or stroke (HR 1.32, 95% CI 0.81 to 2.14) between the PVC group and the control group. In patients with PVCs but without SHD, there was no increased risk of AF or stroke compared with controls from the general population after adjusting for known confounders. However, PVCs were associated with AF in the crude cohort, suggesting that PVCs may be a clinical marker for AF.

Efficacy of Additional Extra Mapping‐Guided Substrate Ablation Beyond Pulmonary Vein Isolation in Persistent Atrial Fibrillation: The Rotate Trial

2025-06-23
Tetsuma Kawaji , Takanori Aizawa , Satoshi Shizuta +7 more | Journal of Cardiovascular Electrophysiology
There are currently no established effective additional substrate ablation strategies beyond pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF). This randomized clinical trial evaluated the efficacy of a novel … There are currently no established effective additional substrate ablation strategies beyond pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF). This randomized clinical trial evaluated the efficacy of a novel substrate ablation technique using the ExTRa Mapping system, which visualizes rotational activation during AF rhythm. This study included 80 patients undergoing initial catheter ablation for persistent AF. Eighty patients whose AF persisted after PVI and ExTRa Mapping were randomly assigned in a 1:1 ratio to either PVI alone or PVI plus ExTRa Mapping-guided substrate ablation targeting areas with high non-passively activated ratio(%NP)( ≥ 35%)(ExTRa group). The primary outcome measure was recurrence of atrial tachyarrhythmias after a 90-day blanking period postablation. Post-PVI ExTRa Mapping assessed a median of 36 sites per patient in both atria. Baseline characteristics were comparable between groups. The ExTRa group showed higher event-free survival from the primary outcome compared to the PVI alone group (85.0% vs. 67.5% at 1-year, p = 0.07). This favorable prognosis was more pronounced for patients with a large( ≥ 12 sites) area of rotational activation area (81.0% vs. 57.9% at 1-year, p = 0.01). Multivariable analysis identified the number of high %NP areas as an independent risk factor for recurrent tachyarrhythmias (HR 1.13, 95%CI 1.03-1.23, p = 0.005), while ExTRa Mapping-guided substrate ablation emerged as a unique protective factor (HR 0.38, 95%CI 0.13-0.99, p = 0.047). While the reduction in atrial tachyarrhythmia recurrence of persistent AF patients did not reach statistical significance, the addition of ExTRa Mapping™-guided substrate ablation beyond PVI demonstrated promising potential, especially in patients with larger rotational activation areas.

Comparison of left atrial appendage occlusion with medical treatment for non-valvular atrial fibrillation: systematic review, network and reconstructed individual patient data meta-analysis

2025-06-23
Tsahi T. Lerman , Roy Hershenson , Noam Greenberg +7 more | Clinical Research in Cardiology

Role of Transesophageal Echocardiography in Guiding and Evaluating Left Atrial Appendage Occlusion in Patients With Non‐Organic Heart Disease

2025-06-23
Xiaoli Long , Xiaohu Guo , Jiwen Xie +4 more | Annals of Noninvasive Electrocardiology
To assess the guiding role of transesophageal echocardiography (TEE) intraoperatively and its evaluative function postoperatively during left atrial appendage occlusion (LAAO) in patients with non-organic heart disease (NOHD). In this … To assess the guiding role of transesophageal echocardiography (TEE) intraoperatively and its evaluative function postoperatively during left atrial appendage occlusion (LAAO) in patients with non-organic heart disease (NOHD). In this retrospective observational study, a total of 48 patients with NOHD who underwent LAAO in the Department of Cardiology at The First People's Hospital of Lanzhou City from April 2020 to September 2022 were recruited. TEE findings during and after the procedure, cardiac chamber size, and cardiac function parameters at different surgical stages, postoperative occlusion efficacy, and complications were recorded. The application value of TEE in LAAO for patients with NOHD was evaluated. Comparative analysis TEE-measured the maximum diameter of the LAAO (22.37 ± 3.86 mm) was significantly smaller than X-ray angiographic measurement (23.45 ± 4.22 mm; p < 0.05). One month after radiofrequency ablation, TTE revealed a statistically significant reduction in left atrial diameter (p < 0.05). Four cases (8%) exhibited minor peri-device leak (< 3 mm), and no major complications occurred. TEE shows significant application value for monitoring anatomical changes, guiding device sizing, and detecting peri-device leaks during and after LAAO for patients with NOHD.

An Evaluation of Four Predictive Scores for New Onset Atrial Fibrillation After Cardiac Surgery in a Tertiary Cardiac Centre

2025-06-23
Shantel Chang , Madeleen van der Merwe , Ammar Zaka +3 more | ANZ Journal of Surgery
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, leading to increased mortality, morbidity, and length of stay. Various predictive indices have been validated to identify patients at … Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, leading to increased mortality, morbidity, and length of stay. Various predictive indices have been validated to identify patients at risk of developing POAF. This study aimed to compare the discriminative ability of four bedside indices that predict POAF in cardiac surgical patients. A total of 2465 consecutive patients who underwent cardiac surgery at an Australian tertiary hospital between 29 December 2015, and 31 December 2022, were retrospectively analysed. Exclusion criteria included pre-existing atrial fibrillation and transcatheter interventions. The area under the receiver-operating characteristic curve (AUC-ROC) analysis and Hosmer-Lemeshow calibration were performed to compare discriminative abilities. A logistic regression model was constructed to evaluate independent risk factors for developing POAF. Older patients (aged > 69) were more likely to develop POAF compared to younger age groups (p < 0.001). The Atrial Fibrillation Risk Index, CHA2DS2-VASC, HATCH and POAF scores had weak discrimination and demonstrated poor predictive ability in this cohort (AUC-ROC 0.49, 0.49, 0.50, 0.52, respectively). Although previously validated in various cohorts, the four bedside predictive indices demonstrated poor discriminative ability and limited generalizability to our tertiary-hospital cohort.

The genomic bases of atrial fibrillation in an Ecuadorian patient: a case report

2025-06-23
Rafael Tamayo‐Trujillo , Patricia Guevara‐Ramírez , Leonel Meza-Chico +6 more | Frontiers in Cardiovascular Medicine
Atrial fibrillation (AF) is one of the most globally prevalent arrhythmias with multifactorial factors, including environmental and genetic predisposition influences. The present case report describes a 30-year-old Ecuadorian mestizo male … Atrial fibrillation (AF) is one of the most globally prevalent arrhythmias with multifactorial factors, including environmental and genetic predisposition influences. The present case report describes a 30-year-old Ecuadorian mestizo male diagnosed with persistent AF with an history of hyperthyroidism, later progressing to hypothyroidism post-radioactive iodine therapy. Genomic test identified variants of uncertain significance in the TTN , MYH11 , and RAF1 genes, which are associated with cardiovascular diseases but not directly linked to AF. The interplay between thyrotoxicosis and genetic predispositions is discussed as a potential mechanism underlying AF development. This report emphasizes the need for genomic screening and personalized strategies in populations like Ecuador with complex genetic and environmental backgrounds.

The Hidden Reservoir: Rethinking Left Atrial Appendage in Stroke

2025-06-23
Noora Saeed , Pushpendra Nath Renjen , Dinesh Mohan Chaudhari +2 more | Apollo Medicine
Background: Once considered a vestigial remnant, the left atrial appendage (LAA) is now understood to play a critical role in cardiac hemodynamics, thrombogenesis, and arrhythmogenesis. Its clinical relevance is particularly … Background: Once considered a vestigial remnant, the left atrial appendage (LAA) is now understood to play a critical role in cardiac hemodynamics, thrombogenesis, and arrhythmogenesis. Its clinical relevance is particularly evident in patients with atrial fibrillation (AF), where it is the predominant site for thrombus formation. Anatomy and Risk Factors: The morphological variants of the LAA—such as chicken wing, cactus, windsock, and cauliflower—have direct implications for stroke risk stratification. The chicken wing morphology is associated with lower stroke risk due to higher flow velocities, while the cauliflower type is more thrombogenic due to its complex structure and reduced flow. Other factors like LAA size, trabeculations, and degree of fibrosis also contribute significantly to thrombosis risk. Diagnostic Advances: Imaging modalities for LAA evaluation have evolved considerably. While transesophageal echocardiography (TEE) remains standard, newer techniques such as cardiac computed tomography (CT) and magnetic resonance imaging (MRI) offer superior sensitivity and specificity in detecting thrombi, while also providing detailed assessment of LAA anatomy and flow dynamics. Management and Treatment Options: Anticoagulation therapy, including warfarin and Direct Oral Anticoagulants (DOACs), remains the mainstay for stroke prevention. However, issues such as bleeding risk and patient noncompliance have led to the development of LAA occlusion strategies. Devices like WATCHMAN and AMULET, as well as surgical options like the AtriClip, are increasingly utilized in patients with contraindications to long-term anticoagulation. Clinical Evidence: Large clinical trials such as ATLAS (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation) and LAAOS III (Left Atrial Appendage Occlusion Study) have demonstrated the efficacy of surgical LAA closure in reducing the risk of thromboembolic events in selected patient populations. Conclusion: The LAA is a dynamic and clinically significant structure with substantial implications in stroke prevention. Its anatomical diversity, enhanced imaging assessment, and evolving therapeutic approaches make it a crucial target in managing patients with atrial fibrillation.

Age‐related variations in patient concerns: A text‐mining analysis of nursing records in catheter ablation cases

2025-06-23
Takahiro Kamihara , Ryo Itoh , Shinji Kaneko +5 more | Geriatrics and gerontology international/Geriatrics & gerontology international
Aim Healthcare workers should empathize with the concerns of patients undergoing invasive treatments, but no studies have analyzed and characterized the language and expressions of these patients. This study utilized … Aim Healthcare workers should empathize with the concerns of patients undergoing invasive treatments, but no studies have analyzed and characterized the language and expressions of these patients. This study utilized text mining to objectively evaluate the words used by patients undergoing catheter ablation. Methods Text mining was done for nursing records from a newly established catheter ablation facility, encompassing 80 379 characters from 34 consecutive patients, and the resulting data was represented visually. Results The study population had an average age of 75 years, and 41.2% were female. Catheter ablation was performed for atrial fibrillation and atrial flutter in 93.9% and 6.1% of cases, respectively. Significant diversity was seen in the subjective descriptions in the nursing records. Notably, in patients aged over 80 years, preoperative records frequently included caregiving‐related terms (e.g., “denture” and “toilet”). Conclusion Text mining of nursing records from patients undergoing catheter ablation revealed that patients' concerns varied significantly by age. Specifically, older patients expressed stronger preoperative and postoperative concerns related to caregiving. This study highlights the importance of providing age‐appropriate nursing care, with objective evidence underscoring the specific needs of older patients. Geriatr Gerontol Int 2025; ••: ••–•• .

Abelacimab Versus Rivaroxaban in Patients With Atrial Fibrillation on Antiplatelet Therapy: A Prespecified Analysis of the AZALEA-TIMI 71 Trial

2025-06-23
Samer Al Said , Siddharth Patel , Robert P. Giugliano +7 more | Circulation
BACKGROUND: Combining antiplatelet therapy (APT) with conventional anticoagulants increases the risk of bleeding. In the AZALEA-TIMI 71 trial (Safety and Tolerability of Abelacimab [MAA868] vs Rivaroxaban in Patients With Atrial … BACKGROUND: Combining antiplatelet therapy (APT) with conventional anticoagulants increases the risk of bleeding. In the AZALEA-TIMI 71 trial (Safety and Tolerability of Abelacimab [MAA868] vs Rivaroxaban in Patients With Atrial Fibrillation), the novel factor XI inhibitor abelacimab significantly reduced the risk of bleeding compared with rivaroxaban in patients with atrial fibrillation. Whether the safety of combination antithrombotic therapy differs in the context of factor XI inhibition has not been well characterized. METHODS: This prespecified analysis of AZALEA-TIMI 71 includes patients randomized between March and December of 2021 to 1 of 2 subcutaneous monthly abelacimab doses (90 or 150 mg) or oral rivaroxaban (20 mg daily, dose reduced to 15 mg in patients with creatinine clearance ≤50 mL/min), stratified by planned use of concomitant APT. The primary composite of major or clinically relevant nonmajor bleeding and other safety and efficacy outcomes were examined by concomitant APT and randomized treatment. RESULTS: Of 1287 patients (44% female; median age, 74 years [interquartile range, 69–78]), 318 (24.7%) were on APT at baseline with planned continuation (15.5% aspirin only, 7.5% P2Y 12 inhibitor only, and 1.6% dual APT). In the rivaroxaban arm, the rate of major or clinically relevant nonmajor bleeding was 10.6% per 100 patient-years with concomitant APT versus 7.7% per 100 patient-years without. In the abelacimab arms, the rates were 2.5% and 3.5% per 100 patient-years for the 90-mg and 150-mg doses, respectively, with concomitant APT and 2.7% and 3.1% per 100 patient-years without. Each abelacimab dose significantly reduced major or clinically relevant nonmajor bleeding compared with rivaroxaban, both in those with concomitant APT (adjusted hazard ratio, 0.26 [95% CI, 0.10–0.70] and hazard ratio, 0.30 [95% CI, 0.12–0.74] for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) and in those without concomitant APT (adjusted hazard ratio, 0.34 [95% CI, 0.19–0.60] and hazard ratio, 0.40 [95% CI, 0.23–0.68] for 90 mg and 150 mg of abelacimab, respectively; P interactions =0.56 and 0.60, respectively). Patients with concomitant APT tended to derive greater absolute risk reductions with abelacimab (8.1% and 7.1% for 90 mg and 150 mg of abelacimab, respectively, versus rivaroxaban) than those without concomitant APT (5.0% and 4.6%, respectively). CONCLUSIONS: Inhibition of factor XI with abelacimab consistently reduced bleeding compared with rivaroxaban regardless of concomitant APT use, with greater absolute reductions in bleeding in those requiring concomitant APT. These data suggest that factor XI inhibition may be a safe anticoagulant option in patients with atrial fibrillation requiring concomitant APT. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04755283.

How to Demonstrate the Underlying Mechanism of Sex Difference in the Incidence of Durable Pulmonary Vein Isolation

2025-06-23
Naoya Kataoka , Teruhiko Imamura | Journal of Cardiovascular Electrophysiology

Reply to Editor: Recurrence of Atrial Fibrillation After Cryoballoon Ablation in Women Is Less Pulmonary Vein Mediated as Compared to Men: Lessons From Repeat Ablation Procedures

2025-06-23
Maxime Tijskens , Yves De Greef | Journal of Cardiovascular Electrophysiology

Efficacy of Dapagliflozin on Recurrence after Catheter Ablation for Atrial Fibrillation: the Statistical Analysis Plan of the DARE-AF Trial

2025-06-22
Zixu Zhao , Ze-Jun Yang , Chi Wang +3 more | medRxiv (Cold Spring Harbor Laboratory)
Background: Atrial fibrillation (AF) recurrence is common in patients after catheter ablation. Previous studies have demonstrated a lower risk of AF recurrence after ablation with the use of sodium-glucose cotransporter … Background: Atrial fibrillation (AF) recurrence is common in patients after catheter ablation. Previous studies have demonstrated a lower risk of AF recurrence after ablation with the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) among patients with diabetes or heart failure. However, the effects of SGLT2i in AF patients after catheter ablation without current indications for SGLT2i were uncertain. Objective: This trial aims to evaluate the effect of dapagliflozin on AF burden after ablation in persistent atrial fibrillation (PeAF) patients. Study Design: Efficacy of DApagliflozin on REcurrence after catheter ablation for Atrial Fibrillation (DARE-AF) is a parallel-group, randomized, open-label randomized controlled trial. We aim to enroll 200 PeAF patients with de novo catheter ablation, and patients with class I indications for SGLT2i (diabetes, heart failure, or chronic kidney disease) are excluded. PeAF patients will be randomized in a 1:1 ratio to intervention or control group. Patients in the intervention group will receive dapagliflozin 10mg once daily for three months. The primary outcome is AF burden accessed by 7-day single-lead electrocardiogram patches at three months after ablation. Conclusions: DARE-AF is the first clinical trial, aiming to evaluate the effect of 3-month treatment with dapagliflozin on AF burden after catheter ablation in PeAF patients without current indications.

Optimal timing for atrial fibrillation patients to undergo catheter ablation

2025-06-22
Mingjie Lin , Huan Liang , Kai Zhang +5 more | Communications Medicine
The optimal timing of undergoing catheter ablation for patients with atrial fibrillation (AF) remains uncertain. We aimed to investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major … The optimal timing of undergoing catheter ablation for patients with atrial fibrillation (AF) remains uncertain. We aimed to investigate the impact of diagnosis-to-ablation time (DAT) on AF recurrence and major adverse cardiovascular and cerebrovascular events (MACCE) following catheter ablation. This study analyzed prospective observational data from a single center, including 2097 participants (59.98 ± 10.57 years, 62.7% male) undergoing AF ablation between January 2016 and December 2020. Patients were stratified by DAT: ≤ 1 year, > 1 to ≤ 3 years, and > 3 years. Cox proportional hazards and logistic regression analyses were used to identify predictors of AF recurrence and MACCE. During the 46.89 ± 16.46 months follow-up, AF recurs in 512 patients (24.6%). A longer delay per month is significantly associated with a higher recurrence of AF based on multivariable Cox regression analysis [Hazard Ratio (HR) 1.003 (95% CI: 1.001-1.005), p = 0.015]. This association remains consistent in patients with persistent AF (HR compared to DAT ≤ 1 year: 1.548 [95% CI: 1.139-2.102], p = 0.016), but not in those with paroxysmal AF. Left atrial diameter ≥40 mm and female are identified as independent predictors of AF recurrence. The overall impact of DAT on MACCE occurrence is not significant, with age and vascular disease being independent predictors. Early catheter ablation is preferable for maintaining sinus rhythm, particularly in persistent AF. However, DAT dose not influence the incidence of MACCE. These findings endorse the paradigm shift towards early ablation.

Clazosentan-related AEs in patients with aSAH

2025-06-21
| Reactions Weekly

Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Valvular Atrial Fibrillation: A Systematic Qualitative Review

2025-06-21
Moiuz Chaudhri , Ahmed D Al Mahrizi , Marc Faltas +7 more | Cureus

Electrocardiographic Alterations in Patients with Cerebrovascular Accidents: A Comprehensive Analysis

2025-06-21
Donaldo Emiliano Silva López , Geraldine Nieves Vázquez , Daniela Espinoza +7 more | International Journal of Medical Science and Clinical Research Studies
Cerebrovascular accidents (CVAs) are frequently associated with a spectrum of electrocardiographic (ECG) abnormalities, which may reflect autonomic dysregulation, structural cardiac involvement, or secondary ischemic injury. This article systematically reviews the … Cerebrovascular accidents (CVAs) are frequently associated with a spectrum of electrocardiographic (ECG) abnormalities, which may reflect autonomic dysregulation, structural cardiac involvement, or secondary ischemic injury. This article systematically reviews the prevalence, characteristics, and underlying mechanisms of ECG changes in CVA patients, with particular emphasis on their diagnostic and prognostic significance. Commonly observed alterations include QT interval prolongation, ST-segment deviations, T-wave inversions, and arrhythmias such as atrial fibrillation and ventricular ectopy. These findings suggest a complex interplay between neurological injury and cardiac function, mediated by neurogenic cardiac injury, catecholamine surge, and systemic inflammatory responses. Furthermore, specific ECG patterns may correlate with the severity and localization of cerebral ischemia, offering potential utility in risk stratification. Understanding these electrocardiographic phenomena is critical for optimizing patient management, distinguishing primary cardiac events from neurogenic changes, and mitigating adverse outcomes in this high-risk population.

Key Insights for DOAC Management in Complex Patients

2025-06-21
Muhammad Zubair | Cardiovascular Drugs and Therapy

Feasibility, Acute Efficacy and Safety of Empirical Superior Vena Cava Isolation in Addition to Pulmonary Vein Isolation Using the Fourth-Generation Cryoballoon: Insights from a Randomized Trial

2025-06-21
Vedran Pašara , Bruno Ban , Ivan Prepolec +5 more | Journal of Clinical Medicine
Background/Objectives: Pulmonary vein isolation (PVI) is the standard treatment for atrial fibrillation (AF), but medium-term success rates remain suboptimal. Non-pulmonary vein triggers, particularly from the superior vena cava (SVC), contribute … Background/Objectives: Pulmonary vein isolation (PVI) is the standard treatment for atrial fibrillation (AF), but medium-term success rates remain suboptimal. Non-pulmonary vein triggers, particularly from the superior vena cava (SVC), contribute to AF recurrence. Empirical SVC isolation (SVCi) in addition to standard PVI may improve outcomes. This study evaluated the acute procedural efficacy and safety of PVI with adjunctive SVCi versus PVI alone in patients with paroxysmal AF (PAF). Methods: In this randomized, controlled, single-center study, 149 patients with PAF were assigned to either standard PVI (n = 74) or PVI with adjunctive empirical SVCi (n = 75) using a fourth-generation CB. Primary endpoints were acute procedural success and the incidence of procedure-related complications, particularly phrenic nerve injury (PNI) and sinus node dysfunction. Results: Acute PVI was achieved in all patients; SVCi was successful in 84.9% of the PVI + SVCi group. Major complication rates were low and comparable between groups (0% vs. 2.6%, p = 0.157). However, the overall complication rate was significantly higher in the PVI + SVCi group (50.6% vs. 6.8%, p &lt; 0.001), driven primarily by transient or impending right PNI (38.6% vs. 6.8%, p &lt; 0.001) and sinus node dysfunction. All PNI events resolved before the end of the procedure. Conclusions: Empirical SVCi using a fourth-generation CB is feasible and generally safe, but carries a higher risk of transient PNI and reversible sinus node dysfunction. Therefore, CB SVCi should be approached with caution. Further studies are needed to evaluate long-term outcomes and assess whether the potential benefits outweigh these procedural risks.

Evaluation of Anticoagulant Use in Post Valvular Heart Surgery in Relation with International Normalised Ratio (INR) and Valve Replaced

2025-06-20
Pawan Soni , Krushna Gopal Panda , Jeffery Joseph +3 more | Indian Journal of Pharmacy Practice

Yeni Nesil Oral Antikoagülan Kullanan İskemik İnme Hastalarında Risk Faktörleri

2025-06-20
Esra Eruyar , Yasemin Atıcı , Ceyla İrkeç | Dicle Medical Journal / Dicle Tip Dergisi
Amaç: Non-valvüler atriyal fibrilasyon (NVAF) iskemik inmenin en yaygın nedenidir. NVAF’ye bağlı inmeden primer korunma tedavisinde varfarin kullanılırken, son zamanlarda yeni nesil oral antikoagülanlar (YOAK) ilk tercih olmaktadır. YOAK kullanan … Amaç: Non-valvüler atriyal fibrilasyon (NVAF) iskemik inmenin en yaygın nedenidir. NVAF’ye bağlı inmeden primer korunma tedavisinde varfarin kullanılırken, son zamanlarda yeni nesil oral antikoagülanlar (YOAK) ilk tercih olmaktadır. YOAK kullanan hastalarda her yıl %1-2 iskemik inme görülmesi nedeniyle riskli hastaların belirlenmesi önemlidir. Bu çalışmada, YOAK kullanırken inme gelişen hastaların klinik özelliklerinin ve riski artıran faktörlerin belirlenmesi amaçlandı. Yöntemler: YOAK kullanırken inme geçiren hastalar ile kontrol grubunun demografik bilgileri, klinik özellikleri, laboratuvar ve radyolojik bulguları retrospektif olarak değerlendirildi. Bulgular: NVAF ilişkili ilk defa inme geçiren 35 hasta dosyasına ulaşıldı. Bu hastaların 13’ü YOAK kullanırken inme geçirmişti, 8’i (%61.5) erkek, 5’i (%39.5) kadın idi. Ortalama yaş 75±11 yıldı. Hastaların başvuru NIHSS’si kontrol grubuna göre yüksekti. TEE’de 3 hastada (%23.1) sol atriyal trombüs tespit edilmişti. Hasta grubunda trigliserit, nötrofil lenfosit oranı (NLO), nötrofil platelet oranı (NPO) ve türetilmiş NLO (dNLO) düzeylerinin kontrol grubuna göre yüksek olduğu bulundu. Sonuç: NVAF nedeniyle YOAK tedavisi alan hastalarda inme geliştiğinde, ilaç başarısızlığına sebep olabilecek sol atriyal trombüs ve konjestif kalp yetmezliği en çok bilinen risk faktörleridir. Bu çalışmada tespit edilen yüksek trigliserit, NLO ve NPO düzeyleri ise riskli hastaları belirlemede diğer önemli parametreler olup daha fazla hasta üzerinde prospektif olarak araştırılmalıdırlar.

The Use of Direct Oral Anticoagulants (DOACs) in the Geriatric Population—How to Overcome the Challenges of Geriatric Syndromes

2025-06-20
Minerva Codruța Bădescu , Diana Popescu , Evelina Maria Gosav +7 more | Journal of Clinical Medicine
Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with … Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights some of the particularities of using direct oral anticoagulants (DOACs) in the geriatric population. We focused on the difficulties of managing DOAC treatment in the presence of geriatric syndromes. We highlighted the practical steps needed to overcome the challenges related to the risk of falling, cognitive impairment, swallowing disorders, and polypragmasy to improve patient care. We provided data to help guide the choice of anticoagulant and dose.

Inflammasome Signaling in Cardiac Arrhythmias: Linking Inflammation, Fibrosis, and Electrical Remodeling

2025-06-20
Paschalis Karakasis , Konstantinos Pamporis , Panagiotis Theofilis +7 more | International Journal of Molecular Sciences
Cardiac arrhythmias, including atrial fibrillation and ventricular arrhythmias, remain the leading causes of morbidity and mortality worldwide. While structural, electrical, and metabolic remodeling have long been recognized as drivers of … Cardiac arrhythmias, including atrial fibrillation and ventricular arrhythmias, remain the leading causes of morbidity and mortality worldwide. While structural, electrical, and metabolic remodeling have long been recognized as drivers of arrhythmogenesis, emerging evidence identifies inflammation—particularly inflammasome signaling—as a central orchestrator of this pathological triad. Among the various inflammasome complexes, the NLRP3 inflammasome has garnered particular attention due to its activation in cardiomyocytes, fibroblasts, and immune cells in diverse clinical contexts. NLRP3 activation precipitates a cascade of downstream events, including interleukin-1β and -18 maturation, oxidative stress amplification, calcium mishandling, and extracellular matrix remodeling, thereby fostering a proarrhythmic substrate. This review synthesizes mechanistic and translational data implicating inflammasome signaling in both atrial and ventricular arrhythmias, with a focus on cellular specificity and electrophysiological sequelae. We explore upstream triggers, such as metabolic stress, gut dysbiosis, and epicardial adipose inflammation, and delineate the downstream impact on cardiac conduction and structural integrity. Emerging therapeutic strategies—including NLRP3 inhibitors, IL-1 antagonists, colchicine, and SGLT2 inhibitors—are critically appraised for their anti-inflammatory and antifibrotic potential. By bridging molecular insights with clinical application, this review underscores the inflammasome as a unifying mechanistic hub in arrhythmia pathogenesis and a promising target for precision-guided therapy.

Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery

2025-06-20
Marina Katerini , Ιωάννα Παπαθανασίου , Lambrini Kourkouta +4 more | Cureus

Atrial Fibrillation in the Emergency Setting: Clinical Approach to Rate Control and Complication Reduction

2025-06-20
A. Barros , Alfredo López , Carlos Henrique da Silva Franco +7 more | Revista de Gestão Social e Ambiental
Objectives: To analyze the main strategies for heart rate control and prevention of complications in patients with atrial fibrillation with rapid ventricular response (AFRVR) in the context of emergency care. … Objectives: To analyze the main strategies for heart rate control and prevention of complications in patients with atrial fibrillation with rapid ventricular response (AFRVR) in the context of emergency care. Theoretical Framework: AFRVR is a common arrhythmia in emergency services, characterized by disorganized atrial electrical activity and elevated ventricular rate, which can cause hemodynamic instability and increase the risk of thromboembolic events. Proper management depends on the patient’s clinical status and prompt intervention. Method: This is an integrative literature review, with searches conducted in the PubMed, SciELO, LILACS, BDENF, and Google Scholar databases. Combined descriptors were used, and inclusion and exclusion criteria were defined, covering publications from 2018 to 2024. Results and Discussion: Studies show that initial treatment depends on the patient’s hemodynamic stability. Beta-blockers and calcium channel blockers are recommended for rate control in stable patients, while electrical cardioversion is indicated in unstable cases. Thromboembolic risk stratification using the CHA₂DS₂-VASc score and early initiation of anticoagulation are essential to prevent complications. Research Implications: The study reinforces the importance of multidisciplinary action, standardized clinical conduct, and adherence to updated clinical guidelines to ensure safety and effectiveness in the treatment of AFRVR in emergency settings. Originality/Value: This review contributes by consolidating evidence-based care practices for the management of atrial fibrillation with rapid ventricular response, standing out as a useful tool for clinical decision-making and improving care quality in critical environments.

Left atrial wall thickness correlates with pulmonary vein reconnection following atrial fibrillation ablation

2025-06-20
Alexander Kushnir , Chirag R. Barbhaiya , Lior Jankelson +7 more | Journal of Interventional Cardiac Electrophysiology

Left atrial appendage occlusion procedure and antithrombotics: less may be enough for lower risk patients: A single-center observational study

2025-06-20
Myung-Rho Kim , Jasmine K. Dugal , Shawn Wang +5 more | Medicine
Antithrombotic therapy following left atrial appendage occlusion (LAAO) is recommended to prevent device-induced thrombosis and stroke. Guidelines suggest oral anticoagulants and aspirin for the first 45 days and then dual … Antithrombotic therapy following left atrial appendage occlusion (LAAO) is recommended to prevent device-induced thrombosis and stroke. Guidelines suggest oral anticoagulants and aspirin for the first 45 days and then dual antiplatelet therapy for 6 months. However, regimens for antithrombotic therapy varies widely. This study aimed to assess the characteristics of patients receiving minimal versus standard antithrombotic therapy post-LAAO, and to examine the association between treatment type and thrombotic/bleeding risk scores. We conducted a retrospective observational study of patients who underwent LAAO at a teaching hospital between April and December 2023. Patients were categorized into minimal (DOAC only) or standard (DOAC plus aspirin) therapy groups during the first 45 days, and into minimal (SAPT) or standard (DAPT) groups from 45 days to 6 months. Outcomes included CHA2DS2-VASc and HAS-BLED scores, comorbidities, and bleeding/thrombotic events. Statistical analyses included univariate and bivariate comparisons using Chi-square, Fisher exact test, and t-tests. Among 33 patients, 82% received minimal therapy and 18% for the standard therapy in the first 45 days. Standard therapy patients had higher rates of transient ischemic attack (50% vs 7.5%), stroke (100% vs 37%), coronary artery disease (100% vs 44.4%), and NSAID use (33.3% vs 3.7%, P < .05). The CHA2DS2-VASc scores were significantly higher in the standard group (6.5 ± 0.5 vs 4.6 ± 1.4, P = .002), with no difference in HAS-BLED scores. From 45 days to 6 months, 15.2% received minimal and 84.8% for the standard therapy, with no significant differences in scores. Patients with lower CHA2DS2-VASc scores were more likely to receive minimal therapy, indicating potential for risk-guided antithrombotic management post-LAAO. Further studies are needed to validate individualized treatment strategies.