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Sample records for atrial fibrillation patients

  1. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A

    2009-01-01

    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care and o...

  2. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial

  3. Increased amount of atrial fibrosis in patients with atrial fibrillation secondary to mitral valve disease

    NARCIS (Netherlands)

    Geuzebroek, Guillaume S. C.; van Amersfoorth, Shirley C. M.; Hoogendijk, Mark G.; Kelder, Johannes C.; van Hemel, Norbert M.; de Bakker, Jacques M. T.; Coronel, Ruben

    2012-01-01

    Objective: Atrial fibrosis is related to atrial fibrillation but may differ in patients with mitral valve disease or lone atrial fibrillation. Therefore, we studied atrial fibrosis in patients with atrial fibrillation + mitral valve disease or with lone atrial fibrillation and compared it with

  4. Atrial fibrillation

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    Objective: Atrial fibrillation is the commonest chronic arrhythmia and the etiology is widely varied. The aim of this study was to determine the etiology, clinical characteristics and treatment offered to adult patients with atrial fibrillation managed in a referral hospital in Port Harcourt, southern Nigeria. Methods:A retrospective ...

  5. Occlusion of left atrial appendage in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    О. Н. Ганеева

    2015-10-01

    Full Text Available The article reviews a new method of prophylaxis of thromboembolitic complications, specifically occlusion of left atrial appendage, in patients with atrial fibrillation. Indications and contraindications for the procedure, as well as a step-by-step process of the intervention itself are described. Special emphasis is placed on the up-to-date evidence and the review of clinical trials.

  6. Atrial Fibrillation

    Science.gov (United States)

    ... A-Z Clinical Trials Publications and Resources Health Education and Awareness The Science Science Home Blood Disorders ... heart's two upper chambers—called the atria (AY-tree-uh)—to fibrillate. The ... a difficult decision concerning surgery for patients with atrial fibrillation, the ...

  7. Management and prognosis of atrial fibrillation in the diabetic patient

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Olesen, Jonas Bjerring

    2015-01-01

    The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation...... and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients........ In the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks...

  8. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...... contains patient level-data from randomized trials of stroke prevention in atrial fibrillation. We used Cox regression models with age as a continuous variable that controlled for sex, year of randomization, and history of cerebrovascular disease, diabetes, hypertension, and congestive heart failure...

  9. Atrial Ectopics Precipitating Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2015-04-01

    Full Text Available Holter monitor tracing showing blocked atrial ectopics and atrial ectopic precipitating atrial fibrillation is being demonstrated. Initially it was coarse atrial fibrillation, which rapidly degenerated into fine atrial fibrillation.

  10. Postoperative atrial fibrillation in patients with left atrial myxoma.

    Science.gov (United States)

    Sahin, Muslum; Tigen, Kursat; Dundar, Cihan; Ozben, Beste; Alici, Gokhan; Demir, Serdar; Kalkan, Mehmet Emin; Ozkan, Birol

    2015-01-01

    The aim of this study was to determine the factors associated with postoperative atrial fibrillation (AF) in patients with left atrial (LA) myxoma. Thirty-six consecutive patients with LA myxoma (10 men, mean age: 49.3 ± 15.7 years), who were operated on between March 2010 and July 2012, were included in this retrospective study. Pre-operative electrocardiograms and echocardiographic examinations of each patient were reviewed. Postoperative AF developed in 10 patients, whereas there was no evidence of paroxysmal AF after resection of the LA myxoma in the remaining 26 patients. The patients who developed AF postoperatively were significantly older than those who did not develop AF (median: 61.5 vs 46 years; p = 0.009). Among the electrocardiographic parameters, only P-wave dispersion differed significantly between postoperative AF and non-AF patients (median: 57.6 vs 39.8 ms, p = 0.004). Logistic regression analysis revealed P- wave dispersion (OR: 1.11, 95% CI: 1.003-1.224, p = 0.043) and age (OR: 1.13, 95% CI: 1.001-1.278, p = 0.048) as independent predictors of postoperative AF in our cohort of patients. P-wave dispersion is a simple and useful parameter for the prediction of postoperative AF in patients with LA myxoma.

  11. [Identification of patients with atrial fibrillation using HRV parameters].

    Science.gov (United States)

    Kikillus, Nicole; Hammer, Gerd; Bolz, Armin

    2008-02-01

    Atrial fibrillation is the most common sustained cardiac rhythm disturbance. One of the most drastic complications is embolism, particularly stroke. Patients with atrial fibrillation have to be identified. This can lead to early therapy and thus avoiding strokes. The algorithm presented here detects atrial fibrillation securely and reliably. It is based on a single-channel ECG, which takes 60 min. First, the R-peaks are detected from the ECG and the RR interval is calculated. To be independent from pulse variations, the RR interval is normalized to 60 bpm. A parameter of heart rate variability is calculated in time domain (SDSD) and the so-called Poincaré plot is generated. The image analysis of the figures of the Poincaré plot is made automatically. The results from analysis in time domain, as well as image analysis, yield a risk level, which indicates the probability for the occurrence of atrial fibrillation. Even if there is no atrial fibrillation in the ECG while analyzing, it is possible to identify patients with atrial fibrillation. The sensitivity depends on the burden of atrial fibrillation. Even if a burden of 0% is assumed, the results still prove satisfactory (sensitivity of nearly 83%).

  12. Dabigatran use in Danish atrial fibrillation patients in 2011

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Gislason, Gunnar; Torp-Pedersen, Christian Tobias

    2013-01-01

    Objective: Dabigatran was recently approved for anticoagulation in patients with atrial fibrillation (AF); data regarding real-world use, comparative effectiveness and safety are sparse. Design: Pharmacoepidemiological cohort study. Methods/settings: From nationwide registers, we identified patie...

  13. Dabigatran versus warfarin in patients with atrial fibrillation

    NARCIS (Netherlands)

    Connolly, Stuart J.; Ezekowitz, Michael D.; Yusuf, Salim; Eikelboom, John; Oldgren, Jonas; Parekh, Amit; Pogue, Janice; Reilly, Paul A.; Themeles, Ellison; Varrone, Jeanne; Wang, Susan; Alings, Marco; Xavier, Denis; Zhu, Jun; Diaz, Rafael; Lewis, Basil S.; Darius, Harald; Diener, Hans-Christoph; Joyner, Campbell D.; Wallentin, Lars; Connolly, S. J.; Ezekowitz, M. D.; Yusuf, S.; Eikelboom, J.; Oldgren, J.; Parekh, A.; Reilly, P. A.; Themeles, E.; Varrone, J.; Wang, S.; Palmcrantz-Graf, E.; Haehl, M.; Wallentin, L.; Alings, A. M. W.; Amerena, J. V.; Avezum, A.; Baumgartner, I.; Brugada, J.; Budaj, A.; Caicedo, V.; Ceremuzynski, L.; Chen, J. H.; Commerford, P. J.; Dans, A. L.; Darius, H.; Di Pasquale, G.; Diaz, R.; Erol, C.; Ferreira, J.; Flaker, G. C.; Flather, M. D.; Franzosi, M. G.; Gamboa, R.; Golitsyn, S. P.; Gonzalez Hermosillo, J. A.; Halon, D.; Heidbuchel, H.; Hohnloser, S. H.; Hori, M.; Huber, K.; Jansky, P.; Kamensky, G.; Keltai, M.; Kim, S.; Lau, C. P.; Le Heuzey, J. Y. F.; Lewis, B. S.; Liu, L. S.; Nanas, J.; Razali, O.; Pais, P. S.; Parkhomenko, A. N.; Pedersen, K. E.; Piegas, L. S.; Raev, D.; Simmers, T. A.; Smith, P. J.; Talajic, M.; Tan, R. S.; Tanomsup, S.; Toivonen, L.; Vinereanu, D.; Xavier, D.; Zhu, J.; Diener, H. C.; Joyner, C. D.; Diehl, A.; Ford, G.; Robinson, M.; Silva, J.; Sleight, P.; Wyse, D. G.; Collier, J.; de Mets, D.; Hirsh, J.; Lesaffre, E.; Ryden, L.; Sandercock, P.; Anastasiou-Nana, M. I.; Andersen, G.; Annex, B. H.; Atra, M.; Bornstein, N. M.; Boysen, G.; Brouwers, P. J. A. M.; Buerke, M.; Burrell, L. M.; Chan, Y. K.; Chen, W. H.; Cheung, R. T. F.; Divakaramenon, S.; Donnan, G. A.; Duray, G. Z.; Dvorakova, H.; Fiedler, J.; Gardinale, E.; Gates, P. C.; Goshev, E. G.; Goto, S.; Gross, B.; Guimaraes, H. P.; Gulkevych, O.; Haberl, R. L.; Hankey, G.; Hartikainen, J.; Healey, J.; Iliesiu, A. M.; Irkin, O.; Jaxa-Chamiec, T.; Jolly, S.; Kaste, K. A. M.; Kies, B.; Kostov, K. D.; Kristensen, K. S.; Labovitz, A. J.; Lassila, R. P. T.; Lee, K. L. F.; Lutay, Y. M.; Magloire, P.; Mak, K. H.; Meijer, A.; Mihov, L.; Morillo, C. A.; Morillo, L. E.; Nair, G. M.; Norrving, B.; Ntalianis, A.; Ntsekhe, M.; Olah, L.; Pasco, P. M. D.; Peeters, A.; Perovic, V.; Petrov, I.; Pizzolato, G.; Rafti, F.; Rey, N. R.; Ribas, S.; Rokoss, M.; Sarembock, I. J.; Sheth, T.; Shuaib, A.; Sitkei, E.; Sorokin, E.; Srámek, M.; Strozynska, E.; Tanne, D.; Thijs, V. N. S.; Tomek, A.; Turazza, F.; Vanhooren, G.; Vizel, S. A.; Vos, J.; Wahlgren, N.; Weachter, R.; Zaborska, B.; Zaborski, J.; Zimlichman, R.; Cong, J.; Fendt, K.; Muldoon, S.; Bajkor, S.; Grinvalds, A.; Malvaso, M.; Pogue, J.; Simek, K.; Yang, S.; Alzogaray, M. F.; Bono, J. O.; Caccavo, A.; Cartasegna, L.; Casali, W. P.; Cuello, J. L.; Cuneo, C. A.; Elizari, M. V.; Fernandez, A. A.; Ferrari, A. E.; Gabito, A. J.; Goicoechea, R. F.; Gorosito, V. M.; Hirschson, A.; Hominal, M. A.; Hrabar, A. D.; Liberman, A.; Mackinnon, I. J.; Manzano, R. D.; Muratore, C. A.; Nemi, S. A.; Rodriguez, M. A.; Sanchez, A. S.; Secchi, J.; Vogel, D. R.; Colquhoun, D. M.; Crimmins, D. S.; Dart, A. M.; Davis, S. M.; Hand, P. J.; Kubler, P. A.; Lehman, R. G.; McBain, G.; Morrison, H. C.; New, G.; Singh, B. B.; Spence, C. Z.; Waites, J. H.; Auer, J.; Doweik, L.; Freihoff, F.; Gaul, G.; Gazo, F.; Geiger, H.; Giacomini, G.; Huber, G. W.; Jukic, I.; Lamm, G.; Niessner, H.; Podczeck, A.; Schuh, J.; Siostrzonek, P.; Steger, C.; Vogel, B.; Watzak, R.; Weber, H. S.; Weihs, W.; Blankoff, I.; Boland, J. L.; Brike, C.; Carlier, M.; Cools, F.; de Meester, A.; de Raedt, H. J.; de Wolf, L.; Dhooghe, G. M.; Dilling-Boer, D.; Elshot, S. R.; Fasseaux, S.; Goethals, M.; Goethals, P.; Gurne, O.; Hellemans, S.; Ivan, B.; Jottrand, M.; Kersschot, I.; Lecoq, E.; Marcovitch, O.; Melon, D.; Miljoen, H.; Missault, L.; Pierard, L. A.; Provenier, F.; Rousseau, M. F.; Stockman, D.; Tran-Ngoc, E.; van Mieghem, W.; Vandekerckhove, Y.; Vandervoort, P.; Verrostte, J.; Vijgen, J.; Armaganijan, D.; Braga, C.; Braga, J. C. F.; Cipullo, R.; Cunha, C. L. P.; de Paola, A.; Delmonaco, M. I.; Guimaraes, F. V.; Herek, L.; Kerr Saraiva, J. F.; Maia, L. N.; Lorga, A. M.; Lorga-Filho, A. M.; Marino, R. L.; Melo, C. S.; Mouco, O. M.; Pereira, V. C.; Precoma, D. B.; Rabelo, W.; Rassi, S.; Rossi, P. R.; Rossi Neto, J. M.; Silva, F. M.; Vidotti, M. H.; Zimmermann, S. L.; Anev, E. D.; Balabanov, T. A.; Baldjiev, E. S.; Bogusheva, E. S.; Chaneva, M. A.; Filibev, I. G.; Gotcheva, N. N.; Goudev, A. R.; Gruev, I. T.; Guenova, D. T.; Kamenova, Z. A.; Manov, E. I.; Panov, I. A.; Parvanova, Z. I.; Pehlivanova, M. B.; Penchev, P. T.; Penkov, N. Y.; Radoslavov, A. L.; Ramshev, K. N.; Runev, N. M.; Sindzhielieva, M. N.; Spirova, D. A.; Tsanova, V. M.; Tzekova, M. L.; Yaramov, G. K.; Aggarwal, R.; Bakbak, A. I.; Bayly, K.; Berlingieri, J. C.; Blackburn, K.; Bobbie, C.; Booth, A. W.; Borts, D.; Bose, S.; Boucher, P.; Brown, K.; Burstein, J. M.; Butt, J. C.; Carlson, B. D.; Chetty, R.; Chiasson, J. D.; Constance, C.; Costi, P.; Coutu, B.; Deneufbourg, I.; Dion, D.; Dorian, P.; Douketis, J. D.; Farukh, S.; Filipchuk, N. G.; Fox, B. A.; Fox, H. I.; Gailey, C. B.; Gauthier, M.; Glanz, A.; Green, M. S.; Habot, J.; Hink, H.; Kearon, C.; Kouz, S.; Lai, C.; Lai, K.; Lalani, A. V.; Lam, A. S.; Lapointe, L. A.; Leather, R. A.; Ma, P. T. S.; MacKay, E.; Mangat, I.; Mansour, S.; Melton, E.; Mitchell, L. B.; Morris, A. L.; Nisker, W. A.; O'Donnell, M. J.; O'Hara, G.; Omichinski, L. M.; Pandey, A. S.; Parkash, R.; Pesant, Y.; Pilon, C.; Pistawka, K. J.; Powell, C. N.; Price, J. B.; Prieur, S.; Rebane, T. M.; Ricci, A. J.; Roberge, J.; Roy, M.; Sapp, J. L.; Savard, D.; Schulman, S.; Sehl, M. J.; Sestier, F.; Shandera, R.; Shu, D.; Sterns, L. D.; St-Hilaire, R.; Syan, G. S.; Talbot, P.; Teitelbaum, I.; Tytus, R. H.; Winkler, L.; Zadra, R.; Zidel, B. S.; Bai, X. J.; Gao, W.; Gao, X.; Guan, D. M.; He, Z. S.; Hua, Q.; Li, H.; Li, L.; Li, W. M.; Lu, G. P.; Lv, S.; Meng, K.; Niu, H. Y.; Qi, D. G.; Qi, S. Y.; Qian, F.; Sun, N. L.; Wang, H. Y.; Wang, N. F.; Yang, Y. M.; Zeng, H.; Zhang, F.; Zhang, F. R.; Zhang, L.; Bohorquez, R.; Rosas, J. F.; Saent, L.; Vacca, M.; Velasco, V. M.; Belohlavek, J.; Cernohous, M.; Choura, M.; Dedek, V.; Filipensky, B.; Hemzsky, L.; Karel, I.; Kopeckova, I.; Kovarova, K.; Labrova, R.; Madr, T.; Poklopova, Z.; Rucka, D.; Simon, J.; Skalicka, H.; Smidova, M.; Spinar, J.; Dodt, K. K.; Egstrup, K.; Friberg, J.; Haar, D.; Husted, S.; Jensen, G. V.; Joensen, A. M.; Klarlund, K. K.; Lind Rasmussen, S.; Melchior, T. M.; Olsen, M. E.; Poulsen, M. K.; Ralfkiaer, N.; Rasmussen, L. H.; Skagen, K.; Airaksinen, K. E.; Huikuri, H. V.; Hussi, E. J.; Kettunen, P.; Mänttäri, M.; Melin, J. H.; Mikkelsson, J.; Peuhkurinen, K.; Virtanen, V. K.; Ylitalo, A.; Agraou, B.; Boucher, L.; Bouvier, J. M.; Boye, A.; Boye, B.; Decoulx, E. M.; Defaye, P.; Delay, M.; Desrues, H.; Gacem, K.; Igigabel, P.; Jacon, P.; Leparree, S.; Magnani, C.; Martelet, M.; Movallem, J.; Olive, T.; Poulard, J. E.; Tiam, B.; Appel, K. F.; Appel, S.; Bansemir, L.; Borggrefe, M.; Brachmann, J.; Bulut-Streich, N.; Busch, K.; Dempfle, C. E. H.; Desaga, M.; Desaga, V.; Dormann, A.; Fechner, I.; Genth-Zotz, S.; Haberbosch, W. G.; Harenberg, J.; Haverkamp, W. L.; Henzgen, R.; Heuer, H.; Horacek, T.; Huttner, H. B.; Janssens, U.; Jantke, H. J.; Klauss, V.; Koudonas, D.; Kreuzer, J.; Kuckuck, H.; Maselli, A.; Müegge, A.; Munzel, T. F.; Nitsche, K.; Nledegjen, A.; Parwani, A.; Pluemer-Schmidt, M.; Pollock, B. W.; Salbach, B. I.; Salbach, P. B.; Schaufele, T.; Schoels, W.; Schwab, S.; Siegmund, U.; Veltkamp, R.; Von Hodenberg, E.; Weber, R.; Zechmeister, M.; Anastasopoulous, A. A.; Foulidis, V. O.; Kaldara, E.; Karamitsos, K.; Karantzis, J.; Kirpizidis, H.; Kokkinakis, C.; Krommydas, A.; Lappas, C.; Lappas, G. I.; Manolis, A.; Manolis, A. S.; Orfanidis, Z.; Papamichalis, M.; Peltekis, L.; Savvas, S.; Skoumpourdis, E. A.; Stakos, D. A.; Styliadis, I.; Triposkiadis, F.; Tsounis, D.; Tziakas, D. N.; Zafiridis, T.; Zarifis, J. H.; Chan, G. C. P.; Chan, W. K.; Chan, W. S.; Lau, C. L.; Tse, H. F.; Tsui, P. T.; Yu, C. M.; Yue, C. S.; Fugedi, K.; Garai, B.; Jánosi, A.; Kadar, A.; Karpati, P.; Keltai, K.; Kosa, I.; Kovacs, I.; Laszlo, Z.; Mezei, L.; Rapi, J.; Regos, L. I.; Szakal, I.; Szigyarto, I.; Toth, K.; Zsa'ry, A.; Agarwal, D. K.; Aggarwal, R. K.; Arulvenkatesh, R.; Bharani, A.; Bhuvaneswaran, J. S.; Byrapaneni, R. B.; Chandwani, P.; Chopra, S.; Desai, N.; Deshpande, V.; Golla, N. P.; Gupta, J. B.; Haridas, K. K.; Hiremath, J.; Jain, A. S.; Jain, M.; Jhala, D. A.; Joseph, J.; Kaila, M.; Kannaiyan, A.; Kumar, S.; Kuruvila, P.; Mahorkar, V. K.; Metha, A.; Naik, A. M.; Narayanan, S.; Panwar, R. B.; Reddy, C.; Sawhney, J. P. S.; Shah, S. M.; Sharma, S.; Shetty, G. S.; Sinha, N.; Sontakke, N. N.; Srinivas, A.; Trivedi, M. R.; Vadagenalli, P. S.; Vijayakumar, M.; Ben-Aharon, Y.; Benhorin, J.; Bogomolny, N.; Botwin-Shimko, S.; Bova, I.; Brenner, B.; Burstein, M.; Butnaru, A.; Caspi, A.; Danenberg, H. D.; Dayan, M.; Eldar, M.; Elian, D.; Elias, M.; Elis, A.; Esanu, G.; Genin, I.; Goldstein, L. H.; Grossman, E.; Hamoud, S.; Hayek, T.; Ilani, N.; Ilia, R.; Klainman, E. I.; Leibowitz, A.; Leibowitz, D.; Levin, I.; Lishner, M.; Lotan, C.; Mahagney, A.; Marmor, A.; Motro, M.; Peres, D.; Plaev, T.; Reisen, L. H.; Rogowski, O.; Schwammenthal, E.; Schwammenthal, Y.; Shechter, M.; Shochat, M.; Shotan, A.; Strasberg, B.; Sucher, E.; Telman, G.; Turgeman, Y.; Tzoran, I.; Weiss, A. T.; Weitsman, T.; Weller, B.; Wexler, D. H.; Wolff, R.; Yarnitsky, D.; Zeltser, D.; Argiolas, G.; Arteni, F.; Barbiero, M.; Bazzucco, R.; Bernardi, D.; Bianconi, L.; Bicego, D.; Brandini, R.; Bresciani, B.; Busoni, F.; Carbonieri, E.; Carini, M.; Catalano, A.; Cavallini, C.; D'Angelo, G.; de Caterina, R.; Di Niro, M.; Filigheddu, F.; Fraticelli, A.; Marconi, R.; Mennuni, M.; Moretti, L.; Mos, L.; Pancaldi, L. G.; Pirelli, S.; Renda, G.; Santini, M.; Tavarozzi, I.; Terrosu, P.; Uneddu, F.; Viccione, M.; Zanini, R.; Zingarini, G.; Aoyagi, T.; Eguma, H.; Fujii, K.; Fukuchi, M.; Fukunami, M.; Furukawa, Y.; Furuya, J.; Haneda, K.; Hara, S.; Hiroe, M.; Iesaka, Y.; Iijima, T.; Ishibashi, Y.; Iwade, K.; Kajiya, T.; Kakinoki, S.; Kamakura, S.; Katayama, Y.; Kihara, Y.; Kimura, K.; Kobayashi, S.; Kono, K.; Koretsune, Y.; Marui, N.; Matsuyama, T.; Meno, H.; Miyamoto, N.; Morikawa, S.; Myojin, K.; Nakamura, T.; Nishi, Y.; Ogawa, T.; Onaka, H.; Sakakibara, T.; Sakurai, S.; Sasaki, Y.; Sato, H.; Sugii, M.; Sumii, K.; Suzuki, S.; Takagi, M.; Takenaka, T.; Takeuchi, K.; Tanaka, S.; Tanouchi, J.; Ueda, K.; Ueyama, Y.; Ujihira, T.; Usui, M.; Yagi, M.; Yamada, T.; Yamamoto, H.; Yokochi, M.; Zen, E.; Abd Ghaphar, A. K.; Ang, C. K.; Chee, K. H.; Fong, A. F. Y.; Ismail, O.; Jeyaindran, S.; Kaur, S.; Lee, T. C.; Sandhu, R. S.; Shah, R. P.; Suganthi, S.; Zainal Abidin, S.; Alvarado-Ruiz, R.; Carrillo, J.; Delgado, E.; Fernandez Bonetti, P. A.; Leiva, J. L.; Meaney, A.; Olvera, R.; Peralta-Heredia, R.; Rodriguez, I.; Ruiz Rabasa, C. M.; Solache, G.; Villeda Espinosa, E.; Ahmed, S.; Badings, E.; Bartels, G. L.; Beganovic, M.; Bruning, T. A.; Ciampricotti, R.; Cozijnsen, L.; Crijns, H. J.; Daniels, M. C. G.; de Waard, D. E. P.; den Hartog, F. R.; Dirkali, A.; Groenemeijer, B. E.; Heesen, W. F.; Heijmeriks, J. A.; Hoogslag, P. A.; Huizenga, A.; Idzerda, H. H.; Kragten, J. A.; Krasznai, K.; Lenderink, T.; Liem, A. H.; Linssen, G. C.; Lok, D. J.; Meeder, J. G.; Michels, H. R.; Plomp, J.; Pos, L.; Posma, J. L.; Postema, P. G.; Salomonsz, R.; Stoel, I.; Tans, J. G.; Thijssen, H. J.; Timmermans, A. J. M.; Tteleman, R. G.; van Bergen, P. F. M. M.; van de Klippe, H. A.; van der Zwaan, C.; van Eck, J. W. M.; van Es, A. J. J.; van Gelder, I. C.; van Kempen, L. H.; van Kesteren, H. A.; van Rossum, P.; Veldmeyer, S.; Wilde, A. A. M.; Arnesen, H.; Atar, D.; Breder, O.; Istad, H.; Radunovic, Z.; Rykke, D. E.; Sirnes, P. A.; Tveit, A.; Ulimoen, S. R.; Cabrera, W.; Duenas, R.; Heredia, J. M.; Horna, M. E.; Hurtado, Y.; Salazar, P. M.; Abola, M. T. B.; Anonuevo, J. C.; Arellano, R. S.; Dioquino, C.; Morales, D. D.; Reyes, E. B.; Rogelio, G. G.; Roxas, A. A.; Sulit, D. J. V.; Bacior, B.; Dulak, E.; Gniot, J.; Goncikowski, J.; Grodecki, J.; Kalarus, Z. F.; Kawecka-Jaszcz, K.; Miekus, P.; Monies, F.; Piepiorka, M.; Pilichowska, E.; Plizio, E.; Rekosz, J.; Rybicka-Musialik, A.; Streb, W. A.; Styczkiewicz, M.; Szpajer, M.; Trusz-Gluza, M.; Wasilewska-Piepiorka, A.; Adragao, P.; Branco, V.; Canhão, P.; Cunha, L.; Falcão, F.; Lopes, G.; Machado, C.; Martinez-Marcos, J.; Monteiro, P. F.; Parreira, L.; Pinto, A. N.; Providencia, L. A.; Salgado, A. V.; Santos, J. F.; Timoteo, A. T.; Capalneanu, R.; Cinteza, M. A.; Margulesai, A. D.; Turdeanu, D. S.; Vintila, V. D.; Baranov, V. L.; Berngardt, E. R.; Dzhordzhikiya, T. R.; Gordeev, I. G.; Grigoryev, Y. V.; Isaeva, M. U.; Ivleva, A. Y.; Kokorin, V. A.; Komarov, A. L.; Maximenko, O. K.; Maykov, E. B.; Novikova, N.; Novikova, T. N.; Panchenko, E. P.; Poltavskaya, M. G.; Popova, Y. N.; Pronina, S. A.; Revishvili, A. Sh; Shlyakhto, E. V.; Shustov, S. B.; Sidorenko, B. A.; Sinopalnikov, A. I.; Sulimov, V.; Syrkin, A. L.; Titkov, A. Y.; Titkov, Y. S.; Zateyshchikov, D. A.; Zavaritskaya, O. P.; Chia, P. L.; Foo, D.; Sim, K. L.; Bugan, V.; Buganova, I.; Dúbrava, J.; Kaliska, G.; Masarovicova, M.; Mikes, P.; Mikes, Z.; Murin, J.; Pella, D.; Rybar, R.; Sedlák, J.; Skamla, M.; Spurný, P.; Strbova, J.; Uhliar, R.; Disler, L. J.; Engelbrecht, J. M.; Jankelow, D.; King, J.; Klug, E. Q.; Munnick, M.; Okreglicki, A. M.; Routier, R. J.; Snyders, F. A.; Theron, H. D.; Wittmer, H.; Cha, T. J.; Cho, J. G.; Choi, I. S.; Choi, J. I.; Choi, K. J.; Han, K. R.; Heo, J. H.; Jang, S. W.; Kang, T. S.; Kim, H. S.; Kim, K. S.; Kim, S. J.; Kim, S. S.; Kim, Y. H.; Kim, Y. N.; Lee, M. H.; Lee, M. Y.; Nam, G. B.; Oh, D. J.; Park, H. W.; Park, J. S.; Rho, T. H.; Shin, D. G.; Shin, E. K.; Alonso, J. J.; Cano, L.; Castellano, N. P.; Criado-Millan, A. J.; Curcio, A.; Egea, P.; Escudier, J. M.; Grande, A.; Grande, J. M.; Gusi-Tragant, G.; Lozano, I. F.; Martin, A. M.; Martinez-Rubio, A.; Mont, L.; Perez-Villacastin, J.; Sosa, L.; Ali, M.; Andersson, T.; Bandh, S.; Blomstrom Lundqvist, C. M.; Cherfan, P.; Fengsrud, E.; Fluur, C.; Herlitz, J.; Hijazi, Z.; Hoglund, N.; Hojeberg, B.; Jabro, J.; Juhlin, T.; Kjellman, B.; Lonnberg, I.; Maru, F.; Morlid, L.; Nilsson, O. R.; Ronn, F.; Rosenqvist, M.; Walfridsson, H.; Engelter, S. T.; Gallino, A.; Lyrer, P. A.; Moccetti, T.; Petrova, I.; Chang, Y. J.; Chen, C. H.; Chen, M. Y. C.; Cheng, J. J.; Chiang, T. R.; Chung, W. T.; Hsia, C. H.; Hsu, C. Y.; Hu, H. H.; Jeng, J. S.; Lai, W. T.; Lien, L. M.; Lin, K. H.; Liu, C. H.; Lo, H. S.; Peng, G. S.; Po, H. L.; Ryu, S. J.; Tsai, C. D.; Tsai, L. M.; Tseng, C. D.; Wang, J. H.; Wang, S. F.; Yang, S. P.; Kiatchoosakun, S.; Krittayaphong, R.; Kuanprasert, S.; Ngarmukos, T.; Simtharakaew, T.; Sukanandachai, B.; Sukonthasam, A.; Suwanagool, A.; Tatsanavivat, P.; Atmaca, Y.; Baris, N.; Boyaci, B.; Demir, M.; Guneri, S.; Usal, A.; Yalcin, R.; Amosova, K. M.; Beregova, O. P.; Besaga, Y. E. M.; Ikorkin, M. R.; Karapetyan, K.; Karpenko, O. I.; Kononenko, L.; Kuryata, O.; Martynova, L.; Motylevska, T.; Okhryamkina, O.; Pavlyk, S. S.; Perepelytsya, M. V.; Rudenko, L. V.; Skarzhevsky, O. A.; Tkachenko, L. A.; Tseluyko, V.; Usan, N.; Voronkov, L. G.; Yshchenko, K. V.; Zharinov, O. J.; Bryson, V. G.; Butler, R.; Cargill, R. I.; Chahal, N. S.; Cleland, J. G.; Cohen, A. T.; Cruddas, E. M.; Davey, P.; Davies, J.; Ford, S. L.; Griffith, K.; Haynes, R.; Hill, S.; Javed, M.; Kadr, H. H.; Lip, G. H.; Machin, J.; McEneaney, D. J.; McInnes, G. T.; McNeill, A. J.; Moriarty, A. J.; Muir, S.; O'Callaghan, J.; Purvis, J. A.; Pye, M.; Senior, R.; Sutton, D. A.; Thomas, S. H. L.; Wilkinson, P. R.; Wilmott, R.; Wrigley, M. J.; Abadier, R.; Abbud, Z. A.; Adams, K. V.; Adler, S. W.; Agarwal, S.; Ahmed, A. M.; Ahmed, I. S.; Aiuto, M. A.; Albrittun, T. D.; Aliyar, P.; Allan, J. J.; Allen, D. P.; Allen, S. L.; Altschuller, A.; Amin, M.; Anand, I. S.; Antolick, A. B.; Arora, R.; Arouni, A. J.; Arslanian, C. L.; Asinger, R. W.; Aycock, G. R.; Bariciano, R. J.; Baron, S. B.; Barr, M. A.; Bartkowiak, A. J.; Baruch, L.; Basignani, C.; Bass, M. L.; Bean, B.; Bedwell, N. W.; Belber, A. D.; Belew, K.; Bell, Y. C.; Bellinger, R. L.; Bennett, W. T.; Bensimhon, D. R.; Benton, R.; Benton, R. E.; Ben-Yehuda, O.; Bertolet, B. D.; Betkowski, A. S.; Bilazarian, S. D.; Bissette, J. K.; Bobade, M. B.; Bolster, D. E.; Bomba, J.; Book, D. M.; Boscia, J. A.; Bouchard, A.; Bowman, L. M.; Bradley, A. J.; Brandt, H. D.; Bricker, C. R.; Brobyn, T. L.; Brock, R. I.; Broderick, T. M.; Broedlin, K.; Brown, A. M.; Browne, K. F.; Burke, S. W.; Burton, M. E.; Buser, G. A.; Capasso, M. K.; Caplan, W. E.; Cappelli, J.; Cardona, C.; Cardona, F.; Carlson, T.; Carr, K. W.; Casey, T.; Cashion, W. R.; Cass, D. T.; Chandrashekar, Y. S.; Changlani, M.; Chapla, P. G.; Chappell, J. H.; Chen, C.; Chen, Y.; Cho, N. R.; Cieszkowski, J. H.; Clark, D. M.; Clayton, R.; Clogston, C. W.; Cockrell, D. J.; Cohen, A. I.; Cohen, T. J.; Cole, J. F.; Conway, G.; Cook, V. R.; Cornish, A. L.; Cossu, S. F.; Costello, D. L.; Courtade, D. J.; Covelli, H. C.; Crenshaw, B. S.; Crews, L. A.; Crossley, G. H.; Culp, S. C.; Curtis, B. M.; Darrow, K.; de Raad, R. E.; DeGregorio, M.; DelNegro, A. A.; Denny, D. M.; Desai, V. S.; Deumite, N. J.; Dewey, L.; Dharawat, R. N.; Dobbs, B.; Donahue, S. M.; Downey, B.; Downing, J.; Drehobl, M. A.; Drewes, W. A.; Drucker, M. N.; Duff, R.; Duggal, M.; Dunlap, S. H.; Dunning, D. W.; DuThinh, V.; Dykstra, G. T.; East, C.; Eblaghie, M. C.; Edelstein, J.; Edmiston, W. A.; Eisen, H. J.; Eisenberg, S. J.; Ellis, J. R.; Ellison, H. S.; Ellsworth, S.; Elshahawy, M.; Emlein, G.; Entcheva, M.; Essandoh, L. K.; Estrada, A. Q.; Ewing, B.; Faillace, R. T.; Fanelli, A.; Farrell, P. W.; Farris, S. W.; Fattal, P. G.; Feigenblum, D. Y.; Feldman, G. J.; Fialkow, J. A.; Fiddler, K. M.; Fields, R. H.; Finkel, M. S.; Finn, C.; Fischell, T. A.; Fishbach, M.; Fishbein, G. J.; Fisher, M. M.; Fleischhauer, F. J.; Folk, T. G.; Folkerth, S. D.; Fortman, R. R.; Frais, M. A.; Friedman, D. C.; Fuchs, G.; Fuller, F.; Garibian, G.; Gee, F. H.; Gelernt, M. D.; Genovely, H. C.; Gerber, J. R.; Germano, J. J.; Giardina, J. J.; Gilbert, J. M.; Gillespie, E. L.; Gilman, E. M.; Gitler, B.; Givens, D. H.; Glover, R.; Gogia, H. S.; Gohn, D. C.; Goldberg, R. K.; Goldberger, J. J.; Goldscher, D. A.; Goldstein, M.; Goraya, T.; Gordon, D. F.; Gottlieb, D.; Grafner, H. L.; Graham, M.; Graves, M. W.; Graziano, M.; Greco, S. N.; Greenberg, M. L.; Greenspon, A. J.; Greer, G. S.; Griffin, D. D.; Grogan, E. W.; Groo, V. L.; Guarnieri, T.; Gupta, A.; Gupta, J.; Hack, T. C.; Hall, B.; Hallak, O.; Halpern, S. W.; Hamburg, C.; Hamroff, G. S.; Han, J.; Handel, F.; Hankins, S. R.; Hanovich, G. D.; Hanrahan, J. A.; Haque, I. U.; Hargrove, J. L.; Harnick, P. E.; Harris, J. L.; Hartley, P. A.; Haskel, E. J.; Hatch, D.; Haught, W. H.; Hearne, S.; Hearne, S. E.; Hemphill, J. A.; Henderson, D. A.; Henes, C. H.; Hengerer-Yates, T.; Hermany, P. R.; Herzog, W. R.; Hickey, K.; Hilton, T. C.; Hockstad, E. S.; Hodnett, P.; Hoffmeister, R.; Holland, J.; Hollenweger, L.; Honan, M. B.; Hoopes, D. A.; Hordes, A. R.; Hotchkiss, D. A.; Howard, M. A.; Howard, V. N.; Hulyalkar, A. R.; Hurst, P.; Hutchison, L. C.; Ingram, J.; Isakov, T.; Ison, R. K.; Israel, C. N.; Jackson, B. K.; Jackson, K. N.; Jacobson, A. K.; Jain, S.; Jarmukli, N. F.; Joffe, I.; Johnson, L. E.; Johnson, S. A.; Johnson, S. L.; Jones, A. A.; Joyce, D. B.; Judson, P. L.; Juk, S. S.; Kaatz, S.; Kaddaha, R. M.; Kaplan, K. J.; Karunaratne, H. B.; Kennett, J. D.; Kenton, D. M.; Kettunen, J. A.; Khan, M. A.; Khant, R. N.; Kirkwood, M. D.; Knight, B. P.; Knight, P. O.; Knutson, T. J.; Kobayashi, J. F.; Kogan, A.; Kogan, A. D.; Koren, M. J.; Kosinski, E. J.; Kosolcharoen, P.; Kostis, J. B.; Kramer, J. H.; Kramer, S. D.; Kron, J.; Kuchenrither, C. R.; Kulback, S. J.; Kumar, A.; Kushner, D.; Kutscher, A.; Lai, C. K.; Lam, J. B.; Landau, C.; Landzberg, J. S.; Lang, D. T.; Lang, J. M.; Lanzarotti, C. J.; Lascewski, D. L.; Lau, T. K.; Lee, J. K.; Lee, S.; Leimbach, W. N.; LePine, A. M.; Lesser, M. F.; Leuchak, S. H.; Levy, R. M.; Lewis, W. R.; Lincoln, T. L.; Lingerfelt, W. M.; Liston, M.; Liu, Z. G.; Lloret, R. L.; Lohrbauer, L.; Longoria, D. C.; Lott, B. M.; Louder, D. R.; Loukinen, K. L.; Lovell, J.; Lue, S.; Mackall, J. A.; Maletz, L.; Marlow, L.; Martin, R. C.; Matsumura, M.; McCartney, M. J.; McDuffie, D.; McGough, M. F.; McGrew, F. A.; McGuinn, Wm P.; McMillen, M. D.; McNeff, J.; McPherson, C. A.; Meengs, M. E.; Meengs, W. L.; Meholick, A. W.; Meisner, J. S.; Melucci, M. B.; Mercando, A.; Merlino, J. D.; Meymandi, S. K.; Miele, M. B.; Miller, R. H.; Miller, S. H.; Minor, S. T.; Mitchell, M. R.; Modi, M.; Mody, F. V.; Moeller, C. L.; Moloney, J. F.; Moran, J. E.; Morcos, N. C.; Morgan, A.; Mukherjee, S. K.; Mullinax, K.; Murphy, A. L.; Mustin, A. J.; Myers, G. I.; Naccarelli, G. V.; Nadar, V. K.; Nallasivan, M.; Navas, J. P.; Niazi, I. K.; Nsah, E. N.; Nunamaker, J. L.; Ochalek, T. B.; O'dea, D. J.; Ogilvie, P. D.; Olliff, B.; Omalley, A. K.; O'Neill, P. G.; Onufer, J. R.; Orchard, R. C.; Orihuela, L. A.; Ortiz, E. C.; O'Sullivan, M. T.; Padanilam, B. J.; Pandey, P.; Patel, D. V.; Patel, R. J.; Patel, V. B.; Patlola, R. R.; Pennock, G. D.; Perlman, R.; Peters, P. H.; Petrillo, A. V.; Pezzella, S.; Phillips, D.; Pierre-Louis, J. R.; Pilcher, G.; Pillai, C.; Pollock, S. G.; Pond, M. S.; Porterfield, J. K.; Presant, L.; Pressler, J.; Pribble, A. H.; Promisloff, S. D.; Pudi, K. K.; Putnam, D. L.; Quartner, J.; Quinn, J. C.; Quinnell, C. M.; Raad, G. L.; Rasmussen, L. A.; Ray, C.; Reiffel, J. A.; Reynertson, S.; Richardson, J. W.; Riley, C. P.; Rippy, J. S.; Rittelmeyer, J. T.; Roberts, D. M.; Robertson, R.; Robinson, V. J. B.; Rocco, T. A.; Rosenbaum, D.; Roth, E. M.; Rottman, J. N.; Rough, R. R.; Rubenstein, J. J.; Sakkal, A. M.; Saleem, T.; Salerno, D. M.; Samendinger, M. L.; Sandeno, S.; Santilli, T. M.; Santucci, P.; Sattar, P.; Saxman, K. A.; Schaefer, S.; Schmidt, J.; Schneider, R. M.; Schocken, D. D.; Schrader, M. K.; Schramm, B. A.; Schultz, R. W.; Schussheim, A. E.; Schwarz, E. F.; Seamon, M. C.; Sestero, J. D.; Shah, M. P.; Shah, R.; Shalaby, A.; Shanes, J. G.; Sheftel, G. L.; Sheikh, K. H.; Shein, A. B.; Shemonsky, N. K.; Shepler, A.; Sheridan, E.; Shipwash, T. M.; Shopnick, R. I.; Short, W. G.; Shoukfeh, M. F.; Sibia, R. S.; Siler, T. M.; Silva, J. A.; Simons, G. R.; Simpson, A. G.; Simpson, H. R.; Simpson, V. J.; Singh, B. N.; Singh, N.; Singh, V. N.; Sitz, C. J.; Skatrud, L.; Sklar, J.; Slotwiner, D. J.; Smith, P. F.; Smith, P. N.; Smith, R. H.; Smith, J. E.; Sodowick, B. C.; Solomon, A. J.; Soltero, E. A.; Sonel, A. F.; Sperling, R.; Spiller, C.; Spink, B. Z.; Sprinkle, L. W.; Spyropoulos, A. C.; Stamos, T. D.; Steljes, A. D.; Stillabower, M. E.; Stover, T.; Strain, J. E.; Strickland, T. L.; Suresh, D. P.; Takata, T. S.; Taylor, J. S.; Taylor, M.; Teague, S. M.; Teixeia, J. M.; Telfer, E. A.; Terry, P. S.; Terry, R. W.; Thai, H. M.; Thalin, M.; Thomas, V. N.; Thompson, C. A.; Thompson, M. A.; Thornton, J. W.; Tidman, R. E.; Toler, B. S.; Traina, M. I.; Trippi, J. A.; Ujiiye, D. L.; Usedom, J. E.; van de Graaff, E.; van de Wall, L. R.; Vaughn, J. W.; Ver Steeg, D.; Vicari, R. M.; Vijay, N.; Vitale, C. B.; Vlastaris, A. G.; Voda, J.; Vora, K. N.; Voyles, W. F.; Vranian, R. B.; Vrooman, P. S.; Waack, P.; Waldo, A. L.; Walker, J. L.; Wallace, M. A.; Walsh, E. A.; Walsh, R. L.; Walton, A.; Washam, M.; Wehner, P. S.; Wei, J. Y.; Weiner, S.; Weiss, R. J.; Wells, D. M.; Wera-Archakul, W.; Wertheimer, J. H.; West, S. A.; Whitaker, J. H.; White, M. L.; White, R. H.; Whitehill, J. N.; Wiegman, P. J.; Wiesel, J.; Williams, J.; Williams, L. E.; Williams, M. L.; Williamson, V. K.; Wilson, V. E.; Wilson, W. W.; Woodfield, S. L.; Wulff, C. W.; Yates, S. W.; Yousuf, K. A.; Zakhary, B. G.; Zambrano, R.; Zimetbaum, P.; Zoble, R.; Zopo, A. R.; Zwerner, P. L.

    2009-01-01

    BACKGROUND: 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. METHODS: In this noninferiority trial, we randomly assigned 18,113 patients who had atrial

  14. [Atrial fibrillation and stroke].

    Science.gov (United States)

    Aamodt, Anne Hege; Sandset, Per Morten; Atar, Dan; Tveit, Arnljot; Russell, David

    2013-08-06

    More than 70,000 Norwegians have atrial fibrillation, which is a major risk factor for ischemic stroke. A large proportion of ischemic strokes caused by atrial fibrillation could be prevented if patients receive optimal prophylactic treatment. This article describes the risk for ischemic stroke in patients with atrial fibrillation, and discusses who should receive prophylactic treatment and which therapy provides the best prevention. The article is based on recently published European, American and Canadian guidelines, a search in PubMed and the authors' own clinical experience. The new risk score CHA2DS2-VASc is better than the CHADS2 score for identifying patients with atrial fibrillation who have a truly low risk of ischemic stroke and are not in need of antithrombotic treatment. Oral anticoagulation therapy is recommended for patients with two or more risk factors for thromboembolism in addition to atrial fibrillation (CHA2DS2-VASc ≥ 2). Patients with atrial fibrillation and a single additional risk factor (CHA2DS2-VASc =1) an individual assessment should be made as to who should receive oral anticoagulants, and for patients with CHA2DS2-VASc = 0 antithrombotic treatment is not recommended. New oral anticoagulants are at least as effective as warfarin for preventing ischemic stroke in patients with nonvalvular atrial fibrillation, they carry a lower risk of cerebral haemorrhage, especially intracranial haemorrhage and are more practical in use. Platelet inhibitors have a minimal role in stroke prevention in patients with atrial fibrillation. Risks stratifying patients using the CHA2DS2-VASc score is a better method for assessing which patients with atrial fibrillation who should receive oral anticoagulation. The introduction of new oral anticoagulants will simplify preventive treatment and hopefully lead to a more efficient anticoagulation treatment in a larger number of patients with atrial fibrillation.

  15. Determinants of Left Atrial Volume in Patients with Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Matthias Bossard

    Full Text Available Left atrial (LA enlargement is an important risk factor for incident stroke and a key determinant for the success of rhythm control strategies in patients with atrial fibrillation (AF. However, factors associated with LA volume in AF patients remain poorly understood.Patients with paroxysmal or persistent AF were enrolled in this study. Real time 3-D echocardiography was performed in all participants and analyzed offline in a standardized manner. We performed stepwise backward linear regression analyses using a broad set of clinical parameters to determine independent correlates for 3-D LA volume.We included 210 patients (70.9% male, mean age 61±11years. Paroxysmal and persistent AF were present in 95 (45% and 115 (55% patients, respectively. Overall, 115 (55% had hypertension, 11 (5% had diabetes, and 18 (9% had ischemic heart disease. Mean indexed LA volume was 36±12ml/m2. In multivariable models, significant associations were found for female sex (β coefficient -10.51 (95% confidence interval (CI -17.85;-3.16, p = 0.0053, undergoing cardioversion (β 11.95 (CI 5.15; 18.74, p = 0.0006, diabetes (β 14.23 (CI 2.36; 26.10, p = 0.019, body surface area (BSA (β 34.21 (CI 19.30; 49.12, p<0.0001, glomerular filtration rate (β -0.21 (CI -0.36; -0.06, p = 0.0064 and plasma levels of NT-pro brain natriuretic peptide (NT-proBNP (β 6.79 (CI 4.05; 9.52, p<0.0001, but not age (p = 0.59 or hypertension (p = 0.42. Our final model explained 52% of the LA volume variability.In patients with AF, the most important correlates with LA volume are sex, BSA, diabetes, renal function and NT-proBNP, but not age or hypertension. These results may help to refine rhythm control strategies in AF patients.

  16. Apixaban versus warfarin in patients with atrial fibrillation

    NARCIS (Netherlands)

    Granger, C.B.; Alexander, J.H.; McMurray, J.J.; Lopes, R.D.; Hylek, E.M.; Hanna, M.; Al-Khalidi, H.R.; Ansell, J.; Atar, D.; Avezum, A.; Bahit, M.C.; Diaz, R.; Easton, J.D.; Ezekowitz, J.A.; Flaker, G.; Garcia, D.; Geraldes, M.; Gersh, B.J.; Golitsyn, S.; Goto, S.; Hermosillo, A.G.; Hohnloser, S.H.; Horowitz, J.; Mohan, P.; Jansky, P.; Lewis, B.S.; Lopez-Sendon, J.L.; Pais, P.; Parkhomenko, A.; Verheugt, F.W.A.; Zhu, J.; Wallentin, L.

    2011-01-01

    BACKGROUND: 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.

  17. Postoperative atrial fibrillation in patients on statins undergoing ...

    African Journals Online (AJOL)

    Conclusion: Although this meta-analysis suggests that chronic statin therapy did not prevent postoperative AF in unselected valvular heart surgical patients, the heterogeneity indicates that this outcome should be viewed with caution and further research is recommended. Keywords: atrial fibrillation, cardiac surgery, statins ...

  18. Edoxaban versus Warfarin in Patients with Atrial Fibrillation

    NARCIS (Netherlands)

    Giugliano, Robert P.; Ruff, Christian T.; Braunwald, Eugene; Murphy, Sabina A.; Wiviott, Stephen D.; Halperin, Jonathan L.; Waldo, Albert L.; Ezekowitz, Michael D.; Weitz, Jeffrey I.; Špinar, Jindřich; Ruzyllo, Witold; Ruda, Mikhail; Koretsune, Yukihiro; Betcher, Joshua; Shi, Minggao; Grip, Laura T.; Patel, Shirali P.; Patel, Indravadan; Hanyok, James J.; Mercuri, Michele; Antman, Elliott M.; Braunwald, E.; Antman, E. M.; Giugliano, R. P.; Ruff, C. T.; Morin, S. E.; Hoffman, E. B.; Murphy, S. A.; Deenadayalu, N.; Grip, L.; Mercuri, M.; Lanz, H.; Patel, I.; Curt, V.; Duggal, A.; Hanyok, J.; Davé, J.; Morgan, D.; Choi, Y.; Shi, M.; Jin, J.; Xie, J.; Crerand, W.; Kappelhof, J.; Maxwell, W.; Skinner, M.; Patel, S.; Betcher, J.; Selicato, G.; Otto, C.; Reissner, C.; Smith, K.; Ostroske, J.; Ron, A.; Connolly, S.; Camm, J.; Ezekowitz, M.; Halperin, J.; Waldo, A.; Paolasso, E.; Aylward, P.; Heidbuchel, H.; Nicolau, J. C.; Goudev, A.; Roy, D.; Weitz, J.; Corbalán, R.; Yang, Y.; Botero, R.; Bergovec, M.; Ŝpinar, J.; Grande, P.; Hassager, C.; Voitk, J.; Huikuri, H.; Nieminen, M.; Blanc, J. J.; LeHeuzey, J. Y.; Mitrovic, V.; Alexopoulos, D.; Sotomora, G.; Kiss, R.; SomaRaju, B.; Lewis, B.; Merlini, P.; Metra, M.; Koretsune, Y.; Yamashita, T.; García-Castillo, A.; Oude Ophuis, T.; White, H.; Atar, D.; Horna, M.; Babilonia, N.; Ruzyllo, W.; Morais, J.; Dorobantu, M.; Ruda, M.; Ostojic, M.; Duris, T.; Dalby, A.; Chung, N.; Zamorano, J. L.; Juul-Möller, S.; Moccetti, T.; Chen, S. A.; Sritara, P.; Oto, A.; Parkhomenko, A.; Senior, R.; Verheugt, F.; Skene, A.; Anderson, J.; Bauer, K.; Easton, J. D.; Goto, S.; Wiviott, S.; Lowe, C.; Awtry, E.; Berger, C. J.; Croce, K.; Desai, A.; Gelfand, E.; Goessling, W.; Greenberger, N. J.; Ho, C.; Leeman, D. E.; Link, M. S.; Norden, A. D.; Pande, A.; Rost, N.; Ruberg, F.; Silverman, S.; Singhal, A.; Vita, J. A.; Vogelmann, O.; Gonzalez, C.; Ahuad Guerrero, R.; Rodriguez, M.; Albisu, J.; Rosales, E.; Allall, O.; Reguero, M.; Alvarez, C.; Garcia, M.; Ameriso, S.; Ameriso, P.; Amuchastegui, M.; Caceres, M.; Beloscar, J.; Petrucci, J.; Berli, M.; Budassi, N.; Valle, M.; Bustamante Labarta, G.; Saravia, M.; Caccavo, A.; Fracaro, V.; Cartasegna, L.; Novas, V.; Caruso, O.; Zarandon, R. Saa; Colombo, H.; Morandini, M.; Cuello, J.; Rosell, M.; Cuneo, C.; Bocanera, M.; D'Amico, A.; Cendali, G.; Dran, R.; Moreno, V.; Estol, C.; Davolos, M.; Facello, A.; Facello, M.; Falu, E.; Iriarte, M.; Femenia, F.; Arrieta, M.; Fuselli, J.; Zanotti, A.; Gant Lopez, J.; Meiller, F.; Garcia Duran, R.; Perlo, D.; Garrido, M.; Ceirano, C.; Giacomi, G.; Eden, M.; Giannaula, R.; Huerta, M.; Goicoechea, R.; von Wulffen, M.; Hominal, M.; Bianchini, M.; Jure, H.; Jure, D.; Kevorkian, R.; Monaco, F.; Lanternier, G.; Belcuore, M.; Liniado, G.; Iglesias, M.; Litvak, B.; Nigro, A.; Llanos, J.; Vignau, S.; Lorente, C.; Shatsky, K.; Lotti, J.; Raimondi, G.; Mackinnon, I.; Carne, M.; Manuale, O.; Calderon, M.; Marino, J.; Funes, I.; Muntaner, J.; Gandur, H.; Nul, D.; Verdini, E.; Piskorz, D.; Tommasi, A.; Povedano, G.; Casares, E.; Pozzer, D.; Fernandez, E.; Prado, A.; Venturini, C.; Ramos, H.; Navarrete, S.; Alvarez, M.; Sanchez, A.; Bowen, L.; Sanjurjo, M.; Codutti, O.; Saravia Toledo, S.; Formoso, I.; Schmidberg, J.; Goloboulicz, A.; Schygiel, P.; Buzzetti, C.; Severino, P.; Morara, P.; Sosa Liprandi, M.; Teves, M.; Vico, M.; Morell, Y.; Anderson, C.; Paraskevaidis, T.; Arstall, M.; Hoffmann, B.; Colquhoun, D.; Price-Smith, S.; Crimmins, D.; Slattery, A.; Dart, A.; Kay, S.; Davis, S.; Silver, G.; Flecknoe-Brown, S.; Roberts, J.; Gates, P.; Jones, S.; Lehman, R.; Morrison, H.; McKeirnan, M.; Li, J.; Paul, V.; Batta, C.; Purnell, P.; Perrett, L.; Szto, G.; O'Shea, V.; Capiau, L.; Banaeian, F.; de Bleecker, J.; de Koning, K.; de Tollenaere, M.; de Bruyne, L.; Desfontaines, P.; Tincani, G.; Meeusen, K.; Herzet, J.; Malmendier, D.; Mairesse, G.; Raepers, M.; Parqué, J.; Clinckemaille, N.; Scavée, C.; Huyberechts, D.; Stockman, D.; Jacobs, C.; Vandekerckhove, Y.; Derycker, K.; Vanwelden, J.; van Welden, J.; Vervoort, G.; Mestdagh, I.; Vrolix, M.; Beerts, C.; Wollaert, B.; Denie, D.; Amato Vincenzo de Paola, A.; Coutinho, E.; Andrade Lotufo, P.; de Melo, R. Ferreira; Atie, J.; Motta, C.; Augusto Alves da Costa, F.; Ferraz, R. Franchin; Bertolim Precoma, D.; Sehnem, E.; Botelho, R.; Cunha, S.; Brondani, R.; Fleck, N.; Chaves Junior, H.; Silva, J.; Costantini, C.; Barroso, D.; de Patta, M.; Pereira, V.; Duda, N.; Laimer, R.; Dutra, O.; Morgado, S.; Faustino Saporito, W.; Seroqui, M.; Ferreira, L.; Araújo, E.; Finimundi, H.; Daitz, C.; Gagliardi, R.; Pereira, G.; Gomes, M.; Gomes, A.; Guimarães, A.; Ninho, L.; Jaeger, C.; Pereira, L.; Jorge, J.; Cury, C.; Kaiser, S.; Almeida, A.; Kalil, C.; Radaelli, G.; Kunz Sebba Barroso de Souza, W.; Morales, K.; Leaes, P.; Luiz, R. Osorio; Pimenta Almeida, J.; Gozalo, A.; Reis, G.; Avellar, K.; Reis Katz Weiand, L.; Leipelt, J.; Rocha, J.; Barros, R.; Rodrigues, L.; Rocha, M. Rubia; Rodrigues, A.; Rodrigues, D.; Rossi dos Santos, F.; Pagnan, L. Goncalves; Sampaio, R.; do Val, R.; Saraiva, J.; Vicente, C.; Simoes, M.; Carraro, A.; Sobral Filho, D.; Lustosa, E.; Villas Boas, F.; Almeida, M.; Zimmermann, S.; Zimmermann, E. Bürger; Chompalova, B.; Parishev, G.; Denchev, S.; Milcheva, N.; Donova, T.; Gergova, V.; Georgiev, B.; Kostova, E.; Kinova, E.; Hergeldjieva, V.; Kamenova, P.; Manolova, A.; Vasilev, I.; Mihov, A.; Miteva, B.; Mincheva, V.; Stoyanovski, V.; Nikolov, F.; Vasilev, D.; Pencheva, G.; Kostov, K.; Petranov, S.; Milusheva, T.; Popov, A.; Staneva, A.; Momchilova-Lozeva, D.; Todorov, G.; Nyagina, M.; Tumbev, H.; Tumbeva, D.; Tzekova, M.; Kitova, M.; Manoylov, E.; Archibald, J.; Antle, S.; Bhargava, R.; Stafford, C.; Bose, S.; Hundseth, M.; Cha, J.; Otis, J.; Chehayeb, R.; Lepage, C.; Chilvers, M.; Vansickle, L.; Cleveland, D.; Valley, S.; Constance, C.; Gauthier, M.; Costi, P.; Masson, C.; Coutu, B.; Denis, I.; Du Preez, M.; Kubanska, A.; Dufresne, M.; Krider, J.; Eikelboom, J.; Zondag, M.; Fortin, C.; Viau, C.; Green, M.; Houbraken, D.; Hatheway, R.; Mabee, J.; Heath, J.; Scott, L.; Ho, K.; Ho, V.; Hoag, G.; Standring, R.; Huynh, T.; Perkins, L.; Kouz, S.; Roy, M.; Labonte, R.; Dewar, C.; Lainesse, A.; St-Germain, L.; Lam, S.; Lam, H.; Lichtenstein, T.; Roberts, P.; Luton, R.; Douglas, S.; Ma, P.; Seib, M.; MacCallum, C.; Matthews, J.; Malette, P.; Vaillancourt, T.; Maranda, C.; Studenikow, E.; Mawji, A.; Morely, A.; Morrison, D.; Roth, M.; Mucha, M.; Najarali, A.; Lamoureux, U.; Nicholson, R.; O'Hara, G.; Banville, P.; O'Mahony, W.; Bolton, R.; Parkash, R.; Carroll, L.; Pesant, Y.; Sardin, V.; Polasek, P.; Turri, L.; Qureshi, A.; Nethercott, C.; Ricci, J.; Bozek, B.; Rupka, D.; Marchand, C.; Shu, D.; Silverio, G.; St-Hilaire, R.; Morissette, A.; Sussman, J.; Kailey, P.; Syan, G.; Bobbie, C.; Talajic, M.; David, D.; Talbot, P.; Tremblay, M.; Teitelbaum, I.; Teitelbaum, J.; Velthuysen, G.; Giesbrecht, L.; Wahby, R.; Morley, A.; Wharton, S.; Caterini, T.; Woodford, T.; Balboa, W.; Matus, L. Retamal; Bugueño, C.; Mondaca, P. Mondaca; Cobos, J.; Obreque, C.; Corbalan, R.; Parada, A.; Florenzano, F.; Diaz, P. Arratia; Lopetegui, M.; Rebolledo, C.; Manriquez, L.; Silva, L. Manríquez; Martinez, D.; Llamas, R. Romero; Opazo, M.; Pérez, M. Carmona; Pincetti, C.; Carrasco, G. Torres; Potthoff, S.; Staub, J. Zapata; Campisto, Y.; Stockins, B.; Lara, C. Lara; Yovaniniz, P.; Azua, M. Grandon; Bai, F.; Xu, G. L.; Chen, J. Z.; Xie, X. D.; Chen, X. P.; Zhang, X.; Dong, Y. G.; Feng, C.; Fu, G. S.; Zhang, P.; Hong, K.; You, Z. G.; Hong, L.; Qiu, Y.; Jiang, X. J.; Qu, Z.; Li, L.; Liu, H.; Li, T. F.; Kong, Y. Q.; Li, W. M.; Liu, B.; Li, Z. Q.; Liu, Y.; Liao, D. N.; Gu, X. J.; Liu, L.; Lu, Z. H.; Ma, S. M.; Yang, Z. Y.; Wang, D. M.; Qi, S. Y.; Wang, G. P.; Shi, X. J.; Wei, M.; Huang, D.; Wu, S. L.; Li, Y. E.; Xu, J. H.; Gu, J. Y.; Xu, Y. M.; Liang, Y. Z.; Yang, K.; Li, A. Y.; Yang, Y. J.; Zheng, X.; Zheng, Y.; Gao, M.; Yin, Y. H.; Xu, Y. P.; Yu, B.; Li, L. L.; Yuan, Z. Y.; Qiang, H.; Zhang, H. Q.; Lin, Y. N.; Zhang, Z.; Kang, H.; Zhao, R. P.; Han, R. J.; Zhao, X. L.; Wang, J. Q.; Zheng, Z. Q.; Li, B. G.; Zhou, S. X.; Zhang, Y. L.; Accini, J.; Accini, M.; Cano, N.; Pineda, L. León; Delgado Restrepo, J.; Arroyave, C.; Fernández Ruiz, R.; Diaz, I. Aldana; Hernandez, H.; Delgado, P.; Jaramillo Muñoz, C.; Builes, A.; Manzur, F.; Rodriguez, E. Rivera; Moncada Corredor, M.; Giraldo, D. Lopez; Orozco Linares, L.; Fonseca, J.; Quintero, A.; Gonzales, C.; Sanchez Vallejo, G.; Mejia, I. Perdomo; Bagatin, J.; Carevic, V.; Car, S.; Jeric, M.; Ciglenecki, N.; Tusek, S.; Ferri Certic, J.; Romic, I.; Francetic, I.; Ausperger, K. Makar; Jelic, V.; Jurinjak, S. Jaksic; Knezevic, A.; Buksa, B.; Samardzic, P.; Lukenda, K. Cvitkusic; Steiner, R.; Kirner, D.; Sutalo, K.; Bakliza, Z.; Vrazic, H.; Lucijanic, T.; Bar, M.; Brodova, P.; Berka, L.; Kunkelova, V.; Brtko, M.; Burianova, H.; Cermak, O.; Elbl, L.; Ferkl, R.; Florian, J.; Francek, L.; Golan, L.; Gregor, P.; Honkova, M.; Hubac, J.; Jandik, J.; Jarkovsky, P.; Jelinek, Z.; Jerabek, O.; Jirmar, R.; Kobza, R.; Kochrt, M.; Kostkova, G.; Kosek, Z.; Kovar, P.; Kuchar, R.; Kvasnicka, J.; Ludka, O.; Machova, V.; Krocova, E.; Melichar, M.; Nechanicky, R.; Olsr, J.; Peterka, K.; Petrova, I.; Havlova, I.; Pisova, J.; Podrazil, P.; Jirsova, E.; Reichert, P.; Slaby, J.; Spacek, R.; Spinar, J.; Labrova, R.; Vodnansky, P.; Samkova, D.; Zidkova, E.; Dodt, K.; Christensen, H.; Christensen, L.; Loof, A.; Ibsen, H.; Madsen, H.; Iversen, H.; Veng-Olsen, T.; Nielsen, H.; Olsen, R.; Overgaard, K.; Petrovic, V.; Raymond, I.; Raae, D.; Sand, N.; Svenningsen, A.; Torp-Pedersen, C.; Jakobsen, U.; Wiggers, H.; Serup-Hansen, K.; Kaik, J.; Stern, A.; Kolk, R.; Laane, E.; Rivis, L.; Paumets, M.; Laheäär, M.; Rosenthal, A.; Rajasalu, R.; Vahula, V.; Ratnik, E.; Kaarleenkaski, S.; Hussi, E.; Valpas, S.; Jäkälä, P.; Lappalainen, T.; Mäenpää, A.; Viitaniemi, J.; Nyman, K.; Sankari, T.; Rasi, H.; Salminen, O.; Virtanen, V.; Nappila, H.; Le Heuzey, J.; Agraou, B.; El Jarroudi, F.; Amarenco, P.; Boursin, P.; Babuty, D.; Boyer, M.; Belhassane, A.; Berbari, H.; Blanc, J.; Dias, P.; Coisne, D.; Berger, N.; Decoulx, E.; El Jarroudi, M.; Dinanian, S.; Arfaoui, M.; Hermida, J.; Deruche, E.; Kacet, S.; Corbut, S.; Poulard, J.; Leparree, S.; Roudaut, R.; Duprat, C.; Al-Zoebi, A.; Wurow, A.; Bernhardt, P.; Dichristin, U.; Berrouschot, J.; Vierbeck, S.; Beyer-Westendorf, J.; Sehr, B.; Bouzo, M.; Schnelzer, P.; Braun, R.; Ladenburger, K.; Buhr, M.; Weihrauch, D.; Contzen, C.; Kara, M.; Daut, W.; Ayasse, D.; Degtyareva, E.; Kranz, P.; Drescher, T.; Herfurth, B.; Faghih, M.; Forck-Boedeker, K.; Schneider, K.; Fuchs, R.; Manuela, W.; Grigat, C.; Otto, A.; Hartmann, A.; Peitz, M.; Heuer, H.; Dieckheuer, U.; Hoffmann, U.; Dorn, S.; Hoffmann, S.; Schuppe, M.; Horacek, T.; Fink, P.; Junggeburth, J.; Schmid, S.; Jungmair, W.; Schoen, B.; Kleinecke-Pohl, U.; Meusel, P.; Koenig, H.; Bauch, F.; Lohrbaecher-Kozak, I.; Grosse, B.; Lueders, S.; Venneklaas, U.; Luttermann, M.; Wulf, M.; Maus, O.; Hoefer, K.; Meissner, G.; Braemer, U.; Meyer-Pannwitt, U.; Frahm, E.; Vogt, S.; Muegge, A.; Barbera, S.; Mueller-Glamann, M.; Raddatz, K.; Piechatzek, R.; Lewinsky, D.; Pohl, W.; Proskynitopoulos, N.; Kuhlmann, M.; Rack, K.; Pilipenko, H.; Rinke, A.; Kühlenborg, A.; Schaefer, A.; Szymanowski, N.; Schellong, S.; Frommhold, R.; Schenkenberger, I.; Finsterbusch, T.; Dreykluft, K.; Schiewe, C.; Schmidt, A.; Schmidt, M.; Schreckenberg, A.; Hellmers, J.; Seibert, H.; Gold, G.; Sohn, H.; Baylacher, M.; Spitzer, S.; Bonin, K.; Stoehring, R.; Taggeselle, J.; Zarpentin, C.; Veltkamp, R.; Ludwig, I.; Voehringer, N. N.; Buchholz, M.; Weyland, K.; Winkelmann, B.; Buelow-Johansen, B.; Wolde, C.; Winter, K.; Mavronasiou, E.; Bourlios, P.; Tziortziotis, A.; Karamitsos, C.; Exarchou, E.; Kifnidis, K.; Daskalaki, A.; Moschos, N.; Dimitra, K.; Olympios, C.; Kartsagkoulis, E.; Pyrgakis, V.; Korantanis, K.; Ayau Milla, O.; Ramirez, V. de Leon; Guzman Melgar, I.; Jimenez, T.; Ovando Lavagnino, A.; Guevara, S.; Rodas Estrada, M.; Sanchez, M.; Pozuelos, J. Mayen; Sanchez Samayoa, C.; Guerra, L.; Velasquez Camas, L.; Almaraz, S. Padilla; Dioszeghy, P.; Muskoczki, E.; Edes, I.; Szatmari, J.; Fiok, J.; Varga, A.; Kanakaridisz, N.; Kosztyu, M.; Kis, E.; Feil, J. Felfoldine; Jakal, A.; Koczka, M.; Kovacs, I.; Baranyai, M.; Kovacs, Z.; Lupkovics, G.; Karakai, H. Horvathne; Matoltsy, A.; Kiss, T.; Medvegy, M.; Kiss, K.; Merkely, B.; Kolumban, E.; Nagy, A.; Palinkas, A.; Toth, S. Rostasne; Sayour, A.; Bognar, A.; Simor, T.; Ruzsa, D.; Sipos, T.; Szakal, I.; Tomcsanyi, J.; Marosi, A.; Vertes, A.; Kincses, M.; Malhan, S.; Abdullakutty, J.; Agarwal, D.; Ranka, R.; Arneja, J.; Memon, A.; Arora, V.; Shree, R.; Avvaru, G.; Shaikh, A.; Babu, P.; Rao, B.; Babu, R.; Reddy, J.; Banker, D.; Sheth, T.; Benjarge, P.; Surushe, S.; Bharani, A.; Solanki, R.; Bhargava, V.; Rathi, A.; Biniwale, A.; Bhuti, M.; Calambur, N.; Karnwal, N.; Chopda, M.; Mali, N.; Goyal, N.; Saini, A.; Gupta, J.; Singh, P.; Hadan, S.; Savanth, P.; Hardas, S.; Thakor, G.; Hiremath, J.; Ghume, A.; Jain, R.; Pahuja, M.; Joseph, S.; Oommen, D.; Joseph, J.; Thomas, R.; Joshi, H.; Iby, N. N.; Kale, V.; Raut, N.; Kandekar, B.; Kandekar, S.; Kishore, R.; Krishnan, H.; Kotiwale, V.; Kulkarni, R.; Deokar, M.; Kulkarni, G.; Lawande, A.; Kumar, P.; Karpuram, M.; Kumar, A.; Francis, J.; Kumbla, M.; Anthony, A.; Lavhe, P.; Kale, M.; Mardikar, H.; Bhaskarwar, P.; Mathur, A.; Sharma, P.; Menon, J.; Francis, V.; Namjoshi, D.; Shelke, S.; Narendra, J.; Natarajan, S.; Oomaan, A.; Gurusamy, P.; Angel, J.; Purayil, M. Padinhare; Shams, S.; Pandurangi, U.; Sababathi, R.; Parekh, P.; Jasani, B.; Patki, N.; Babbar, A.; Pinto, B.; Kharalkar, H.; Premchand, R.; Jambula, H.; Rao, M.; Vuriya, A.; Ravi Shankar, A.; Reddy, R.; Bekal, S.; Barai, A.; Saha, D.; Gadepalli, R.; Sant, H.; Jadhav, D.; Sarna, M.; Arora, T.; Sawhney, J.; Singh, R.; Sethi, K.; Bansal, N.; Sethia, A.; Sethia, S.; Shetty, G.; Sudheer, R.; Singh, G.; Gupta, R.; Srinivas, A.; Thankaraj, L.; Varma, S.; Kaur, A.; Vinod, M. Vijan; Thakur, B.; Zanwar, I.; Dharmarao, A.; Atar, S.; Lasri, E.; Dicker, D.; Marcoviciu, D.; Elias, M.; Ron, G. Avraham; Francis, A.; Ghantous, R.; Goldhaber, A.; Goldhaber, M.; Gottlieb, S.; Rouwaida, S.; Grossman, E.; Dagan, T.; Hasin, Y.; Roshrosh, M.; Hayek, T.; Majdoub, A.; Klainman, E.; Genin, I.; Lahav, M.; Gilat, T.; Ben Ari, M.; Lishner, M.; Karny, M.; Ouzan, E.; Givoni, H.; Rozenman, Y.; Logvinenko, S.; Schiff, E.; Sterlin, J.; Shochat, M.; Aloni, I.; Swissa, M.; Belatsky, V.; Tsalihin, D.; Kisos, D.; Zeltser, D.; Platner, N.; Berni, A.; Giovannelli, F.; Boriani, G.; Cervi, E.; Comi, G.; Peruzzotti, L.; Cuccia, C.; Forgione, C.; de Caterina, R.; de Pace, D.; de Servi, S.; Mariani, M.; Di Lenarda, A.; Mazzone, C.; Di Pasquale, G.; Di Niro, M.; Fattore, L.; Bosco, B.; Grassia, V.; Murena, E.; Laffi, N. N.; Gaggioli, G.; Lo Pinto, G.; Raggi, F.; Marino, P.; Francalacci, G.; Babbolin, M.; Bulgari, M.; Penco, M.; Lioy, E.; Perrone Filardi, P.; Marciano, C.; Pirelli, S.; Paradiso, G.; Piseddu, G.; Fenu, L.; Raisaro, A.; Granzow, K.; Rasura, M.; Cannoni, S.; Severi, S.; Breschi, M.; Toschi, V.; Gagliano, M.; Zacà, V.; Furiozzi, F.; Hirahara, T.; Akihisa, U.; Masaki, W.; Ajioka, M.; Matsushita, C.; Anzai, T.; Mino, K.; Arakawa, S.; Tsukimine, A.; Endo, H.; Fujiwara, M.; Fujii, K.; Kozeni, S.; Fujii, E.; Kotera, M.; Fujimoto, S.; Omae, K.; Fujimoto, K.; Ichishita, Y.; Fujita, T.; Ito, Y.; Fukamizu, S.; Harada, J.; Fukuda, N.; Fujimoto, C.; Funazaki, T.; Yamaguchi, A.; Furukawa, Y.; Kamitake, C.; Hagiwara, N.; Naganuma, M.; Hara, S.; Kumagai, S.; Harada, K.; Fuki, Y.; Haruna, T.; Nakahara, Y.; Hashimoto, Y.; Shimazu, Y.; Hiasa, Y.; Oga, Y.; Higashikata, T.; Nakagawa, Y.; Hirayama, A.; Kawaguchi, A.; Iesaka, Y.; Miyamoto, C.; Iijima, T.; Higuchi, K.; Ino, H.; Noguchi, H.; Inomata, T.; Nakamura, K.; Ishibashi, Y.; Nozaki, T.; Ishii, Y.; Tomita, H.; Ishimaru, S.; Ise, M.; Itamoto, K.; Ito, T.; Onishi, M.; Iwade, K.; Sakuma, Y.; Iwasaki, T.; Nagatome, H.; Kakinoki, S.; Adachi, C.; Kamakura, S.; Nakahara, F.; Kamijo, M.; Iida, S.; Kamiyama, K.; Fujii, R.; Kato, K.; Ishida, A.; Kazatani, Y.; Ichikawa, Y.; Kitazawa, H.; Igarashi, C.; Kobayashi, Y.; Kikuchi, R.; Kohno, M.; Tamura, S.; Yumoto, I.; Kurabayashi, M.; Koya, E.; Masuyama, T.; Kaneno, Y.; Matsuda, K.; Ebina, E.; Meno, H.; Satake, M.; Mita, T.; Takeda, M.; Miyamoto, N.; Kimizu, T.; Miyauchi, Y.; Sakamoto, S.; Munemasa, M.; Murata, J.; Nagai, Y.; Sakata, Y.; Naito, S.; Oyama, H.; Nishi, Y.; Nagase, T.; Ochiai, J.; Junko, H.; Ogawa, T.; Sugeno, M.; Oguro, H.; Tanabe, M.; Okada, K.; Moriyama, Y.; Okajima, K.; Nakashima, M.; Okazaki, O.; Wada, H.; Okishige, K.; Kitani, S.; Okumura, K.; Narita, Y.; Onaka, H.; Moriyama, H.; Ozaki, Y.; Tanikawa, I.; Sakagami, S.; Nakano, A.; Sakuragi, S.; Hayashi, N.; Sakurai, S.; Ooki, H.; Sasaki, T.; Oosawa, N.; Satoh, A.; Fujimoto, E.; Seino, Y.; Narumi, M.; Shirai, T.; Shigenari, M.; Shoji, Y.; Ueda, J.; Sugi, K.; Miyazaki, E.; Sumii, K.; Asakura, H.; Takagi, M.; Mohri, S.; Takahashi, W.; Yoshida, K.; Takahashi, A.; Kishi, N.; Takahashi, T.; Sakurai, Y.; Takeda, K.; Yahata, A.; Takenaka, T.; Yamagishi, K.; Takeuchi, S.; Watanabe, E.; Tanaka, K.; Uchida, M.; Tanouchi, J.; Nishiya, Y.; Tsuboi, H.; Tsuboi, N.; Terakura, K.; Uematsu, M.; Yasumoto, S.; Ueyama, Y.; Usuda, K.; Sakai, Y.; Yagi, M.; Sato, A.; Yagi, H.; Kuroda, T.; Yamabe, H.; Sakamoto, Y.; Yamada, T.; Yamano, R.; Yamagishi, T.; Sasaki, S.; Yamamoto, Y.; Yamashina, A.; Takiguchi, M.; Yonehara, T.; Yoshino, H.; Nomura, H.; Yoshioka, K.; Fujiwara, Y.; Bayram Llamas, E.; Hurtado, A.; Calvo Vargas, C.; Limon, M. 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Tejada; Cabrera, J.; Mendoza, R. Esteves; Chavez, C.; Luna, C.; Lema, J.; Carrion, A.; Llerena, N.; Bedregal, S. Araoz; Medina Palomino, F.; Rodriguez, J.; Minchola, J.; Bautista, C.; Negron Miguel, S.; Armas, B. Honores; Rodriguez, A.; Romero, N.; Torres, P.; Rodriguez, K. Fernandez; Yanac Chavez, P.; Delgado, S.; Sambaz, C. 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Masson, E.; Cowan, L.; Nelson, L.; Curtis, B.; Sarpola, N.; Dang, N.; Morgan, T.; Daniels, S.; Leka, G.; Datta, S.; Wulf, A.; Dave, K.; Dave, B.; Davuluri, A.; Ebreo, N.; de Lemos, J.; Debes, C.; Dean, J.; Warmack, D.; Degarmo, R.; Carey, J.; Steward, A.; Desire, A.; Waters, L.; Devenport, S.; Briscoe, C.; Dhar, S.; Ucik, S.; DiGiovanna, M.; Tisdale, L.; Donovan, D.; Rodriguez, L.; Dotani, I.; Olson, A.; Drozdiak, R.; Habibi, S.; D'Souza, A.; Cullen, T.; Eade, J.; Dunn, K.; Eldadah, Z.; Quick, R.; Ellis, J.; Cristaldi, J.; Erenrich, N.; Johnson, C.; O'Brien, J.; Ettinger, N.; Shipp, A.; Everhart, B.; DeSalle, D.; Fahmy, R.; Watkins, D.; Feld, L.; Tameron, A.; Feldman, J.; Tang, N.; Felten, W.; Prior, J.; Fialkow, J.; Calvo, M.; Finkel, M.; Shriver, D.; Finkelstein, S.; Fischell, T.; Drew, B.; Fishbein, G.; Donahue, S.; Flores, E.; Slayton, C.; Forman, S.; Solis, A.; Frais, M.; Thrope, C.; Franco, M.; Gentry, P.; French, W.; Morales, C.; Friedlander, I.; Gaffney, M.; Jones, J.; Garb, J.; Miranda, J.; George, F.; Valentine, H.; Gerber, J.; Hinchion, N.; Gillespie, E.; Keane-Richmond, P.; Gogia, H.; Ewing, B.; Goldscher, D.; Latteri, J.; Goldstein, M.; Gowda, S.; Rafala, E.; Graham, S.; Bonora, M.; Griffin, S.; Aull, L.; Griffin, J.; Goodman, V.; Grossman, C.; Davis, A.; Grove, D.; Mabe, K.; Guarino, J.; Gabela, W.; Guarnieri, T.; Guerrero, N. N.; Foster, B.; Guthrie, R.; Felsman, D.; Gvora, T.; McLean, R.; Hack, T.; Morelli, L.; Hamroff, G.; Bentivenga, L.; Han, M.; Cavanna, L.; Harris, J.; Bobade, M.; Hearne, S.; Krater, C.; Heiman, M.; Dandekar, U.; Shah, D.; Henderson, D.; Millard, D.; Henry, S.; Harkins, V.; Hermany, P.; Batchell, K.; Herrod, J.; Miranda, D.; Herson, S.; Carey, G.; Hinchman, D.; Vieira, P.; Hippert, R.; Dutter, S.; Hoekstra, J.; Homan, J.; Homayouni, A.; Horton, K.; Sloss, D.; Hotchkiss, D.; Turner, N.; Houchin, V.; Howard, V.; Hays, D.; Howard, L.; Craft, D.; Huang, P.; Truva, C.; Hunter, J.; Battistelli, E.; Hurst, P.; Garza, M.; Hussain, M.; Tambawala, M.; Ison, R.; Butcher, S.; Jardula, M.; Andresen, T.; Johnson, F.; Phillips, T.; Jones, R.; Hughett, G.; Jovin, I.; Nichols, M.; Judson, P.; Royes, A.; Kahn, B.; Coombs, V.; Kai, W.; Dugal, J.; Kandath, D.; Kostedt, G.; Kaplan, K.; Cook, S.; Kapoor, A.; Ruggiero, M.; Karunaratne, H.; Behm, K.; Kastelic, R.; Davis, C.; Keller, R.; Keller, J.; Kerkering, M.; Bartholomaus, D.; Kersh, R.; Buhler, A.; Kesselbrenner, M.; DiCorcia, L.; Khan, B.; Binns, M.; Khan, M.; Khan, G.; Kindman, L.; Averett, P.; Korpas, D.; Godfrey, C.; Kotha, P.; Sanchez, E.; Kozlowski, J.; Watts, S.; Krichmar, P.; Marquez, D.; Laliotis, A.; Jauregui, V.; Lambert, C.; Coyle, G. Stagi; Landau, C.; Ferguson, D.; Lang, J.; Simmons, T.; Langevin, E.; Faucett, S.; Ledbetter, L.; Royse, H.; Lentz, M.; Smith, D.; Lesser, M.; Hartley, L.; Lewis, D.; Bonds, C.; Lillestol, M.; Miller, D.; Ling, L.; Murphy, R.; Littlefield, R.; Wofford, E.; Lomnitz, D.; Lone, B.; Davids, M.; Looby, R.; Ault, S.; Lui, H.; Wright, H.; Lurie, M.; Edelstein, J.; Macomber, J.; Bush, D.; Magee, A.; Doctor, A.; Mainigi, S.; Lisiecki, B.; Makam, S.; Casas, R.; Mandviwala, M.; Marar, I.; Rabadi-Marar, D.; Marenberg, M.; Bedenko, E.; Massin, E.; Hicks, T.; McCartney, M.; Stubbs, L.; McGarvey, J.; Schwarz, L.; McGuire, K.; McKenzie, M.; Rodkey, K.; McKnight, T.; Paul, J.; McLaurin, B.; Lack, A.; Mega, J.; Marti, J.; Meholick, A.; Skinner, J.; Mehrle, A.; Wall, J.; Mendelson, R.; Cervellione, K.; Mercado, A.; Cajulis, C.; Michlin, B.; Romero-Colon, J.; Milas, J.; Sanders, D.; Miller, R.; Sanchez, S.; Miller, S.; Gryczan, J.; Mody, F.; Strugatsky, S.; Moran, J.; Garner, S.; Morledge, J.; Bowman, B.; Mouhaffel, A.; Parrott, N.; Mounsey, P.; Schuler, C.; Mowdy, M.; Todd, S.; Mullen, P.; Raziano, S.; Murphy, A.; Oehmann, V.; Nadar, V.; Parker, A.; Naidu, J.; West, M.; Nallasivan, M.; Goza, J.; Nguyen, T.; Nomanee, S.; Nielsen, R.; Wilmot, M.; Oberoi, M.; Thakkar, N.; Oppenheimer, K.; McCormick, J.; Orchard, R.; Garcia, L.; Osborne, J.; Gonzalez, M.; Oza, S.; Joseph, L.; Patnam, S.; Dennison, K.; Pavon, H.; Gorry, N.; Pearlstein, R.; Montayne, S.; Pentz, W.; Duncan, D.; Peters, P.; Chacon, L.; Petruzziello, F.; Morlando, F.; Pettis, K.; Brown, F.; Pezzella, S.; Kirk, D.; Poulathas, A.; Cush, S.; Pratt, R.; Neeper, L.; Pribble, A.; Lowe, K.; Pudi, K.; Sham, L.; Pugeda, J.; Ebert, J.; Quadrel, M.; Rafla, E.; Quinlan, E.; Reed, C.; Quinn, J.; Hemmen, C.; Rama, P.; Domingo, D.; Redondo, V.; Wroblewski, J.; Renzi, M.; Stanley, E.; Richwine, R.; Pazier, P.; Riofrio, K.; Braun, D.; Robinson, J.; Cherrico, M.; Roehll, W.; Hollihan, P.; Rosado, N. N.; Barnhorst, M.; Rosado, J.; Bamhorst, M.; Rosen, R.; Martin, C.; Ross, S.; Freeman, R.; Ruoff, G.; Nelson, T.; Sacco, J.; Ball, E.; Samal, A.; Schomburg, J.; Sandberg, J.; Lafave, J.; Savin, V.; Clifton, R.; Schaefer, S.; Fekete, A.; Schneider, R.; Schneider, W.; Schulman, D.; Mercer, S.; Seals, A.; Ullig, T.; Holt, A.; Seide, H.; Mather, N.; Shah, G.; Witt, P.; Shalaby, A.; Seese, M.; Shanes, J.; Fleets, J.; Shaoulian, E.; Hren, A.; Sheikh, K.; Hengerer, T.; Shih, H.; Browning, J.; Shoukfeh, M.; Stephenson, L.; Siler, T.; Champagne, M.; Simpson, P.; Meyer, R.; Singh, N.; Turner, K.; Singh, V.; Nelson, M.; Skierka, R.; Hughes, B.; Keene, R.; Smith, R.; Hodnett, P.; Spangenthal, S.; Thomason, L.; Sperling, M.; Vasquez, E.; Spivack, E.; McCartney, P.; Staniloae, C.; Liu, M.; Steljes, A.; Cox, C.; Struble, R.; Vittitow, T.; Suresh, D.; Frost, J.; Swerchowsky, V.; Freemyer, D.; Szulawski, I.; Herwehe, S.; Tahirkheli, N.; Springer, K.; Takata, T.; Bruton, T.; Talano, J.; Leo, L.; Tami, L.; Corchado, D.; Tatarko, M.; Swauger, M.; Tawney, K.; Dastoli, K.; Teague, S.; Young, K.; tee, H.; Mitchell, T.; Teixeira, J.; Southam, D.; Torres, M.; Tucker, P.; Salas, L.; Updegrove, J.; Hanna, K.; Val-Mejias, J.; Harrelson, K. Gonzalez; Vemireddy, D.; Cardoza, T.; Verma, S.; Parsons, T.; Vicari, R.; Warren, K.; Vijay, N.; Washam, M.; Vossler, M.; Kilcup, S.; Walsh, R.; Renaud, K.; Ward, S.; Locklear, T.; Waxman, F.; Sanchez, G.; Weiss, R.; St Laurent, B.; Westcott, J.; Williams, D.; Gibson, C.; Williams, R.; Dowling, C.; Willis, J.; VonGerichten, S.; Wood, K.; Capasso-Gulve, E.; Worley, S.; Pointer, S.; Yarows, S.; Sheehan, T.; Yasin, M.; Yi, J.; Dongas, B.; Yousuf, K.; Zakhary, B.; Curtis, S.; Zeig, S.; Mason, T.; Zellner, C.; Harden, M.; Roper, E.; Waseem, M.; Grammer, M.

    2013-01-01

    BackgroundEdoxaban 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. MethodsWe conducted a randomized, double-blind, double-dummy trial comparing two

  19. Management of atrial fibrillation in patients with heart failure

    NARCIS (Netherlands)

    Neuberger, Hans-Ruprecht; Mewis, Christian; van Veldhuisen, Dirk J.; Schotten, Ulrich; van Gelder, Isabelle C.; Allessie, Maurits A.; Boehm, Michael

    2007-01-01

    Atrial. fibrillation (AF) and chronic heart failure (CHF) are two major and even growing cardiovascular conditions that often coexist. However, few data are available to guide treatment of AF in patients with CHF. This review summarizes current literature concerning the following topics: (i)

  20. Atrial Fibrillation and Hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Jayaprasad N

    2005-10-01

    Full Text Available Atrial fibrillation occurs in 10 – 15% of patients with hyperthyroidism. Low serum thyrotropin concentration is an independent risk factor for atrial fibrillation. Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes. Hyperthyroidism results in excess mortality from increased incidence of circulatory diseases and dysrhythmias. Incidence of cerebral embolism is more in hyperthyroid patients with atrial fibrillation, especially in the elderly and anti-coagulation is indicated in them. Treatment of hyperthyroidism results in conversion to sinus rhythm in up to two-third of patients. Beta-blockers reduce left ventricular hypertrophy and atrial and ventricular arrhythmias in patients with hyperthyroidism. Treatment of sub clinical hyperthyroidism is controversial. Optimizing dose of thyroxine treatment in those with replacement therapy and beta-blockers is useful in exogenous subclinical hyperthyroidism.

  1. Abnormal atrial activation in young patients with lone atrial fibrillation

    DEFF Research Database (Denmark)

    Holmqvist, Fredrik; Olesen, Morten S; Tveit, Arnljot

    2011-01-01

    -wave morphology distribution was seen between patients with early-onset, lone paroxysmal AF and age- and gender-matched healthy control subjects. This finding indicates that alterations in atrial electrophysiology are common in the early stage of the arrhythmia, and since it occurs in young patients without co...

  2. Effect of Early Direct Current Cardioversion on the Recurrence of Atrial Fibrillation in Patients With Persistent Atrial Fibrillation

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra

    2015-01-01

    In patients with persistent atrial fibrillation (AF), the sinus rhythm (SR) can be restored by direct current cardioversion (DCC), although the recurrence of AF after successful DCC is common. We examined whether transesophageal echocardiography (TEE)-guided early DCC, compared with the conventio......In patients with persistent atrial fibrillation (AF), the sinus rhythm (SR) can be restored by direct current cardioversion (DCC), although the recurrence of AF after successful DCC is common. We examined whether transesophageal echocardiography (TEE)-guided early DCC, compared...

  3. Structural and functional characteristics of myocard in patients with different forms of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    L. I. Vasilyeva

    2015-02-01

    Full Text Available Aim. To study structural and functional characteristics of myocard in patients with different forms of atrial fibrillation. Atrial fibrillation is the most prevalent arrhythmia in clinical practice. Atrial fibrillation is a progressive disease: the duration of paroxysms increases over time and paroxysmal atrial fibrillation transforms to persistent, the last one becomes refractory to pharmacological and electrical cardioversion in time and transforms to permanent. So assessment of myocardial remodeling in patients with persistent and permanent atrial fibrillation is very actual. Methods and results. According to the aim of the study 133 patients with persistent atrial fibrillation and 100 patients with permanent atrial fibrillation were included into the study. Echocardiographic parameters of left and right atria function were studied. Conclusion. It was found that patients with persistent and permanent atrial fibrillation are characterized with both left and right atrias remodeling. Remodeling of the atrias is less pronounced in patients with permanent atrial fibrillation in comparison with persistent atrial fibrillation patients and arrhythmia recurrence.

  4. [Low energy transcatheter atrial defibrillation in one patient with refractory atrial fibrillation].

    Science.gov (United States)

    Asenjo, R; Morris, R; Llancaqueo, M; Lopetegui, M; Marín, G; Morales, P

    1998-03-01

    Most cases of atrial fibrillation are converted with antiarrhythmic medications or external electric defibrillation. However, in some refractory patients, an internal transcatheter defibrillation must be attempted. We report a 50 years old male with an atrial fibrillation of one year duration that was refractory to pharmacological treatment and in whom external cardioversion was unsuccessful. After the application of a bifasic shock of 10 joules between a catheter in the right atrium and another one located at the coronary sinus, the patient was converted to sinus rhythm. At two months of follow up, the patient continues in sinus rhythm.

  5. 'What else can I do?': Insights from atrial fibrillation patient communication online.

    Science.gov (United States)

    Redman, Kirsten; Thorne, Sally; Lauck, Sandra B; Taverner, Tarnia

    2017-03-01

    Many patients with atrial fibrillation experience uncertainty and psychological distress. Internet support groups for atrial fibrillation have yet to be studied. To determine the content and dialogue on an online message board for atrial fibrillation with the purpose of elucidating information and support needs from patient perspectives. Interpretative description methodology was undertaken to explore conversation from a publicly available website for atrial fibrillation over a 3-month period. Individuals interacted with the message board to make sense of their atrial fibrillation events by sharing experiences with medications, complementary and alternative medicine, trigger avoidance and ablation. The opinions of lay experts on the message board, anecdotal stories and hyperlinked Internet data were all highly valued sources of information in the messages. Using the learning gained from the board, individuals proceeded with strategies to treat their atrial fibrillation, often in a trial and error fashion. Throughout the process, individuals came back to the board, to update on their progress and gain assistance from others. The studied atrial fibrillation population had unmet needs for education regarding non-pharmacological approaches to treat atrial fibrillation. In the absence of opportunity to discuss these needs with healthcare professionals, patients may be vulnerable to unproved approaches advocated by Internet peers. Further research is suggested to examine the prevalence of complementary and alternative medicine use in the atrial fibrillation population and to understand better how social media can be utilised to support atrial fibrillation patients.

  6. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, Jeroen; Tomini, Florian; van Asselt, Thea; Crijns, Harry; Vrijhoef, Hubertus

    AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  7. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, J.M.L.; Tomini, F.; van Asselt, A.D.I.; Crijns, H.J.G.M.; Vrijhoef, H.J.M.

    2013-01-01

    Aims A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

  8. Left atrial size in patients with cryptogenic stroke as a predictor of occurrence of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Antonio Cruz Culebras

    2017-04-01

    Full Text Available Objective: To determine whether the left atrial size can predict the development of atrial fibrillation (AF in patients with embolic stroke of undetermined source (ESUS. Methods: Patients with ischemic stroke were included prospectively (January 2015-July 2015 when ESUS was suspected. Clinical and cardiac imaging data were recorded. Patients with cardiac failure were excluded. Results: a total of 55 patients were included. Medium age was 71 years. The proportion of patients who developed AF during the follow-up (1 year was 23, 63%. 10 % of patients did not have any vascular risk factor. Basal ECG was normal in 98% of cases. The left atrial size volume was 36, 08 ml in patients who developed AF and 27, 14 ml in patients who did not. Conclusions: In patients with ESUS, left atrial size dimensions do not predict the occurrence of AF.

  9. Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

    Science.gov (United States)

    Almeida, Eduardo Dytz; Guimarães, Raphael Boesche; Stephan, Laura Siga; Medeiros, Alexandre Kreling; Foltz, Katia; Santanna, Roberto Tofani; Pires, Leonardo Martins; Kruse, Marcelo Lapa; de Lima, Gustavo Glotz; Leiria, Tiago Luiz Luz

    2015-01-01

    Introduction Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce. Objective To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use. Methods Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012. Results We included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%. Conclusions The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates. PMID:26016782

  10. Living with Atrial Fibrillation: An Analysis of Patients' Perspectives.

    Science.gov (United States)

    Altiok, Meral; Yilmaz, Mualla; Rencüsoğullari, Ibrahim

    2015-12-01

    The aim of this study was to determine the perceptions of patients with atrial fibrillation regarding the disease, to reveal their feelings, thoughts and wishes, and to investigate their perspectives and coping behaviors towards their condition. Phenomenological methodology was used. The study population consisted of a total of 225 patients treated by the cardiology department of a university hospital, while the study sample consisted of 32 patients who met the inclusion criteria. A semistructured interview addressed perceptions of patients with atrial fibrillation regarding the disease. Data were collected by asking the participants the three questions on the In-depth Individual Interview Form. Data were analyzed using the continuous comparative method of Colaizzi. In the study sample, 50.0% of participants were female, 69.0% were married, and the mean age was 66.90 years (± 7.90 years). As a result of the content analysis, four main themes and 15 subthemes were identified: patient's mental status regarding the disease, patient's social status regarding the disease, patient's physical condition regarding the disease, and disease management and coping with the disease. The study found that individuals with atrial fibrillation faced major limitations in their daily living activities and social lives due to the disease symptoms and warfarin use. Patients need to be provided with relevant individual training and counselling so that they lead more satisfactory lives. In addition, appropriate health appointment and monitoring systems should be developed for patients to reduce the problems associated with frequent follow-up appointments. Copyright © 2015. Published by Elsevier B.V.

  11. Atrial fibrillation and female sex.

    Science.gov (United States)

    Anselmino, Matteo; Battaglia, Alberto; Gallo, Cristina; Gili, Sebastiano; Matta, Mario; Castagno, Davide; Ferraris, Federico; Giustetto, Carla; Gaita, Fiorenzo

    2015-12-01

    Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age, however, female patients being more prevalent, the absolute number of patients affected is similar between sexes. Despite this, few data are available in the literature concerning sex-related differences in atrial fibrillation patients. The present systematic review therefore considers comorbidities, referring symptoms, quality of life, pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome. In brief, female atrial fibrillation patients more commonly present comorbidities, leading to a higher prevalence of persistent atrial fibrillation; moreover, they refer to hospital care later and with a longer disease history. Atrial fibrillation symptoms relate to low quality of life in female patients; in fact, atrial fibrillation paroxysm usually presents higher heart rate, leading to preferentially adopt a rate rather than a rhythm-control strategy. Female atrial fibrillation patients present an increased risk of stroke, worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile. Trans-catheter ablation is under-used in female patients and, on the contrary, they are more commonly affected by anti-arrhythmic drug side effects.

  12. What patients want and need to know about atrial fibrillation

    Directory of Open Access Journals (Sweden)

    McCabe PJ

    2011-11-01

    Full Text Available Pamela J McCabe Saint Mary's Hospital, Mayo Clinic, Rochester, MN, USA Abstract: Clinicians in a variety of settings are called upon to care for patients diagnosed with atrial fibrillation (AF, a common chronic condition that affects up to 3 million people in the USA. Evidence-based guidelines provide clinicians with direction for treatment of AF, but recommended content for educating patients and counseling about self-management of AF is not included in published guidelines. When patients believe they have a good understanding of AF they report fewer symptoms, perceive greater control over AF, and attribute less emotional distress to AF. Thus, providing patients with information about AF and how to manage it is important for promoting positive outcomes. The purpose of this article is to offer evidence-based recommendations for content to include in self-management education and counseling for patients with AF. Approaches for educating and counseling patients related to AF pathophysiology, the nature of AF (its cause, consequences, and trajectory, treatments, action plans, and symptom management, and managing the psychosocial challenges of living with AF, are discussed. Keywords: atrial fibrillation, patient education, self-management education, counseling

  13. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease

    NARCIS (Netherlands)

    Brakel, T.J. van; Krieken, T. van der; Westra, S.W.; Laak, J.A.W.M. van der; Smeets, J.L.R.M.; Swieten, H.A. van

    2013-01-01

    PURPOSE: This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for

  14. Left atrial appendage closure devices for cardiovascular risk reduction in atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Cruz-Gonzalez I

    2015-05-01

    Full Text Available Ignacio Cruz-Gonzalez,* Juan Carlos Rama-Merchan,* Javier Rodriguez-Collado, Javier Martin-Moreiras, Alejandro Diego-Nieto, Antonio Arribas-Jimenez, Pedro Luís SanchezDepartment of Cardiology, University Hospital of Cardiology and IBSAL, Salamanca, Spain *Ignacio Cruz-Gonzalez and Juan Carlos Rama-Merchan have contributed equally to this work and should be considered co-first authors Abstract: Atrial fibrillation (AF is the most common sustained arrhythmia in clinical practice. AF is associated with a 4–5-fold increased risk of stroke and systemic embolism. Oral anticoagulant is the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. Autopsy and surgical data have suggested that 90% of atrial thrombi in nonvalvular AF patients originate from the left atrial appendage, leading to the development of percutaneous closure for thromboembolic prevention. This paper examines the current evidence on left atrial appendage closure devices for cardiovascular risk reduction in AF patients. Keywords: atrial fibrillation, left atrial appendage, stroke, oral anticoagulant, percutaneous closure, thromboembolic prevention

  15. Managing atrial fibrillation in active patients and athletes.

    Science.gov (United States)

    Reiss, R A

    1999-03-01

    Atrial fibrillation in young or middle-aged active patients can often be managed with medication. Evaluation should address associated conditions and predisposing factors such as idiopathic hypertrophic subaortic stenosis, Wolff-Parkinson-White syndrome, congenital heart disease, hyperthyroidism, excess alcohol or other drug use, and exercise-induced catecholamine release. Diagnostic studies may include an ECG, 24-hour Holter or event monitoring, exercise treadmill testing, stress echocardiography, electrophysiologic studies, and laboratory testing. Electrocardioversion provides rapid, predictable treatment, but ablation therapy is sometimes needed.

  16. Management and prognosis of atrial fibrillation in diabetic patients

    DEFF Research Database (Denmark)

    Fumagalli, Stefano; Said, Salah A; Laroche, Cecile

    2017-01-01

    of DM was 20.6%. Diabetics were older (71±9 vs. 68±12 years, p Quality of life amongst DM patients was significantly worse (AF-QoL score...... had significantly higher all-cause (11.9 vs. 4.9%, p quality of life. After one year, all-cause, CV and non......Aims: Diabetes mellitus (DM) is one of the most important cardiovascular (CV) risk factors. The aim of this study was to evaluate clinical correlates of DM, including management and outcomes, in the EURObservational Research Programme (EORP) - Atrial Fibrillation (AF) General Pilot (EORP...

  17. Pharmacological Treatment for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Kaoru Sugi, MD PhD

    2005-01-01

    Full Text Available Pharmacological treatment for atrial fibrillation has a variety of purposes, such as pharmacological defibrillation, maintenance of sinus rhythm, heart rate control to prevent congestive heart failure and prevention of both cerebral infarction and atrial remodeling. Sodium channel blockers are superior to potassium channel blockers for atrial defibrillation, while both sodium and potassium channel blockers are effective in the maintenance of sinus rhythm. In general, digitalis or Ca antagonists are used to control heart rate during atrial fibrillation to prevent congestive heart failure, while amiodarone or bepridil also reduce heart rates during atrial fibrillation. Anticoagulant therapy with warfarin is recommended to prevent cerebral infarction and angiotensin converting enzyme antagonists or angiotensin II receptor blockers are also used to prevent atrial remodeling. One should select appropriate drugs for treatment of atrial fibrillation according to the patient's condition.

  18. Atrial fibrillation: inflammation in disguise?

    NARCIS (Netherlands)

    Lappegard, K.T.; Hovland, A.; Pop, G.A.M.; Mollnes, T.E.

    2013-01-01

    Atrial fibrillation is highly prevalent, and affected patients are at an increased risk of a number of complications, including heart failure and thrombo-embolism. Over the past years, there has been increasing interest in the role of inflammatory processes in atrial fibrillation, from the first

  19. Increased left atrial pressure in non-heart failure patients with subclinical hypothyroidism and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Akinori Sairaku

    2016-05-01

    Full Text Available Background The impact of subclinical hypothyroidism on the cardiovascular risk is still debated. We aimed to measure the relationship between subclinical hypothyroidism and the left atrial (LA pressure. Methods The LA pressures and thyroid function were measured in consecutive patients undergoing atrial fibrillation (AF ablation, who did not have any known heart failure, structural heart disease, or overt thyroid disease. Results Subclinical hypothyroidism (4.5≤ thyroid-stimulating hormone 18 mmHg (odds ratio 3.94, 95% CI 1.28 11.2; P = 0.02. Conclusions Subclinical hypothyroidism may increase the LA pressure in AF patients.

  20. Impact of atrial fibrillation on mortality in patients with chronic heart failure

    NARCIS (Netherlands)

    van den Berg, MP; van Gelder, IC; van Veldhuisen, DJ

    2002-01-01

    Chronic heart failure and atrial fibrillation often occur together. The aim of the study is to review the available literature on the impact of atrial fibrillation on mortality in patients with heart failure. Using MEDLINE six full papers were identified. In the studies with severe heart failure

  1. The Complexity of the Patient Perspective of Living with Atrial Fibrillation

    DEFF Research Database (Denmark)

    Høgh, Vibeke; Riahi, Sam; Delmar, Charlotte

    2017-01-01

    ’ perspective of living with atrial fibrillation by combining qualitative and quantitative data sources and methods. Related to a one-year patient journey of living with paroxysmal atrial fibrillation it is here illustrated how scores from questionnaires can be explored by supporting the scores with qualitative...

  2. Edoxaban versus warfarin in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Giugliano, Robert P; Ruff, Christian T; Braunwald, Eugene

    2013-01-01

    BACKGROUND: 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. METHODS: 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. RESULTS: 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

  3. Digoxin use and risk of mortality in hypertensive patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Okin, Peter M; Hille, Darcy A; Wachtell, Kristian

    2015-01-01

    , diabetes, history of ischemic heart disease, stroke, or heart failure, baseline Cornell product, QRS duration, heart rate, serum glucose, creatinine and high-density lipoprotein cholesterol, and a propensity score for digoxin use entered as standard covariates, and for in-treatment heart rate, pulse......BACKGROUND: Digoxin is widely used for rate control of atrial fibrillation. However, recent studies have reported conflicting results on the association of digoxin with mortality when used in patients with atrial fibrillation. Moreover, the relationship of digoxin use to mortality in hypertensive...... patients with atrial fibrillation has not been examined. METHODS AND RESULTS: All-cause mortality was examined in relation to in-treatment digoxin use in 937 hypertensive patients with ECG left ventricular hypertrophy in atrial fibrillation at baseline (n = 134) or who developed atrial fibrillation during...

  4. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

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    Naser Safaie

    2010-09-01

    Full Text Available "nPatients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  5. Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation : importance of new-onset atrial fibrillation and total atrial conduction time

    NARCIS (Netherlands)

    Buck, Sandra; Rienstra, Michiel; Maass, Alexander H.; Nieuwland, Wybe; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    AIMS: Cardiac resynchronization therapy (CRT) is an established therapy for patients with heart failure and sinus rhythm (SR), but its value in atrial fibrillation (AF) remains unclear. Furthermore, response to CRT may be difficult to predict in these patients. The aim of our study was to

  6. APPROACHES TO ANTITHROMBOTIC THERAPY IN ELDERLY PATIENTS WITH ATRIAL FIBRILLATION

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    E. A. Ushkalova

    2017-01-01

    Full Text Available Advanced age is the most important and independent risk factor for the development of atrial fibrillation (AF. The proportion of patients with AF at the age of 65-85 years reaches 70%, and average age of patients with AF is 75 years. Antithrombotic therapy of AF in the elderly is challenging for several reasons. On the one hand, elderly patients are at an increased risk of systemic embolism and stroke and fatal outcomes of stroke are higher in the elderly compared with these in the younger patients. On the other hand, elderlies are at an increased risk of bleeding. In addition, they have important comorbidities and are treated with drugs that can interact with antithrombotic agents. The article discusses tools used to assess risks of thromboembolic and hemorrhagic complications and general approaches to antithrombotic treatment of elderly patients.

  7. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study....... RESULTS: A total of 4134 patients were included in the study. Overall, the yearly proportion of patients with known AF varied between 9% and 18%. No significant change was observed (P = .511). The proportion of patients with known AF treated with anticoagulants at the time of the stroke and the proportion...... was observed. An explanation could be an increase in the prevalence of AF in the general population, leaving the proportion of patients admitted with ischemic stroke unchanged. Other risk factors have been sought reduced as well with the implementation of national guidelines regarding hypertension...

  8. Clinical review : Treatment of new-onset atrial fibrillation in medical intensive care patients - a clinical framework

    NARCIS (Netherlands)

    Sleeswijk, Mengalvio E.; Van Noord, Trudeke; Tulleken, Jaap E.; Ligtenberg, Jack J. M.; Girbes, Armand R. J.; Zijlstra, Jan G.

    2007-01-01

    Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of

  9. Management of Atrial Fibrillation in Critically Ill Patients

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    Mattia Arrigo

    2014-01-01

    Full Text Available Atrial fibrillation (AF is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV. If pharmacological treatment is indicated, clinicians can choose between the rate control and the rhythm control strategy. The optimal substance should be selected depending on its potential adverse effects. A beta-1 antagonist with a very short half-life (e.g., esmolol is an advantage for ICU patients because the effect of beta-blockade on cardiovascular stability is unpredictable in those patients. Amiodarone is commonly used in the ICU setting but has potentially severe cardiac and noncardiac side effects. Digoxin controls the ventricular response at rest, but its benefit decreases in the presence of adrenergic stress. Vernakalant converts new-onset AF to sinus rhythm in approximately 50% of patients, but data on its efficacy and safety in critically ill patients are lacking.

  10. Antithrombotic treatment in elderly patients with atrial fibrillation.

    Science.gov (United States)

    Suárez Fernández, C; Camafort, M; Cepeda Rodrigo, J M; Díez-Manglano, J; Formiga, F; Pose Reino, A; Tiberio, G; Mostaza, J M

    2015-04-01

    Atrial fibrillation (AF) in the elderly is a complex condition due to the high number of frequently associated comorbidities, such as cardiovascular and kidney disease, cognitive disorders, falls and polypharmacy. Except when contraindicated, anticoagulation is necessary for preventing thromboembolic events in this population. Both vitamin K antagonists and direct oral anticoagulants (dabigatran, rivaroxaban and apixaban) are indicated in this context. Renal function should be closely monitored for this age group when these drugs are used. In recent years, various clinical practice guidelines have been published on patients with AF. The majority of these guidelines make specific recommendations on the clinical characteristics and treatment of elderly patients. In this update, we review the specific comments on the recommendations concerning antithrombotic treatment in elderly patients with nonvalvular AF. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  11. HYPERTHYROIDISM AND ATRIAL FIBRILLATION

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    I. M. Marusenko

    2017-01-01

    Full Text Available Review on a problem of the development of atrial fibrillation in patients with thyrotoxicosis is presented. Thyrotoxicosis is one of the most frequent endocrine diseases, conceding only to a diabetes mellitus. The most frequent reasons of hyperthyroidism are Graves’ disease and functional thyroid autonomy. The authors give an analysis of data on the cardiac effects of thyrotoxicosis, features of heart remodeling under the influence of thyroid hyperfunction, prevalence of atrial fibrillation in thyrotoxicosis, depending on age, as well as the possibility of restoring sinus rhythm in the combination of these diseases. Particular attention is paid to the effect on the heart of subclinical thyrotoxicosis, which is defined as a dysfunction of the thyroid gland, characterized by low serum concentration of thyrotropin, normal values of free thyroxine and free triiodothyronine. Subclinical hyperthyroidism is also capable of causing heart remodeling and diastolic dysfunction.Prevalence of thyrotoxicosis in elderly people is higher in areas of iodine deficiency; it is relevant for our country due to the large territory of iodine deficiency. In elderly patients, the cardiac effects of thyrotoxicosis prevail in the clinical picture, that makes it difficult to diagnose endocrine disorders, and correction of thyrotoxicosis is critically important for the successful control of the heart rhythm. The article also discusses the problem of thyrotoxic cardiomyopathy, caused by the toxic effect of excess thyroid hormones: features of this heart disorder, factors affecting its formation, clinical significance and contribution to the development of rhythm disturbances. The greatest significance is the development of atrial fibrillation as a result of thyrotox-icosis in older patients who already have various cardiovascular diseases.Atrial fibrillation is the most frequent heart rhythm disorder in thyrotoxicosis. The main cause of arrhythmia in hyperthyroidism is the

  12. Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure.

    Science.gov (United States)

    Hohendanner, Felix; Heinzel, F R; Blaschke, F; Pieske, B M; Haverkamp, W; Boldt, H L; Parwani, A S

    2017-10-16

    Heart failure and atrial fibrillation are common and responsible for significant mortality of patients. Both share the same risk factors like hypertension, ischemic heart disease, diabetes, obesity, arteriosclerosis, and age. A variety of microscopic and macroscopic changes favor the genesis of atrial fibrillation in patients with preexisting heart failure, altered subcellular Ca(2+) homeostasis leading to increased cellular automaticity as well as concomitant fibrosis that are induced by pressure/volume overload and altered neurohumoral states. Atrial fibrillation itself promotes clinical deterioration of patients with preexisting heart failure as atrial contraction significantly contributes to ventricular filling. In addition, atrial fibrillation induced tachycardia can even further compromise ventricular function by inducing tachycardiomyopathy. Even though evidence has been provided that atrial functions significantly and independently of confounding ventricular pathologies, correlate with mortality of heart failure patients, rate and rhythm controls have been shown to be of equal effectiveness in improving mortality. Yet, it also has been shown that cohorts of patients with heart failure benefit from a rhythm control concept regarding symptom control and hospitalization. To date, amiodarone is the most feasible approach to restore sinus rhythm, yet its use is limited by its extensive side-effect profile. In addition, other therapies like catheter-based pulmonary vein isolation are of increasing importance. A wide range of heart failure-specific therapies are available with mixed impact on new onset or perpetuation of atrial fibrillation. This review highlights pathophysiological concepts and possible therapeutic approaches to treat patients with heart failure at risk for or with atrial fibrillation.

  13. Atrial fibrillation and delayed gastric emptying.

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    Isadora C Botwinick

    Full Text Available BACKGROUND: Atrial fibrillation and delayed gastric emptying (DGE are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7(th postoperative day. METHODS: We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. RESULTS: Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005. Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03. 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007. This association held true when controlling for age. CONCLUSION: Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.

  14. Sudden death in a young patient with atrial fibrillation

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    María Tamargo

    2017-08-01

    Full Text Available Sudden cardiac death (SCD in young patients without structural heart disease is frequently due to inherited channelopathies such as long QT syndrome (LQTS, Brugada syndrome or Catecholaminergic polymorphic ventricular tachycardia. Accordingly, the addition of genetic testing to clinical data may be useful to identify the cause of the sudden death in this population. Mutations in the KCNQ1 encoded Kv7.1 channel are related to type 1 LQTS, familial atrial fibrillation (AF, short QT syndrome, and SCD. We present a clinical case where the presence of AF after resuscitation in a young man with cardiac arrest was the key clinical data to suspect an inherited disorder and genetic testing was the main determinant for identifying the cause of the cardiac arrest. The KCNQ1 p.Arg231His mutation explained the combined phenotype of AF and susceptibility to ventricular arrhythmias. The case highlights the importance of continued research in genetics and molecular mechanisms of channelopathies.

  15. Lenient versus Strict Rate Control in Patients with Atrial Fibrillation.

    NARCIS (Netherlands)

    Van Gelder, Isabelle C.; Groenveld, Hessel F.; Crijns, Harry J. G. M.; Tuininga, Ype S.; Tijssen, Jan G. P.; Alings, A. Marco; Hillege, Hans L.; Bergsma-Kadijk, Johanna A.; Cornel, Jan H.; Kamp, Otto; Tukkie, Raymond; Bosker, Hans A.; Van Veldhuisen, Dirk J.; Van den Berg, Maarten P.

    2010-01-01

    Background: Rate control is often the therapy of choice for atrial fibrillation. Guidelines recommend strict rate control, but this is not based on clinical evidence. We hypothesized that lenient rate control is not inferior to strict rate control for preventing cardiovascular morbidity and

  16. Detection of paroxysmal atrial fibrillation in acute stroke patients

    NARCIS (Netherlands)

    Rizos, T.; Rasch, C.; Jenetzky, E.; Hametner, C.; Kathoefer, S.; Reinhardt, R.; Hepp, T.; Hacke, W.; Veltkamp, R.

    2010-01-01

    Atrial fibrillation (AF) is a frequent cause of stroke, but detecting paroxysmal AF (pAF) poses a challenge. We investigated whether continuous bedside ECG monitoring in a stroke unit detects pAF more sensitively than 24-hour Holter ECG, and tested whether examining RR interval dynamics on

  17. Zoledronic acid and atrial fibrillation in cancer patients.

    Science.gov (United States)

    Arslan, Cagatay; Aksoy, Sercan; Dizdar, Omer; Dede, Didem S; Harputluoglu, Hakan; Altundag, Kadri

    2011-03-01

    Treatment with a bisphosphonate was found to be associated with a significantly increased risk for atrial fibrillation (AF) in a few studies. A recent study showed that once-yearly infusions of intravenous zoledronic acid (ZA) significantly increased the risk of serious AF in postmenopausal women with osteoporosis. This study was conducted to determine the frequency of atrial fibrillation among cancer patients receiving the standard treatment of ZA. Patients with bone metastases who presented to our outpatient clinic for any reason (routine control, chemotherapy, or ZA administration) were included in the study. All patients had been receiving 4 mg ZA at 4-week intervals, with each dose administered over 15 min. A short survey was completed and standard 12-lead ECG recordings were obtained. One hundred and twenty-four cancer patients with documented bone metastases were evaluated. Mean age of the patients was 55 ± 13.0 years, 60% of the patients were female. Forty-one percent of the patients had breast cancer, 18% had non-small cell lung cancer, and the remainder had other solid tumors. Mean duration of ZA administration was 13.4  ± 15.0 months. Mean total cumulative dose was 54  ± 15.0 mg per patient. Sixty patients (48%) had previously been treated with anthracycline-containing regimens, and 37 (30%) had received chest radiotherapy that might affect the heart. Twenty-three percent of the patients had hypertension, 10% had diabetes mellitus, 3.7% had myocardial infarction history, 1.9% had congestive heart failure, and 1% had valvular disease; 10.5% were current smokers and 32% ex-smokers. On ECG evaluation, we observed normal sinus rhythm in 58%, sinus tachycardia in 15%, sinus bradicardia in 3.2%, and ventricular extrasystole in 5.7% of the patients. There was no AF in any of the cases. There was no increase in the risk of AF frequency in cancer patients who were treated with intravenous ZA, although most of the patients had additional risk factors

  18. Analysis of immune cell populations in atrial myocardium of patients with atrial fibrillation or sinus rhythm.

    Science.gov (United States)

    Smorodinova, Natalia; Bláha, Martin; Melenovský, Vojtěch; Rozsívalová, Karolína; Přidal, Jaromír; Ďurišová, Mária; Pirk, Jan; Kautzner, Josef; Kučera, Tomáš

    2017-01-01

    Atrial fibrillation (AF) is the most common arrhythmia and despite obvious clinical importance remains its pathogenesis only partially explained. A relation between inflammation and AF has been suggested by findings of increased inflammatory markers in AF patients. The goal of this study was to characterize morphologically and functionally CD45-positive inflammatory cell populations in atrial myocardium of patients with AF as compared to sinus rhythm (SR). We examined 46 subjects (19 with AF, and 27 in SR) undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atrial tissue were examined using immunohistochemistry. The number of CD3+ T-lymphocytes and CD68-KP1+ cells were elevated in the left atrial myocardium of patients with AF compared to those in SR. Immune cell infiltration of LA was related to the rhythm, but not to age, body size, LA size, mitral regurgitation grade, type of surgery, systemic markers of inflammation or presence of diabetes or hypertension. Most of CD68-KP1+ cells corresponded to dendritic cell population based on their morphology and immunoreactivity for DC-SIGN. The numbers of mast cells and CD20+ B-lymphocytes did not differ between AF and SR patients. No foci of inflammation were detected in any sample. An immunohistochemical analysis of samples from patients undergoing open heart surgery showed moderate and site-specific increase of inflammatory cells in the atrial myocardium of patients with AF compared to those in SR, with prevailing population of monocyte-macrophage lineage. These cells and their cytokine products may play a role in atrial remodeling and AF persistence.

  19. Analysis of immune cell populations in atrial myocardium of patients with atrial fibrillation or sinus rhythm.

    Directory of Open Access Journals (Sweden)

    Natalia Smorodinova

    Full Text Available Atrial fibrillation (AF is the most common arrhythmia and despite obvious clinical importance remains its pathogenesis only partially explained. A relation between inflammation and AF has been suggested by findings of increased inflammatory markers in AF patients.The goal of this study was to characterize morphologically and functionally CD45-positive inflammatory cell populations in atrial myocardium of patients with AF as compared to sinus rhythm (SR.We examined 46 subjects (19 with AF, and 27 in SR undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atrial tissue were examined using immunohistochemistry.The number of CD3+ T-lymphocytes and CD68-KP1+ cells were elevated in the left atrial myocardium of patients with AF compared to those in SR. Immune cell infiltration of LA was related to the rhythm, but not to age, body size, LA size, mitral regurgitation grade, type of surgery, systemic markers of inflammation or presence of diabetes or hypertension. Most of CD68-KP1+ cells corresponded to dendritic cell population based on their morphology and immunoreactivity for DC-SIGN. The numbers of mast cells and CD20+ B-lymphocytes did not differ between AF and SR patients. No foci of inflammation were detected in any sample.An immunohistochemical analysis of samples from patients undergoing open heart surgery showed moderate and site-specific increase of inflammatory cells in the atrial myocardium of patients with AF compared to those in SR, with prevailing population of monocyte-macrophage lineage. These cells and their cytokine products may play a role in atrial remodeling and AF persistence.

  20. Use of amiodarone for atrial fibrillation in patients with preexisting pulmonary disease in the AFFIRM study.

    Science.gov (United States)

    Olshansky, Brian; Sami, Magdi; Rubin, Andrew; Kostis, John; Shorofsky, Stephen; Slee, April; Greene, H Leon

    2005-02-01

    In the Atrial Fibrillation Follow-up Investigation of Rhythm Management study, preexisting pulmonary disease did not preclude the use of amiodarone. Preexisting pulmonary disease was associated with a higher risk of pulmonary death and had a higher risk of diagnosed amiodarone pulmonary toxicity. However, use of amiodarone in the presence of preexisting pulmonary disease did not increase pulmonary death and all-cause mortality rates. Cautious use of amiodarone to treat atrial fibrillation appears acceptable in elderly patients with atrial fibrillation, even if preexisting pulmonary disease is present.

  1. Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Skielboe, Ane Katrine; Bandholm, Thomas Quaade; Hakmann, Stine

    2017-01-01

    BACKGROUND: Physical activity at moderate-high intensity is recommended to prevent lifestyle diseases. Patients with atrial fibrillation are at risk of a sedentary lifestyle due to fear of exercise-induced episodes of atrial fibrillation. The burden of arrhythmia can be reduced by physical exercise...... intensity physical exercise was not superior to low intensity physical exercise in reducing burden of atrial fibrillation. HI exercise was well tolerated; no evidence of an increased risk was found for HI compared to LI exercise. Larger studies are required to further prove our findings. TRIAL REGISTRATION...

  2. Improving antithrombotic management in patients with atrial fibrillation: current status and perspectives

    DEFF Research Database (Denmark)

    Levi, Marcel; Hobbs, F D Richard; Jacobson, Alan K

    2009-01-01

    Despite overwhelming evidence of the benefits of risk-adjusted oral anticoagulation on stroke reduction in patients with atrial fibrillation (AF), there is still considerable undertreatment. A multidisciplinary expert group was formed to discuss issues surrounding anticoagulant treatment of patie...

  3. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B

    2015-01-01

    STUDY QUESTION: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? METHODS: This Danish cohort study (1996-201...

  4. Effect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Bang, Casper N; Greve, Anders M; Boman, Kurt

    2012-01-01

    Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS)....

  5. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  6. Frequency and significance of right atrial appendage thrombi in patients with persistent atrial fibrillation or atrial flutter.

    Science.gov (United States)

    Cresti, Alberto; García-Fernández, Miguel Angel; Miracapillo, Gennaro; Picchi, Andrea; Cesareo, Francesca; Guerrini, Francesco; Severi, Silva

    2014-11-01

    Atrial fibrillation (AF) and atrial flutter (AFL) are strong atrial thrombosis (THR) risk factors. In recent-onset tachyarrhythmias, the incidence of left atrial appendage (LAA) THR, detected by transesophageal echocardiography (TEE), has been widely studied, ranging from 6% to 18% (AF) and 4% to 11% (AFL). On the contrary, few studies have assessed right atrial appendage (RAA) THR, and there is no information on the relation between the RAA flow characteristics and the presence of RAA THR. The aims of this study were to evaluate the incidence of RAA THR in a population of patients undergoing TEE-guided cardioversion for recent-onset atrial tachyarrhythmias and to analyze RAA Doppler flow and its relation to thrombus formation. From 1998 to 2012, patients admitted to the emergency department for persistent, non-self-terminating atrial tachyarrhythmia lasting >2 days who gave informed consent for TEE-guided cardioversion were prospectively enrolled in the study. Among 1,042 patients, complete anatomic and functional studies of the LAA and RAA were feasible in 983 (AF, n = 810 [23%]; AFL, n = 173 [5%]). The presence of RAA and LAA THR, appendage emptying velocities, and the presence of severe spontaneous echocardiographic contrast were studied. The overall incidence of atrial THR was 9.7% (96 of 983). The incidence of THR was 9.3% (91 of 983) in the LAA and 0.73% (seven of 983) in the RAA (P thrombi are significantly less frequent than LAA thrombi but may reach large dimensions. Multiplane TEE allows RAA morphologic and functional assessment. Before TEE-guided cardioversion, both the LAA and the RAA must be routinely studied. Copyright © 2014 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  7. Dementia and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Pastori, Daniele; Miyazawa, Kazuo; Lip, Gregory Y H

    2018-01-01

    The risk of developing dementia is increased in patients with atrial fibrillation (AF), with the incidence of both conditions increasing with aging. Patients with dementia frequently do not receiving adequate thrombo-prophylaxis, because of the inability to monitor INR and/or to achieve...... in therapeutic range during VKAs therapy, the assessment of cognitive impairment may help identify those patients who may benefit from switching to NOACs. In conclusion, patients with AF and dementia benefit from anticoagulation and should not be denied receiving adequate stroke prevention. Cognitive function...

  8. Circulating microRNA-1a is a biomarker of Graves' disease patients with atrial fibrillation.

    Science.gov (United States)

    Wang, Fang; Zhang, Sheng-Jie; Yao, Xuan; Tian, Dong-Mei; Zhang, Ke-Qin; She, Dun-Min; Guo, Fei-Fan; Zhai, Qi-Wei; Ying, Hao; Xue, Ying

    2017-07-01

    It has been increasingly suggested that specific microRNAs expression profiles in the circulation and atrial tissue are associated with the susceptibility to atrial fibrillation. Nonetheless, the role of circulating microRNAs in Graves' disease patients with atrial fibrillation has not yet been well described. The objective of the study was to identify the role of circulating microRNAs as specific biomarkers for the diagnosis of Graves' disease with atrial fibrillation. The expression profiles of eight serum microRNAs, which are found to be critical in the pathogenesis of atrial fibrillation, were determined in patients with Graves' disease with or without atrial fibrillation. MicroRNA expression analysis was performed by real-time PCR in normal control subjects (NC; n = 17), patients with Graves' disease without atrial fibrillation (GD; n = 29), patients with Graves' disease with atrial fibrillation (GD + AF; n = 14), and euthyroid patients with atrial fibrillation (AF; n = 22). Three of the eight serum microRNAs,i.e., miR-1a, miR-26a, and miR-133, had significantly different expression profiles among the four groups. Spearman's correlation analysis showed that the relative expression level of miR-1a was positively correlated with free triiodothyronine (FT3) and free thyroxine (FT4), and negatively related to thyroid stimulating hormone. Spearman's correlations analysis also revealed that the level of miR-1a was negatively correlated with a critical echocardiographic parameter (left atrial diameter), which was dramatically increased in GD + AF group compared to GD group. Furthermore, the receiver-operating characteristic curve analysis indicated that, among the eight microRNAs, miR-1a had the largest area under the receiver-operating characteristic curves not only for discriminating between individuals with and without Graves' disease, but also for predicting the presence of atrial fibrillation in patients with Graves' disease. Our findings

  9. Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure

    NARCIS (Netherlands)

    van den Berg, MP; de Kam, PJ; Boomsma, F; Crijns, HJGM; van Veldhuisen, DJ

    Background: Congestive heart failure (CHF) is characterized by neurohormonal activation, including increased plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal ANP (N-ANP). Onset of atrial fibrillation (AF) further increases these peptides, but it may be hypothesized that

  10. Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

    Science.gov (United States)

    Chavez, Ernesto Koehler; Colafranceschi, Alexandre Siciliano; Monteiro, Andrey José de Oliveira; Canale, Leonardo Secchin; Mesquita, Evandro Tinoco; Weksler, Clara; Barbosa, Odilon Nogueira; Oliveira, Anderson

    2017-01-01

    Objective To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach. PMID:28832799

  11. Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

    Directory of Open Access Journals (Sweden)

    Ernesto Koehler Chavez

    Full Text Available Abstract Objective: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA, type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

  12. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

    2016-01-01

    BACKGROUND: To assess the effects of comprehensive cardiac rehabilitation compared with usual care on physical activity and mental health for patients treated with catheter ablation for atrial fibrillation. METHODS: The patients were randomized 1:1 stratified by paroxysmal or persistent atrial...... questionnaire. Exploratory outcomes were collected. RESULTS: 210 patients were included (mean age: 59 years, 74% men), 72% had paroxysmal atrial fibrillation prior to ablation. Compared with usual care, the cardiac rehabilitation group had a beneficial effect on Vo2 peak at four months (24.3mL kg(-1) min(-1...

  13. Impact of dronedarone on hospitalization burden in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Torp-Pedersen, Christian; Crijns, Harry J G M; Gaudin, Christophe

    2011-01-01

    Hospitalization or death from any cause in patiENTs with Atrial fibrillation/atrial flutter (ATHENA), a composite of first CV hospitalization or death from any cause, was significantly reduced by dronedarone. This post hoc analysis evaluated the secondary endpoint of CV hospitalization and the clinical benefit...

  14. Factors associated with 'caregiver burden' for atrial fibrillation patients.

    Science.gov (United States)

    Coleman, C I; Coleman, S M; Vanderpoel, J; Nelson, W; Colby, J A; Scholle, J M; Kluger, J

    2012-10-01

    The burden on caregivers providing support to atrial fibrillation (AF) patients has not been evaluated. To examine the interrelationship between unpaid caregiver, patient and thromboprophylaxis characteristics and caregiver burden in AF. We conducted a cross-sectional survey study of AF patient-caregiver dyads recruited from cardiology clinics at an urban teaching hospital. Eligible patients had a diagnosis of AF, received thromboprophylaxis to prevent stroke, lived in the community and had an adult, unpaid, English-speaking caregiver. Hierarchical multivariate regression was used to evaluate the association between caregiver, patient and thromboprophylaxis characteristics and caregiver burden as measured by the 'Caregiver Reaction Assessment' (CRA). Eighty patient-caregiver dyads were surveyed. The mean ± standard deviation scores for each CRA domain were 'Disrupted schedule' (2.4 ± 1.0), 'Financial problems' (2.1 ± 0.8), 'Lack of family support' (1.9 ± 0.7), 'Health problems' (1.9 ± 0.7) and 'Self-esteem' (0.9 ± 0.5). Significantly greater caregiver burden due to 'Disrupted schedule' was seen in those spending > 4 h/week providing care and when caring for frail, sick or disabled patients, with higher CHADS2 scores and requiring help with their medications. 'Financial problems' burden scores were significantly associated with caring for frail patients and those requiring more frequent office follow-up. 'Lack of family support' scores were inversely associated with having somebody else to help provide care and increased as patients CHADS2 score increased. Lower 'Health problem' burden scores were associated with female gender and higher scores with the need to spend > 4 h/week providing care. The greatest burden to caregivers of AF patients occurs due to schedule disruption. © 2012 Blackwell Publishing Ltd.

  15. Algorithm for identifying patients with paroxysmal atrial fibrillation without appearance on the ECG.

    Science.gov (United States)

    Kikillus, Nicole; Hammer, Gerd; Wieland, Steven; Bolz, Armin

    2007-01-01

    Although atrial fibrillation is the most common sustained cardiac rhythm disturbance, it remains under-diagnosed. One of the most drastic complications is embolism, and strokes in particular. Patients having atrial fibrillation must be identified in order to reduce the number of strokes. The algorithm presented detects atrial fibrillation, even without it being indicated in the analyzed ECG. Based on parameters of heart rate variability, only a 60-minute single channel ECG is required. At first, all R peaks are detected and all RR intervals are calculated. After normalizing the RR intervals, the time domain parameter SDSD is calculated and the so-called Poincaré Plot is generated. The image and the time domain analysis assess a risk level, which determines whether the patient is suffering from atrial fibrillation. The resulting sensitivity calculated for ECG recordings from the MIT-BIH Atrial Fibrillation Database is 91.5% and the specificity determined for the ECG recordings from the MIT-BIH Normal Sinus Rhythm Database is 96.9%. The sensitivity depends on the atrial fibrillation burden. Even if a burden of 0 % is assumed, the results still prove satisfactory (sensitivity nearly 83%).

  16. Atrial Fibrillation and Stroke

    Science.gov (United States)

    ... faulty heart valves, lung disease, and stimulant or alcohol abuse. Some people will have no identifiable cause for their AF. × Definition Atrial fibrillation (AF) describes the rapid, irregular beating ...

  17. Deglutition induced atrial tachycardia and atrial fibrillation.

    Science.gov (United States)

    Kanjwal, Yousuf; Imran, Naser; Grubb, Blair

    2007-12-01

    Deglutition induced supraventricular tachycardia is an uncommon condition postulated to be a vagally mediated phenomenon due to mechanical stimulation. Patients usually present with mild symptoms or may have severe debilitating symptoms. Treatment with Class I agents, beta blockers, calcium channel blockers, amiodarone and radiofrquency catheter ablation has shown to be successful in the majority of reported cases. We report the case of a 46-year-old healthy woman presenting with palpitations on swallowing that was documented to be transient atrial tachycardia with aberrant ventricular conduction as well as transient atrial fibrillation. She was successfully treated with propafenone with no induction of swallowing-induced tachycardia after treatment. This is also the first case to show swallowing-induced atrial tachycardia and atrial fibrillation in the same patient.

  18. Permanent atrial fibrillation ablation surgery in patients with advanced age

    Directory of Open Access Journals (Sweden)

    Stephan Geidel

    2005-10-01

    Full Text Available Background: Even if permanent atrial fibrillation (pAF is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56 with pAF (≥6 months underwent either monopolar (Group A, B: n=51 vs. n=44 or bipolar (Group A, B: n=19 vs. n=12 radiofrequency (RF ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA class and conversion rate to stable sinus rhythm (SR. Results: Early mortality (<30 days was 2.9% in Group A (Group B: 0%, cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03 and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%. Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age.

  19. Anticoagulation therapy in elderly patients with atrial fibrillation: results from the Registry of Atrial Fibrillation To Investigate the Implementation of New Guidelines (RAFTING).

    Science.gov (United States)

    Pipilis, Athanasios; Farmakis, Dimitrios; Kaliambakos, Sotirios; Goudevenos, John; Lekakis, John

    2017-07-01

    Patients with atrial fibrillation aged 75 years or older have a CHA2DS2VASc score that dictates oral anticoagulants. We recorded physicians' anticoagulation attitudes in elderly patients with atrial fibrillation and assessed the impact of stroke and bleeding risk. Atrial Fibrillation To Investigate the Implementation of New Guidelines , a countrywide prospective registry performed in Greece during 2010, a period when only vitamin-K antagonists (VKA) were available, enrolled 1127 patients with atrial fibrillation diagnosis during Emergency Departments visit in 31 representative hospitals; 807 patients had known atrial fibrillation and of those, 342 aged 75 years or older. We recorded preadmission anticoagulation treatment and associated it with clinical characteristics and stroke/bleeding risk. Patients on VKA (n = 207; 61%) were younger (81 ± 4 vs. 83 ± 5; P 4) or modified HASBLED (low: 0-2, high: >2) scores. VKA were prescribed in 65% of patients with very high CHA2DS2VASc score as compared with 55% of those with high score (P = 0.065). VKA were used equally in low or high-modified HASBLED score (61% vs. 59%; P = 0.78). The interaction between CHA2DS2VASc and HASBLED was significant (P < 0.001) in patients on VKA; in patients with low HASBLED, VKA use was similar in high versus very high CHA2DS2VASc score (58 vs. 64%), whereas in patients with high HASBLED, VKA use tended to be higher in very high versus high CHA2DS2VASc score (66 vs. 43%). In this countrywide atrial fibrillation registry, 61% of elderly patients received VKA, a decision driven mainly by stroke risk. VKA use was not higher in patients with low bleeding risk.

  20. ANTIARRHYTHMIC EFFICACY OF PROPAFENONE IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    R. D. Kurbanov

    2011-01-01

    Full Text Available Aim. To assess propafenone antiarrhythmic efficacy and optimal timing of the drug administration for relief of persistent atrial fibrillation (PAF. Material and methods. 24 patients (19 men, 5 women, aged 53,8±13,3 with PAF (duration is more than 7 days were included in the study. PAF was confirmed clinically as well as by ECG and daily ECG monitoring. Indications for sinus rhythm recovery by propafenone were defined in according to the ACC/AHA/ESC recommendations (2006. 12-lead ECG was performed before the fist administration and 2, 4, 8, 12, 24 hours and some next days after propafenone therapy start. Echocardiography and thyroid hormone tests were also performed. Propafenone was administered additionally to standard treatment of the underlying disease and oral anticoagulants. The first dose of propafenone was 300 mg, after 4 hours patients received next dose of 300 mg if atrial fibrillation persisted and no side effects were observed, then doses of 300 mg were administered every 6-8 hours (but not more than 900-1200 mg per day during 5 days. Maintenance propafenone dose of 450-600 mg daily was used in case of sinus rhythm recovery. Results. Sinus rhythm was restored in 41,6% of patients taking propafenone, and time of sinus rhythm recovery was 53,1±28,9 hours after therapy start. Propafenone antiarrhythmic efficacy in the loading dose (300 mg was 4,2%. Propafenone efficacy during the first 24 hours (dose of 700±282,8 mg was 12,5%. The maximum rate of sinus rhythm recovery was observed during the first 2-3 days of propafenone receiving (60% of all patients with rhythm recovery. Patients with unrecovered sinus rhythm had longer duration of PAF in comparison with this in effectively treated patients, 105,8±89,0 vs 39,7±38,9 days (p<0,05, respectively, as well as the more prominent basal pulse deficit, 24,6±15,0 vs 13,56±5,7 beats per minute (p<0,05, respectively. Cardiac and transient noncardiac side effects were registered in 8,6 and 4

  1. Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.

    Science.gov (United States)

    Nair, Chandra K; Aronow, Wilbert S; Shen, Xuedong; Anand, Kishlay; Holmberg, Mark J; Esterbrooks, Dennis J

    2009-11-01

    The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up. Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.

  2. INTRAOPERATIVE RADIOFREQUENCY AND CRYOABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH VALVULAR HEART DISEASE

    Directory of Open Access Journals (Sweden)

    N. Maghamipour N. Safaie

    2007-05-01

    Full Text Available Patients with valvular heart disease and suffering atrial fibrillation of more than 12 months duration have a low probability of remaining in sinus rhythm after valve surgery alone. We performed intra-operative radiofrequency ablation or cryoablation as an alternative to surgical maze ІІІ procedure to create linear lesion lines for conversion of this arrhythmia to sinus rhythm. A total of 30 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant maze procedure with radiofrequency or cryo probes. These patients aged 48.10 ± 9.84 years in radiofrequency ablation group and 51.10 ± 13.93 years in cryoablation group. Both atrial ablation with radiofrequency probes, needed 26.15 ± 3.67 min extra ischemic time and ablation by mean of cryo-probes needed an extra ischemic time of 29.62 ± 4.27 min. There was one in hospital death postoperatively because of respiratory failure but no other complication. 6 months after the operation, among 30 patients with both atrial ablations, 25 patients were in sinus rhythm, no patient had junctional rhythm and 5 patients had persistent atrial fibrillation. At 12 months follow up, freedom from atrial fibrillation was 85% in radiofrequency group and 80% in cryo group. Doppler echocardiography in these patients demonstrated atrial contractility in 70% of the patients. Intraoperative radiofrequency or cryo-ablation of both atriums are effective and less invasive alternatives for the original maze procedure to eliminate the atrial fibrillation, and can be done in patients with valvular heart disease without increasing the risk of operation.

  3. Left atrial appendage occlusion versus standard medical care in patients with atrial fibrillation and intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Nielsen-Kudsk, Jens Erik; Johnsen, Søren Paaske; Wester, Per

    2017-01-01

    of the composite outcome as compared to patients treated with standard medical care (events/1,000 years [95% confidence interval]: 53.3 [44.3-64.1] vs. 366.7 [298.2-450.9]; hazard ratio 0.16 [0.07-0.37]). CONCLUSIONS: LAAO is suggested to be of major clinical benefit in AF patients having sustained an ICH......AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nordic...... countries with AF and previous ICH who underwent LAAO using the AMPLATZER Cardiac Plug or the AMPLATZER AMULET were compared to a propensity score-matched group of 151 patients receiving standard medical therapy. The two groups were matched so that their risks for stroke and bleeding were similar (CHA2DS2...

  4. Amiodarone significantly decreases atrial fibrillation in patients undergoing surgery for lung cancer.

    Science.gov (United States)

    Riber, Lars P; Christensen, Thomas D; Jensen, Henrik K; Hoejsgaard, Anette; Pilegaard, Hans K

    2012-08-01

    Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing thoracic surgery. Although postoperative atrial fibrillation often is regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including transient or permanent stroke, acute myocardial infarction, and death. A total of 254 consecutively eligible enrolled patients undergoing surgery for lung cancer were included in this randomized, controlled, double-blinded trial. Patients received 300 mg of amiodarone or placebo intravenously over 20 minutes immediately after surgery and an oral dose of 600 mg of amiodarone or placebo twice daily during the first 5 postoperative days. The patients in the amiodarone prophylaxis group had a reduction in the risk of atrial fibrillation of 23% (12 to 31); number needed to treat was 4.4 (3.1 to 7.8). A total of 38 in the control group and 11 in the amiodarone group experienced atrial fibrillation (pamiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for patients with lung cancer undergoing surgery. It significantly reduced the incidence of postoperative atrial fibrillation. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Bang, Casper N; Okin, Peter M; Køber, Lars

    2014-01-01

    ); higher hemoglobin (6.3 ± 2.2 vs. 6.0 ± 2.7 mmol/l) and prevalence of diabetes (20.6 vs. 12.8%, P ≤ 0.004) than patients without psoriasis. In multivariable Cox analysis, adjusting for age, sex, hemoglobin, diabetes, time-varying SBP, heart rate, study treatment and Sokolow-Lyon hypertrophy, psoriasis...... has a similar prevalence in hypertensive patients as in the general population. Psoriasis independently predicted new-onset atrial fibrillation despite lower age and electrocardiographic LVH in psoriasis patients than in patients without psoriasis.......BACKGROUND: Inflammation contributes to the pathogenesis of psoriasis as well as atrial fibrillation. The impact of psoriasis and its association with new-onset atrial fibrillation was assessed in hypertensive patients with left ventricular hypertrophy (LVH). METHODS: The predictive value...

  6. Visualisation during ablation of atrial fibrillation - stimulating the patient's own resources

    DEFF Research Database (Denmark)

    Nørgaard, Marianne W.; Pedersen, Preben Ulrich; Bjerrum, Merete

    2015-01-01

    BACKGROUND: Going through ablation of atrial fibrillation can be accompanied by pain and discomfort when a light, conscious sedation is used. Visualisation has been shown to reduce the patients' perception of pain and anxiety during invasive procedures, when it is used together with the usual pain...... management. PURPOSE: The purpose of this study was to investigate patients' experiences with visualisation in relation to pain and anxiety during an intervention consisting of visualisation, when undergoing ablation of atrial fibrillation. METHODS: Qualitative interviews were conducted with 14 patients from...... of managing anxiety' and 'benefits of visualisation'. The transversal analyses revealed two overall themes which highlight the experiences of being guided in visualisation during ablation of atrial fibrillation: 'stimulation of the patients' own resources' and 'being satisfied without complete analgesia...

  7. [New Treatment for Vascular Thrombosis Prevention in Patients With Atrial Fibrillation: Left Atrial Appendage Occlusion].

    Science.gov (United States)

    Lin, Chen-Wei; Wang, Shiao-Pei

    2017-06-01

    Atrial fibrillation (AF) is a common type of arrhythmia that increases significantly the risk of blood clots in the heart and of stroke. Therefore, stroke prevention is a key goal of AF treatment. In the past, patients were required to take anticoagulants for the remainder of their life, to regularly the monitor international normalized ratio (INR) of prothrombin time (PT), and to avoid possible negative interactions with various drugs and foods. Left atrial appendage occlusion (LAAO), a novel device and technique, was thus developed for AF patients with contraindications to anticoagulants and a high risk of bleeding. When using this technique, the occluder is placed on the left atrial appendage in order to effectively prevent blood stasis and thrombi accumulation. Transesophageal echocardiogram and computed tomography are conducted prior to the LAAO procedure, which is similar to the procedure used for cardiac catheterization. After the LAAO procedure, the patient remains in the intensive care unit (ICU), where vital signs, bleeding at the puncture site, and pericardial tamponade complications are monitored. Health education on daily activities, anticoagulant use, and regular follow-up should be given prior to hospital discharge. While LAAO may not reduce the incidence of stroke, the benefits of this procedure include a significant reduction in bleeding complications as compared to procedures that use oral anticoagulants. Further studies including long-term follow up and in-depth examinations of this procedure are necessary. The present article offers a reference for clinical staffs who are responsible for the care of patients treated using the LAAO procedure.

  8. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation...... progression was defined as a ≥3-point worsening on the Scandinavian Stroke Scale during the first 48 h after randomization. Blood samples were analyzed for D-dimer, prothrombin fragment 1 + 2, soluble fibrin monomer, and C-reactive protein. Results -  A total of 382 patients were included in the analyses...

  9. Assessment of left atrial volume and function in patients with permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James

    2014-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how...

  10. Late Sodium Current in Human Atrial Cardiomyocytes from Patients in Sinus Rhythm and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Poulet, Claire; Wettwer, Erich; Grunnet, Morten

    2015-01-01

    Slowly inactivating Na+ channels conducting "late" Na+ current (INa,late) contribute to ventricular arrhythmogenesis under pathological conditions. INa,late was also reported to play a role in chronic atrial fibrillation (AF). The objective of this study was to investigate INa,late in human right...

  11. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Raatikainen, M J Pekka; Hakalahti, Antti; Uusimaa, Paavo

    2015-01-01

    BACKGROUND: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order...

  12. Left ventricular diastolic dysfunction and N-terminal probrain sodium-uretic peptid level in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dzyak G.V.

    2013-06-01

    Full Text Available In our study 100 consecutive non-valvular permanent atrial fibrillation patients with NYHA I – III heart failure, 43 - 86 years old (65 men and 35 women were examined. Control group consisted of 30 patients with arterial hypertension and coronary artery disease matched by age, sex with basic group. Relationship of NT-proBNP with echocardiographic parameters of left heart were studied. Transthoracic echocardiography with tissue doppler measurements were performed on echocardiograph “SONOS 7500”. For left ventricular filling pressure assessment ratio Em/Ea was used due to its diagnostic value in atrial fibrillation (regardless of left ventricular ejection fraction. Mean left ventricular filling pressure was increased in patients with heart failure: in atrial fibrillation group and controls as well. In comparison with controls atrial fibrillation group was more likely to have higher both systolic and diastolic left atrial square and volume. According to Em/Ea in 95% of patients with non-valvular atrial fibrillation high left ventricular filling pressure was observed, this testifies to diastolic dysfunction. This parameter correlated well with left atrial square and volume during systole and diastole. Correlation between NT pro-BNP level and NYHA class of heart failure, left ventricular filling pressure was determined in patients with atrial fibrillation. Tissue doppler echocardiography makes it possible to diagnose left ventricular diastolic dysfunction in atrial fibrillation patients.

  13. Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects

    NARCIS (Netherlands)

    Teuwen, C.P.; Ramdjan, T.T.; Gotte, M.; Brundel, B.J.; Evertz, R.; Vriend, J.W.; Molhoek, S.G.; Dorman, H.G.; Opstal, J.M. van; Konings, T.C.; Voort, P. van der; Delacretaz, E.; Houck, C.; Yaksh, A.; Jansz, L.J.; Witsenburg, M.; Roos-Hesselink, J.W.; Triedman, J.K.; Bogers, A.J.; Groot, N.M. de

    2015-01-01

    BACKGROUND: The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the

  14. Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects

    NARCIS (Netherlands)

    Teuwen, Christophe P.; Ramdjan, Tanwier T. T. K.; Gotte, Marco; Brundel, Bianca J. J. M.; Evertz, Reinder; Vriend, Joris W. J.; Molhoek, Sander G.; Dorman, Henderikus G. R.; van Opstal, Jurren M.; Konings, Thelma C.; van der Voort, Pepijn; Delacretaz, Etienne; Houck, Charlotte; Yaksh, Ameeta; Jansz, Luca. J.; Witsenburg, Maarten; Roos-Hesselink, Jolien W.; Triedman, John K.; Bogers, Ad J. J. C.; de Groot, Natasja M. S.

    2015-01-01

    Background The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the

  15. The predictive role of E/e' on ischemic stroke and atrial fibrillation in Japanese patients without atrial fibrillation.

    Science.gov (United States)

    Arai, Riku; Suzuki, Shinya; Semba, Hiroaki; Arita, Takuto; Yagi, Naoharu; Otsuka, Takayuki; Sagara, Koichi; Sasaki, Kenichi; Kano, Hiroto; Matsuno, Shunsuke; Kato, Yuko; Uejima, Tokuhisa; Oikawa, Yuji; Kunihara, Takashi; Yajima, Junji; Yamashita, Takeshi

    2018-02-13

    The predictive role of E/e' on ischemic stroke (IS) and atrial fibrillation (AF) in Japanese patients without AF are unclear. Shinken database includes all the new patients visiting the Cardiovascular Institute Hospital in Tokyo, Japan. E/e' has been routinely measured since 2007. Patients without AF for whom E/e' was measured at the initial visit between 2007 and 2014 (n=11 477, mean age 57.2 years old, men 59.5%) were divided into E/e' tertiles (11.00). During the mean follow-up period of 1.8 years, 58 IS and 140 new appearances of AF were observed. High E/e' tertile was associated with more prevalence of atherothrombotic risks. The cumulative incidence of IS events and new appearance of AF at 6 years in low, middle, and high E/e' tertiles were 0.5%, 1.4%, and 3.0%/year (log-rank test, pE/e' tertile was independently associated with IS (HR, 2.857, 95%CI 1.257-6.495, p=0.012). Although high E/e' tertile was independently associated with new appearance of AF when adjusted for coexistence of atherothrombotic risk factors (HR, 1.694, 95%CI, 1.097-2.616, p=0.017), the association was attenuated after adjustment for left atrial dimension. E/e' was significantly associated with incidence of IS and new appearance of AF in non-AF patients. Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  16. Concomitant ablation for atrial fibrillation during septal myectomy in patients with hypertrophic obstructive cardiomyopathy.

    Science.gov (United States)

    Bogachev-Prokophiev, Alexander V; Afanasyev, Alexander V; Zheleznev, Sergei I; Pivkin, Alexei N; Fomenko, Michael S; Sharifulin, Ravil M; Karaskov, Alexander M

    2017-09-01

    The appearance of atrial fibrillation is associated with significant clinical deterioration in patients with obstructive hypertrophic cardiomyopathy; therefore, maintenance of sinus rhythm is desirable. Guidelines and most articles have reported the results of catheter ablation and pharmacologic atrial fibrillation treatment; nevertheless, data regarding concomitant procedures during septal myectomy are limited. The aim of this study was to assess the outcomes of concomitant atrial fibrillation treatment in patients with obstructive hypertrophic cardiomyopathy. Between 2010 and 2013 in our clinic, 187 patients with obstructive hypertrophic cardiomyopathy underwent extended myectomy. In 45 cases, concomitant Cox-Maze IV procedure was performed; however, obstructive hypertrophic cardiomyopathy was the primary indication for surgery. Atrial fibrillation was paroxysmal in 26 patients (58%) and nonparoxysmal in 19 patients (42%). The mean age of patients was 52.8 ± 14.2 years (range, 22-74 years). Mean peak gradient was 90.7 ± 24.2 mm Hg, and interventricular septum thickness was 26.1 ± 4.3 mm. Mean atrial fibrillation duration was 17.3 ± 8.5 months. There were no early deaths. No procedure-related complications occurred with regard to ablation procedure. Complete atrioventricular block was achieved in 2 patients (4.0%). Mean crossclamping time was 61 ± 36 minutes. Peak left ventricular outflow tract gradient was 12.6 ± 5.5 mm Hg based on transesophageal echocardiography. The Maze IV procedure was used for ablation in all patients (radiofrequency ablation with bipolar clamp + cryolesion for mitral and tricuspid lines). Because of the atrial wall thickness (5-6 mm), applications were performed 8 to 10 times on each line. There were no cases of pacemaker implantation due to sinus node dysfunction. All patients were discharged in stable sinus rhythm. Mean follow-up was 23.7 ± 1.3 months. The rate of atrial fibrillation freedom was 100% (45

  17. Quality of life in patients with paroxysmal atrial fibrillation and its predictors : importance of the autonomic nervous system

    NARCIS (Netherlands)

    van den Berg, M.P; Hassink, R.J; Tuinenburg, A.E; van Sonderen, E.; Lefrandt, J.D; Kam, P.J; van Gelder, Isabelle; Smit, A.J; Sanderman, R.; Crijns, H.J G M

    Aims To determine the impact of paroxysmal atrial fibrillation on quality of life and to determine the predictors of quality of life, particularly the role of symptomatology and autonomic function. Methods and Results The study group comprised 73 patients with paroxysmal atrial fibrillation (mean

  18. Hospitalisation patterns change over time in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Fristrup Qvist, Janne; Høgh Sørensen, Pernille; Dixen, Ulrik

    2014-01-01

    INTRODUCTION: Atrial fibrillation (AF) is a cardiac epidemic. In this study, we aimed to describe the causes of hospital-isation in an AF population over time and to study how different AF treatment strategies affected hospitalization. MATERIAL AND METHODS: This was an observational study in which...... long-term follow-up data were collected from hospital records, discharge papers and diagnostic codes. The study population (n = 156) was observed over a total period of ten years which was divided into two successive observation periods (OP), OP1 and OP2. Fourteen endpoints of cardiovascular...... hospitalisations were evaluated. RESULTS: The causes of hospitalisation shifted over time. We observed a lower proportion of admissions due to AF in OP2 (63%) than in OP1 (87%) and a higher proportion of admissions due to congestive heart failure (16% versus 3%) and of days of inpatient care due to ischaemic...

  19. Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; Thomas, L.; Alings, M.; Atar, D.; Aylward, P.; Goto, S.; Hanna, M.; Huber, K.; Husted, S.; Lewis, B.S.; McMurray, J.J.; Pais, P.; Pouleur, H.; Steg, P.G.; Verheugt, F.W.A.; Wojdyla, D.M.; Granger, C.B.; Wallentin, L.

    2014-01-01

    AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was

  20. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R

    2012-01-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients...

  1. Effect of clopidogrel added to aspirin in patients with atrial fibrillation

    NARCIS (Netherlands)

    Connolly, Stuart J.; Pogue, Janice; Hart, Robert G.; Hohnloser, Stefan H.; Pfeffer, Marc; Chrolavicius, Susan; Yusuf, Salim; Connolly, S. J.; Yusuf, S.; Camm, J.; Chrolavicius, S.; Commerford, P.; Flather, M.; Hart, R. G.; Hohnloser, S. H.; Joyner, C.; Pfeffer, M.; Gaudin, C.; Blumenthal, M.; Marchese, C.; Pogue, J.; Hart, R.; Hohnloser, S.; Anand, I.; Arthur, H.; Avezum, A.; Budaj, A.; Ceremuzynski, L.; de Caterina, R.; Diaz, R.; Dorian, P.; Flaker, G.; Fox, K. A. A.; Franzosi, M. G.; Goldhaber, S.; Golitsyn, S.; Granger, C.; Halon, D.; Hermosillo, A.; Hunt, D.; Jansky, P.; Karatzas, N.; Keltai, M.; Kozan, O.; Lanas, F.; Lau, C. P.; Le Heuzey, J. Y.; Lewis, B. S.; Morais, J.; Morillo, C.; Paolasso, E.; Peters, R. J.; Pfisterer, M.; Piegas, L.; Pipilis, A.; Sitkei, E.; Swedberg, K.; Talajic, M.; Valentin, V.; van Mieghem, W.; Varigos, J.; Ameriso, S.; Atra, M.; Berwanger, O.; Bonilla, C.; Bornstein, N.; Chamiec, T.; Chan, Y. K.; Cottin, Y.; Csiba, L.; Cybulski, J.; Czepiel, A.; de Raedt, H.; Dvorakova, H.; Eikelboom, J.; Ergene, O.; Fodor, G.; Galli, M.; Gardinale, E.; Gross, B.; Goodfield, P.; Happola, O.; Healey, J.; Himbert, D.; Jacobsson, F.; Kalvach, P.; Kies, B.; Laine, M.; Lam, A.; Lewis, S.; Leys, D.; Maggioni, A. P.; Massaro, A.; Mayosi, B. M.; Norrving, B.; Okay, T.; Olah, L.; Osende, J. O.; Oto, A.; Peeters, A.; Penicka, M.; Perakis, A.; Pizzolato, G.; Rafti, F.; Renkin, J.; Siva, A.; Steg, P. G.; Stockins, B.; Strozynska, E.; Turazza, F.; Vanderhoven, L.; Vizel, S.; Widimsky, P.; Zaborski, J.; Albers, G.; Hankey, G.; Shuaib, A.; Silva, J.; Wyse, D. G.; Cairns, J. A.; Gent, M.; Hirsh, J.; Marler, J.; Pritchett, E.; Wittes, J.; Beresh, H.; Floyd, L.; Gasic, Z.; Holadyk-Gris, I.; Lawrence, M.; Moro, I.; Perry, S.; Roberts, J.; Rodrigues, T.; Robinson, L.; Stevens, C.; Worthy, L.; Yuan, F.; Ahuad Guerrero, R. A.; Allall, O.; Amuchastegui, L. M.; Boskis, M.; Bustamante Labarta, M. H.; Castellanos, C. R.; Chiale, P.; Cuneo, C. A.; Czcczuo, A.; Gabito, A. J.; Garrido, M.; Guzmán, L. A.; Hasban, E. G.; Hershson, A. R.; Hominal, M. A.; Krauss, J. G.; Luciardi, H. L.; Marzetti, E. M.; Montaña, O. R.; Rabinovich, R. F.; Ramos, H. R.; Sanchez, A. S.; Schygiel, P. O.; Sumay, G. M.; Vogel, D. R.; Zaidman, C. J.; Aroney, G. M.; Ashby, D. T.; Barlow, M. A.; Cooke, P.; Cross, D. B.; Fitzpatrick, M. A.; Garrahy, P.; Karrasch, J.; Nelson, G. I.; Rees, D.; Roger, S. D.; Rogers, J.; Singh, B. B.; Stickland, J. F.; Waites, J. H.; Walsh, W. F.; Eichinger, J.; Huber, K.; Leisch, F.; Boland, J.; Conraads, V. M.; Cools, F. J. C.; de Roy, L.; El Allaf, D.; Mairesse, G. H.; Vankelecom, B.; Abrantes, J.; Armaganijan, D.; Atié, J.; Blacher, C.; Bodanese, L. C.; Braga, J. C. F.; Braile, M. V.; Chaves, H.; Coelho, O. R.; Cunha, C. L. P.; de Lima, G. G.; de Paola, A. A. V.; Esteves, J. P.; Francischetti, A.; Francischetti, A. E.; Lorga-Filho, A. M.; Maia, L. N.; Marcussi, D. M.; Marin-Neto, J. A.; Meneghelo, Z. M.; Rocha, R. Mourilhe; Nogueira, P. R.; Oigman, W.; Paiva, M.; Précoma, D. B.; Rabelo, W.; Rabelo, A.; Rassi, S.; Rassi, A.; Reis, G.; Rossi, P. R.; Rossi Neto, J. M.; Saraiva, J. K.; Sobral-Filho, D. C.; Zimmermann, S. L.; Ashton, T. A.; Bhargava, R.; Carroll, S.; Chehayeb, R.; Connors, S. P.; Constance, C.; Costi, P.; Coutu, B.; Crystal, E.; Douketis, J. D.; Fortin, C.; Fox, B. A.; Gupta, M. K.; Krahn, A. D.; Kuritzky, R.; Kwok, K.; Leader, R.; Ma, P.; Mangat, I.; Maranda, C. R.; Matangi, M. F.; Moddel, G.; Mukherjee, A.; Nawaz, S.; Palaic, M.; Pandey, A. S.; Rebane, T. M.; Ruel, M.; Sapp, J. L.; Senaratne, M. P.; St-Hilaire, R.; Talbot, P.; To, T. B.; Vakani, M.; Weigel, M. A.; Wulffhart, Z.; Yao, L.; Zaniol, D.; Conejeros, C. R.; Corbalán, R.; Dussaillant, G. R.; Escobar, E.; Hassi, M. E.; Parra, C. A.; Stockins, B. A.; Varleta, P. E.; Berka, L.; Dedek, V.; Florian, J.; Hejhal, O.; Herold, M.; Klimsa, Z.; Kotik, I.; Simon, J.; Smetana, K.; Spinar, J.; Spinarová, L.; Tousek, F.; Husted, S.; Nielsen, T.; Pehrson, S.; Tuxen, C.; Harjola, V. P.; Huikuri, H. V.; Kettunen, R. V. J.; Melin, J. H.; Peuhkurinen, K.; Carlioz, R.; Coisne, D.; Decoulx, E.; Defaye, P.; Demarcq, J. M.; Gacem, K.; Galley, D. L.; Lardoux, H. M.; Mabo, P.; Mansour, M.; Olive, T. G.; Poulard, J. E.; Pruvot, C. F.; Rey, J. L.; Bauer, W. R.; Baumann, G.; Berghöfer, G.; Boehm, G.; Borggrefe, M. M.; Brücker, G.; Darius, H.; Duray, G. Z.; Felix, S. B.; Fink, P.; Fritz, H.; Haberl, R.; Hoffmann, S.; Horacek, T.; Kalusche, D. W.; Kasper, W.; Katus, H. A.; Klepzig, H. H.; Loos, U.; Merher, R.; Munzel, T.; Neuzner, J.; Ochs, H. R.; Pieske, B.; Pollock, B. W.; Schmidt, A.; Schumacher, M.; Seidl, K.; Speier, U.; Spitzer, S. G.; Stenzel, G.; Volkmann, H.; Wunderlich, J.; Zacharzowsky, U.; Antonakoudis, H.; Georgakopoulos, N.; Goudevenos, J. A.; Iliopoulos, T. A.; Kallikazaros, I.; Pyrgakis, V. N.; Skoufas, P.; Chan, W. K.; Chan, H. W.; Fung, J. W. H.; Li, S. K.; Wong, K. S.; Forster, T.; Kárpáti, P.; Keltai, K.; Kovacs, A.; Kurta, G.; Laszlo, Z.; Rapi, J.; Regos, L.; Rostas, L.; Szakál, I.; Tomcsanyi, J.; Toth, C.; Bloch, L.; Khader, N.; Klainman, E.; Koukoui, D.; Lotan, C.; Marmor, A.; Omary, M. Z.; Reisin, L. H.; Vered, Z.; Zeltser, D.; Zimlichman, R.; Bianconi, L.; Bicego, D.; Cosmi, D.; Filigheddu, F.; Garini, A.; Lunati, M.; Moretti, L.; Mos, L.; Pontiroli, A. E.; Renda, G.; Ricci, S.; Rossi, P.; Santonastaso, M.; Scioli, G. A.; Stramba-Badiale, M.; Terrosu, P.; Omar, R.; Ong, T. K.; Ahmad, W. A. Wan; Alvarado, R.; Calvo, C.; Cordero-Cabra, J. A.; Hernández, I.; Jerjes-Sanchez, C.; Lara, S.; Lopez Rosas, E.; Molina, L.; Morales, E.; Petersen-Aranguren, F.; Picos Bovio, E. M.; Pozas, G.; Robles Torres, F. J.; Holwerda, K.; Lok, D. J. A.; Nierop, R.; Pieterse, M. G. C.; van der Heijden, R.; van Kempen, L.; Oie, B. K.; Omland, T. M.; Otterstad, J.; von Brandis, C.; Bronisz, M.; Chizynski, K.; Czerski, T.; Dluzniewski, M.; Gessek, J.; Gieroba, A.; Gniot, J. R.; Gorny, J.; Halaczuiewicz, H.; Janik, K.; Janion, M.; Jerzykowska, O.; Kawka-Urbanek, T.; Kincel, K.; Kocon, S.; Kopaczewski, J.; Krasowski, W.; Makuch, M.; Malinowski, S.; Miastkowski, Z.; Mickiewicz-Pawlowska, M.; Miekus, P.; Obrebska-Tabaczka, E.; Ogorek, M.; Piasecka-Krysiak, E.; Piepiorka, A. W.; Piotrowski, W.; Pluta, W.; Puzio, E.; Rekosz, J.; Sinkiewicz, W.; Stopinski, M.; Szelemej, R.; Tendera, M.; Trusz-Gluza, M.; Wilkoszynski, M.; Zalska, B.; Antunes, E.; Carrageta, M. O.; de Sousa, J.; Martins, L.; Mendonca, M. I.; Silvestre, I.; Akatova, E. V.; Aleksandrov, V.; Antuch, E. A.; Arutyunov, G.; Bart, B.; Belousov, Y. B.; Chernichka, I. I.; Dovgalevsky, P.; Gratsiansky, N.; Ivleva, A. Y.; Kislyak, O. A.; Mareyev, V. Y.; Maykov, E. B.; Milyagin, V.; Novikova, T. N.; Panchenko, E. P.; Reshetko, O.; Semernin, E.; Sidorenko, B. A.; Sinopalnikov, A.; Skvortsova, V.; Solomatin, A.; Sukhinina, T. S.; Suslina, Z. A.; Titkov, Y.; Tsyrline, V.; Chan, B.; Foo, D.; Omar, A. R.; teo, W. S.; Brown, B. G.; Ebrahim, I. O.; Gibson, G. J.; Klug, E.; Marx, J. D.; Mntla, P. S.; Okreglicki, A.; Pretorius, M.; Roos, J. S.; Snyders, F.; van Zyl, L. J.; Cano, L.; Garcia-Puig, J.; Hernandez-Madrid, A.; Mostaza, J. M.; Orriach, M. D.; Sabate, X.; Viñolas, X.; Blomström, P.; Johansson, L.; Klintberg, L.; Lycksell, M.; Nilsson, O.; Rasmanis, G.; Nilehn, K. E. Saldeen; Ulvenstam, G.; Baumgartner, R. W.; François, M.; Gallino, A.; Moccetti, T.; Tettenborn, B. E.; Chou, H.-T.; Kuo, J.-Y.; Lai, W.-T.; Lin, J. L.; Lin, L.-J.; Ueng, K. C.; Yeih, D.-F.; Bakar, M.; Ilerigelen, B.; Kumral, E.; Nisanci, Y.; Savas, Z. I.; Adgey, Y.; Brack, M. J.; Cleland, J.; Davey, P. P.; Davies, J.; Glen, S. K.; Jennings, K.; Levy, T.; Lip, G. Y. H.; Moriarty, A. J.; Pearson, C.; Purvis, J. A.; Pye, M. P.; Savelieva, I.; Senior, R.; Trouton, T. G.; Ahmed, I. S.; Amin, M.; Anderson, J. L.; Bauernfeind, R. A.; Belew, K.; Bilazarian, S. D.; Black, R. A.; Burton, M. E.; Cebe, J. E.; Chandrashekhar, Y. S.; Chen, C.; Das, D.; Denny, D. M.; Desai, V.; Fahmy, R. N.; Fishbein, G. J.; Gelernt, M. D.; Gerber, J.; Goldberg, M. C.; Grena, P. G.; Honan, M. B.; Hunter, J. J.; Jacobson, J.; Jarmukli, N. F.; Klancke, K.; Kobayashi, J. F.; Lewis, S. J.; Little, T.; Mallis, I.; Marani, A. M.; Marshall, J. J.; Meltzer, P.; Menapace, F. J.; O'Neill, P. G.; Pearce, D. J.; Quick, A.; Ravipudi, S.; Rivera, E.; Sackett, M.; Salerno, D. M.; Schussheim, A.; Sheikh, K.; Shettigar, U. R.; Treasure, C. B.; Vidaillet, H.; Vijay, N.; Wagner, D.; Walker, J. L.; Winters, S. L.; Young, D. R.; Zoble, R. G.

    2009-01-01

    BACKGROUND: 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

  2. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy...

  3. Temporal trends in the prescription of vitamin K antagonists in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Friberg, J; Gislason, G H; Gadsbøll, N

    2006-01-01

    OBJECTIVES: Anticoagulation therapy is recommended in patients with atrial fibrillation (AF) and risk factors for stroke. We studied the temporal trends in the prescription of vitamin K antagonists (VKA) in patients with a first hospital diagnosis of AF in Denmark, 1995-2002. DESIGN: The Danish...

  4. Non-Vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, L.; Fosbøl, E L; Gadsbøll, K.

    2016-01-01

    Among atrial fibrillation (AF) patients, Danish nationwide registries (2011-2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29...

  5. Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Fosbøl, Emil Loldrup; Gadsbøll, Kasper

    2016-01-01

    Among atrial fibrillation (AF) patients, Danish nationwide registries (2011-2015) were used to examine temporal trends of initiation patterns of oral anticoagulation (OAC) treatment according to age. Overall, 43,299 AF patients initiating vitamin K antagonists (VKA) (42%), dabigatran (29...

  6. Association of left atrial function and left atrial enhancement in patients with atrial fibrillation: cardiac magnetic resonance study.

    Science.gov (United States)

    Habibi, Mohammadali; Lima, Joao A C; Khurram, Irfan M; Zimmerman, Stefan L; Zipunnikov, Vadim; Fukumoto, Kotaro; Spragg, David; Ashikaga, Hiroshi; Rickard, John; Marine, Joseph E; Calkins, Hugh; Nazarian, Saman

    2015-02-01

    Atrial fibrillation (AF) is associated with left atrial (LA) structural and functional changes. Cardiac magnetic resonance late gadolinium enhancement (LGE) and feature-tracking are capable of noninvasive quantification of LA fibrosis and myocardial motion, respectively. We sought to examine the association of phasic LA function with LA enhancement in patients with AF. LA structure and function was measured in 90 patients with AF (age 61±10 years; 76% men) referred for ablation and 14 healthy volunteers. Peak global longitudinal LA strain, LA systolic strain rate, and early and late diastolic strain rates were measured using cine-cardiac magnetic resonance images acquired during sinus rhythm. The degree of LGE was quantified. Compared with patients with paroxysmal AF (60% of cohort), those with persistent AF had larger maximum LA volume index (56±17 versus 49±13 mL/m(2); P=0.036), and increased LGE (27.1±11.7% versus 36.8±14.8%; Prate, early diastolic strain rate, and late diastolic strain rate) were lower in patients with persistent AF (Prate, early diastolic strain rate, and late diastolic strain rate (Pmeasurement of LA function using feature-tracking cardiac magnetic resonance may add important information about the physiological importance of LA fibrosis. © 2015 American Heart Association, Inc.

  7. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar

    2012-01-01

    To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.......To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke....

  8. Genetic aspects of atrial fibrillation

    NARCIS (Netherlands)

    Wiesfeld, ACP; Hemels, MEW; Van Tintelen, JP; Van den Berg, MP; Van Veldhuisen, DJ; Van Gelder, IC

    2005-01-01

    Atrial fibrillation (AF) occurs predominantly in the elderly and is commonly associated with underlying cardiac diseases. A significant number of patients, however, have early onset AF that is not associated with any underlying disease. At present, it is unknown how often this form of AF is familial

  9. Atrial mapping and radiofrequency catheter ablation in patients with idiopathic atrial fibrillation. Electrophysiological findings and ablation results.

    Science.gov (United States)

    Gaita, F; Riccardi, R; Calò, L; Scaglione, M; Garberoglio, L; Antolini, R; Kirchner, M; Lamberti, F; Richiardi, E

    1998-06-02

    Knowledge of the electrophysiological substrates and the cure of atrial fibrillation (AF) is still unsatisfactory. The goal of this study was to evaluate the electrophysiological features of idiopathic AF and their relationship to the results of radiofrequency (RF) catheter ablation of AF and the safety and effectiveness of this procedure. Sixteen patients with idiopathic AF underwent atrial mapping during AF and then RF ablation in the right atrium. The atrial activation was simultaneously recorded in four regions in the right atrium: high lateral wall (HL), low lateral wall (LL), high septum (HS), and low septum (LS) and in the left atrium through the coronary sinus (CS). In these regions, we evaluated the atrial fibrillation intervals (FF) and the morphological features of AF recordings by Wells' classification. No complications occurred during RF ablation. Of the 16 patients, 9 (56%) without AF recurrences during the follow-up (11 +/- 4 months) were considered successfully ablated. These patients showed a significantly shorter mean FF interval in the HS and the LS (122 +/- 32 and 126 +/- 28 ms, respectively), than in the HL and LL (159 +/- 24 and 156 +/- 28 ms, respectively). Moreover, the septum had more irregular electrical activity with greater beat-to-beat changes in FF and a higher prevalence of type III AF than the lateral region. The CS had similar behavior to the septum. Conversely, patients with unsuccessful ablation had an irregular atrial activity in the lateral wall, septum, and CS with no significant differences between the different sites. Right atrial endocardial catheter ablation of AF is a safe procedure and may be effective in some patients with idiopathic AF. The atrial mapping during AF showed a more disorganized right atrial activation in the septum than in the lateral wall in patients with successful ablation.

  10. [Atrial fibrillation before and after pacemaker implantation (WI and DDD) in patients with complete atrioventricular block].

    Science.gov (United States)

    Matusik, Paweł; Woznica, Natalia; Lelakowsk, Jacek

    2010-05-01

    Atrial fibrillation (AF) is a frequent problem of patients with pacemakers, and depends not only on disease but also on stimulation method. The aim of the study was to estimate the prevalence of AF before and after pacemaker implantation as well as to assess the influence of VVI and DDD cardiac pacing on onset of AF in patients with complete atrioventricularblock (AVB). We included 155 patients controlled between 2000 and 2008 in Pacemaker Clinic because of AVB III degree, treated with VVI or DDD pacemaker implantation. Information about the health status of the patients was gathered from medical documentation and analysis of clinical ambulatory electrocardiograms. The study group comprised of 68 women and 87 men, mean age 68.7 +/- 13.9 years during implantation. 69% of patients had VVI pacemaker. There were 72.3% of patients with sinus rhythm before pacemaker implantation. During follow-up 4 +/- 2.8 years in 19.6% cases onset of atrial fibrillation de novo was diagnosed (in 31.3% in VVI mode vs. 2.2% in DDD mode; p = 0.00014). Mean time to AF since implantation was approximately 2.5 years. In VVI group (21 persons) amounted 32.1 months, while in 1 patient with DDD pacemaker 18 months. Between group with AF after implantation and with sinus rhythm preserved there was no statistically significant difference in age or gender (p = 0.89512 and p = 0.1253, respectively). Prevalence of atrial fibrillation after pacemaker implantation increased to 40%. Atrial fibrillation is frequent in patients before and after pacemaker implantation, especially in patients stimulated in VVI mode. Major possibility of atrial fibrillation onset after pacemaker implantation should result in more attention during routine ECG examination.

  11. RR-Interval variance of electrocardiogram for atrial fibrillation detection

    Science.gov (United States)

    Nuryani, N.; Solikhah, M.; Nugoho, A. S.; Afdala, A.; Anzihory, E.

    2016-11-01

    Atrial fibrillation is a serious heart problem originated from the upper chamber of the heart. The common indication of atrial fibrillation is irregularity of R peak-to-R-peak time interval, which is shortly called RR interval. The irregularity could be represented using variance or spread of RR interval. This article presents a system to detect atrial fibrillation using variances. Using clinical data of patients with atrial fibrillation attack, it is shown that the variance of electrocardiographic RR interval are higher during atrial fibrillation, compared to the normal one. Utilizing a simple detection technique and variances of RR intervals, we find a good performance of atrial fibrillation detection.

  12. Restoring sinus rhythm in patients with previous pacemaker implantation submitted to cardiac surgery and concomitant surgical ablation of atrial fibrillation.

    Science.gov (United States)

    Marques, Marta P; Melo, João Q; Knaut, Michel; Alfieri, Ottavio; Benussi, Stefano; Williams, Mathew R; Hornero, Fernando

    2008-04-01

    Some patients submitted to cardiac surgery have concomitant atrial fibrillation and a previously implanted pacemaker. Because it is unknown if there is any potential for these patients to reassume a regular rate sinus rhythm after ablation of atrial fibrillation, we reviewed the results of all patients with pacemaker enrolled in the Registry of Atrial Fibrillation. Thirty-six patients were included in this study. Twenty-six had valve disease, seven had coronary disease and three had congenital heart disease. They were submitted concomitantly to ablation of atrial fibrillation using biatrial approaches (seven patients), left sided (27), or right sided (three patients). Thirty-three hospital survivors had a mean follow-up of 18 months, and a maximum of 25 months. At 1 year (n=21), patients' rhythm was sinus non-pacing dependent (52%), sinus pacing-dependent (14%), and atrial fibrillation (14%). At 2 years (n=14), patients' rhythm was sinus non-pacing dependent (57%) and atrial fibrillation (43%). The only factor that may have had impact on the recovery of sinus rhythm at 1 year was the small size of the left atrium (p=0.05). We conclude that in a significant number of patients, having a pacemaker before surgery does not preclude sinus rhythm recovery after a cardiac operation and ablation for concomitant atrial fibrillation.

  13. Late Sodium Current in Human Atrial Cardiomyocytes from Patients in Sinus Rhythm and Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Claire Poulet

    Full Text Available Slowly inactivating Na+ channels conducting "late" Na+ current (INa,late contribute to ventricular arrhythmogenesis under pathological conditions. INa,late was also reported to play a role in chronic atrial fibrillation (AF. The objective of this study was to investigate INa,late in human right atrial cardiomyocytes as a putative drug target for treatment of AF. To activate Na+ channels, cardiomyocytes from transgenic mice which exhibit INa,late (ΔKPQ, and right atrial cardiomyocytes from patients in sinus rhythm (SR and AF were voltage clamped at room temperature by 250-ms long test pulses to -30 mV from a holding potential of -80 mV with a 100-ms pre-pulse to -110 mV (protocol I. INa,late at -30 mV was not discernible as deviation from the extrapolated straight line IV-curve between -110 mV and -80 mV in human atrial cells. Therefore, tetrodotoxin (TTX, 10 μM was used to define persistent inward current after 250 ms at -30 mV as INa,late. TTX-sensitive current was 0.27±0.06 pA/pF in ventricular cardiomyocytes from ΔKPQ mice, and amounted to 0.04±0.01 pA/pF and 0.09±0.02 pA/pF in SR and AF human atrial cardiomyocytes, respectively. With protocol II (holding potential -120 mV, pre-pulse to -80 mV TTX-sensitive INa,late was always larger than with protocol I. Ranolazine (30 μM reduced INa,late by 0.02±0.02 pA/pF in SR and 0.09±0.02 pA/pF in AF cells. At physiological temperature (37°C, however, INa,late became insignificant. Plateau phase and upstroke velocity of action potentials (APs recorded with sharp microelectrodes in intact human trabeculae were more sensitive to ranolazine in AF than in SR preparations. Sodium channel subunits expression measured with qPCR was high for SCN5A with no difference between SR and AF. Expression of SCN8A and SCN10A was low in general, and lower in AF than in SR. In conclusion, We confirm for the first time a TTX-sensitive current (INa,late in right atrial cardiomyocytes from SR and AF patients at room

  14. Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the Swedish Atrial Fibrillation Cohort study.

    Science.gov (United States)

    Friberg, Leif; Benson, Lina; Lip, Gregory Y H

    2015-02-01

    Patients who have both atrial fibrillation (AF) and renal failure have an increased risk of thrombo-embolism. Renal failure is also a risk factor for bleeding, which makes decisions regarding thromboprophylaxis complicated. Our aim was to determine risks for ischaemic stroke and bleeding in patients with AF and renal failure in relation to anticoagulant strategies. This is retrospective non-randomized study of Swedish health registers comprising 307 351 patients with AF, of whom 13 435 had a previous diagnosis of renal failure. Ischaemic stroke occurred more often in AF patients with renal failure (annual rate, 3.9% vs. no renal failure, 2.9%), but this was related to concomitant comorbidities [adjusted hazard ratio (HR) 1.02, 95% confidence interval (CI) 0.95-1.10]. Adding renal failure to the established stroke risk stratification schemes (CHADS2 and CHA2DS2-VASc) did not improve their predictive value. Renal failure was an independent risk factor for intracranial bleeding [adjusted HR: 1.27 (1.09-1.49)]. Most patients with renal failure benefited from warfarin treatment, despite their high bleeding risk. The incidence of the combined endpoint ischaemic or haemorrhagic stroke or death was lower among those who used warfarin than among those who did not use warfarin (adjusted HR: 0.76, CI 0.72-0.80). Patients with both AF and renal failure will probably benefit most from having the same treatment as is recommended for other patients with AF, without setting a higher or lower threshold for treatment. Adding additional points for renal failure to the CHADS2 and CHA2DS2-VASc scores did not improve their predictive value. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  15. Safety and efficacy of anticoagulation for secondary stroke prevention in atrial fibrillation patients: The AMADEUS trial

    NARCIS (Netherlands)

    Lane, D.A.; Kamphuisen, P.W.; Minini, P.; Buller, H.R.; Lip, G.Y.H.

    2010-01-01

    ackground: Patients with atrial fibrillation (AF) and previous ischemic stroke are at high risk of recurrent stroke, but are also perceived to be at increased bleeding risk while treated with anticoagulants. Methods: Post-hoc analyses examined the efficacy and safety of anticoagulation of 4576 AF

  16. Predictors of non-pharmacological intervention in patients with paroxysmal atrial fibrillation : Value of neuroticism

    NARCIS (Netherlands)

    Hemels, Martin E. W.; van den Berg, Maarten P.; Ranchor, Adelita V.; van Sonderen, Eric L. P.; van Gelder, Isabelle C.; van Veldhuisen, Dirk J.

    2006-01-01

    Background: Non-pharmacological intervention is gaining increasing popularity in the treatment of patients with paroxysmal atrial fibrillation. We sought to investigate which factors play a role in the choice for non-pharmacological intervention with a particular focus on neuroticism. Methods: The

  17. Benefits and risks for the individual, anticoagulation for patients with atrial fibrillation

    NARCIS (Netherlands)

    van den Ham, H.A.

    2016-01-01

    In this thesis we explored the individual benefit risk (BR) balance for oral anticoagulants (OACs) used in patients with atrial fibrillation (AF) to prevent ischaemic stroke and other thromboembolisms.We found that compared to vitamin K antagonists (VKAs), non-vitamin K antagonists (NOACs) are

  18. The effect of activation rate on left atrial bipolar voltage in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Williams, Steven E; Linton, Nick; O'Neill, Louisa; Harrison, James; Whitaker, John; Mukherjee, Rahul; Rinaldi, Christopher A; Gill, Jaswinder; Niederer, Steven; Wright, Matthew; O'Neill, Mark

    2017-09-01

    Bipolar voltage is used during electroanatomic mapping to define abnormal myocardium, but the effect of activation rate on bipolar voltage is not known. We hypothesized that bipolar voltage may change in response to activation rate. By examining corresponding unipolar signals we sought to determine the mechanisms of such changes. LA extrastimulus mapping was performed during CS pacing in 10 patients undergoing first time paroxysmal atrial fibrillation ablation. Bipolar and unipolar electrograms were recorded using a PentaRay catheter (4-4-4 spacing) and indifferent IVC electrode, respectively. An S1S2 pacing protocol was delivered with extrastimulus coupling interval reducing from 350 to 200 milliseconds. At each recording site (119 ± 37 per LA), bipolar peak-to-peak voltage, unipolar peak to peak voltage and activation delay between unipole pairs was measured. Four patterns of bipolar voltage/extrastimulus coupling interval curves were seen: voltage attenuation with plateau voltage >1 mV (48 ± 15%) or voltage unaffected by coupling interval with plateau voltage >1 mV (17 ± 10%) or voltage attenuation were associated with significantly greater unipolar voltage attenuation at low (25 ± 28 mV/s vs. 9 ± 11 mV/s) and high (23 ± 29 mV/s vs. 6 ± 12 mV/s) plateau voltage sites (P voltage attenuation (P = 0.026). Bipolar electrogram voltage is dependent on activation rate at a significant proportion of sites. Changes in unipolar voltage and timing underlie these effects. These observations have important implications for use of voltage mapping to delineate abnormal atrial substrate. © 2017 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals, Inc.

  19. Apixaban: Effective and Safe in Preventing Thromboembolic Events in Patients with Atrial Fibrillation and Renal Failure.

    Science.gov (United States)

    Cortese, Francesca; Scicchitano, Pietro; Gesualdo, Michele; Ricci, Gabriella; Carbonara, Santa; Franchini, Carlo; Pia Schiavone, Brigida Immacolata; Corbo, Filomena; Ciccone, Marco Matteo

    2017-11-17

    Thromboembolic events, principally stroke, represent one of the leading causes of morbidity and mortality among subjects with atrial fibrillation. Chronic kidney disease determines a further increase of thromboembolic events, bleeding and mortality and complicates the pharmacological management of patients with atrial fibrillation, mainly due to the side effects of antiarrhythmic and anticoagulant drugs with renal excretion. Apixaban is a new oral anticoagulant characterized by good bioavailability and renal elimination accounting for only 25%, showing a safety profile and effectiveness in patients with renal impairment. In this manuscript, we reviewed literature data on the use of apixaban in the management of non-valvular atrial fibrillation in patients with renal failure, in order to clarify an often-debated topic in clinical practice. A PubMed search was performed on the terms atrial fibrillation, apixaban and renal failure with the aim of identifying relevant manuscripts, large randomized clinical trials, meta-analyses, and current guidelines. Literature data show that apixaban could represent an interesting alternative to warfarin and other selective antagonists of coagulation factors in patients with impaired renal function. About the risk of major bleeding, apixaban appears to be safer than warfarin in the presence of any degree of renal failure. Apixaban show to be an effective anticoagulant in patients with atrial fibrillation, even superior to warfarin in reducing the risk of stroke and systemic embolism regardless of the presence of renal insufficiency. Moreover, Food and Drug Administration allows the use of apixaban in patients with end stage renal disease on hemodialysis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Outcomes for Atrial Fibrillation Patients with Silent Left Atrial Thrombi Detected by Transesophageal Echocardiography.

    Science.gov (United States)

    Inoue, Koichi; Suna, Shinichiro; Iwakura, Katsuomi; Oka, Takafumi; Masuda, Masaharu; Furukawa, Yoshio; Egami, Yasuyuki; Kashiwase, Kazunori; Hirata, Akio; Watanabe, Tetsuya; Takeda, Toshihiro; Mizuno, Hiroya; Minamiguchi, Hitoshi; Kitamura, Tetsuhisa; Dohi, Tomoharu; Nakatani, Daisaku; Hikoso, Shungo; Okuyama, Yuji; Sakata, Yasushi

    2017-09-15

    Although we have occasionally experienced silent thrombi in the left atrium (LA), defined as thrombi free from embolic events, by screening transesophageal echocardiography (TEE) for atrial fibrillation (AF), few data are available on predictors and outcomes of silent LA thrombi in patients with AF. We retrospectively reviewed clinical records and identified 83 patients (2.6%) with silent LA thrombi, out of 4,214 TEE procedures in 3,139 patients with AF at 6 hospitals from January 2010 to December 2012. The median [interquartile range] CHA2DS2-VASc score was 3 [2, 5]. Most patients (n = 71, 86%) were taking oral anticoagulants before the TEE, and 59 patients (71%) had heart failure (HF). During follow-up periods of 905 [620, 1301] days, ischemic stroke and systemic embolism, and hemorrhagic stroke occurred only in 3 (3.6%) and 2 patients (2.4%), respectively. All-cause death developed in 14 patients (17%), and cardiac death was the primary cause of death (n = 9, 11%). Multivariate Cox regression analysis showed the composite end point of death, stroke, systemic embolism, and major bleeding was significantly associated with age (hazard ratio; 1.06, 95% confidence interval; 1.01 to 1.11, p = 0.019) and HF (3.18, 1.27 to 7.99, p = 0.014). In conclusion, the incidence of ischemic stroke after detecting silent LA thrombi was relatively low in patients with AF under oral anticoagulation. Advanced age and HF were predictors for worse outcomes in AF patients with silent LA thrombi. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Ablation of Atrial Fibrillation in Patients with Congenital Heart Disease.

    Science.gov (United States)

    Refaat, Marwan M; Ballout, Jad; Mansour, Moussa

    2017-12-01

    With improved surgical techniques and medical management for patients with congenital heart diseases, more patients are living longer and well into adulthood. This improved survival comes with a price of increased morbidity, mainly secondary to increased risk of tachyarrhythmias. One of the major arrhythmias commonly encountered in this subset of cardiac patients is AF. Similar to the general population, the risk of AF increases with advancing age, and is mainly secondary to the abnormal anatomy, abnormal pressure and volume parameters in the hearts of these patients and to the increased scarring and inflammation seen in the left atrium following multiple surgical procedures. Catheter ablation for AF has been shown to be a very effective treatment modality in patients with refractory AF. However, data and guidelines regarding catheter ablation in patients with congenital heart disease are not well established. This review will shed light on the procedural techniques, success rates and complications of AF catheter ablation in patients with different types of CHD, including atrial septal defects, tetralogy of Fallot, persistent left superior vena cava, heterotaxy syndrome and atrial isomerism, and Ebstein anomaly.

  2. Prognostic importance of a restrictive transmitral filling pattern in patients with symptomatic congestive heart failure and atrial fibrillation

    DEFF Research Database (Denmark)

    Raunsø, Jakob; Møller, Jacob Eifer; Kjaergaard, Jesper

    2009-01-01

    BACKGROUND: Restrictive diastolic filling pattern is associated with increased mortality in patients with myocardial infarction and heart failure. Most studies have excluded patients with atrial fibrillation. The aim of the present study was to assess the prognostic value of a restrictive filling...... pattern in patients with atrial fibrillation. METHODS: Doppler echocardiography including pulsed wave Doppler assessment of transmitral flow was performed in 880 patients with a clinical diagnosis of heart failure on hospital admission. Filling was considered restrictive when the mitral deceleration time...

  3. Left atrial reverse remodeling and prevention of progression of atrial fibrillation with atrial resynchronization device therapy utilizing dual-site right atrial pacing in patients with atrial fibrillation refractory to antiarrhythmic drugs or catheter ablation.

    Science.gov (United States)

    Nagarakanti, Rangadham; Slee, April; Saksena, Sanjeev

    2014-09-01

    Dual-site right atrial pacing (DAP) produces electrical atrial resynchronization but its long-term effect on the atrial mechanical function in patients with refractory atrial fibrillation (AF) has not been studied. Drug-refractory paroxysmal (PAF) and persistent AF (PRAF) patients previously implanted with a dual-site right atrial pacemaker (DAP) with minimal ventricular pacing modes (AAIR or DDDR mode with long AV delay) were studied. Echocardiographic structural (left atrial diameter [LAD] and left ventricular [LV] end diastolic diameter [EDD], end systolic diameter [ESD]) and functional (ejection fraction [EF]) parameters were serially assessed prior to, after medium-term (n = 39) and long-term (n = 34) exposure to DAP. During medium-term follow-up (n = 4.5 months), there was improvement in left atrial function. Mean peak A wave flow velocity increased with DAP as compared to baseline (75 ± 19 vs. 63 ± 23 cm/s, p = 0.003). The long-term impact of DAP was studied with baseline findings being compared with last follow-up data with a mean interval of 37 ± 25 (range 7-145) months. Mean LAD declined from 45 ± 5 mm at baseline to 42 ± 7 mm (p = 0.003). Mean LVEF was unchanged from 52 ± 9 % at baseline and 54 ± 6 % at last follow-up (p = 0.3). There was no significant change in LV dimensions with mean LVEDD being 51 ± 6 mm at baseline and 53 ± 5 mm at last follow-up (p = 0.3). Mean LVESD also remained unchanged from 35 ± 6 mm at baseline to 33 ± 6 mm at last follow-up (p = 0.47). During long-term follow-up, 30 patients (89 %) remained in sinus or atrial paced rhythm as assessed by device diagnostics at 3 years. DAP can achieve long-term atrial reverse remodeling and preserve LV systolic function. DAP when added to antiarrhythmic drug (AAD) and/or catheter ablation (ABL) maintains long-term rhythm control and prevents AF progression in elderly refractory AF patients

  4. Anticoagulant and Antiplatelet Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease

    Science.gov (United States)

    Mischke, Karl; Knackstedt, Christian; Marx, Nikolaus

    2012-01-01

    Anticoagulation represents the mainstay of therapy for most patients with atrial fibrillation. Patients on oral anticoagulation often require concomitant antiplatelet therapy, mostly because of coronary artery disease. After coronary stent implantation, dual antiplatelet therapy is necessary. However, the combination of oral anticoagulation and antiplatelet therapy increases the bleeding risk. Risk scores such as the CHA2DS2-Vasc score and the HAS-BLED score help to identify both bleeding and stroke risk in individual patients. The guidelines of the European Society of Cardiology provide a rather detailed recommendation for patients on oral anticoagulation after coronary stent implantation. However, robust evidence is lacking for some of the recommendations, and especially for new oral anticoagulants and new antiplatelets few or no data are available. This review addresses some of the critical points of the guidelines and discusses potential advantages of new anticoagulants in patients with atrial fibrillation after stent implantation. PMID:22577538

  5. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention

    DEFF Research Database (Denmark)

    Lamberts, Morten; Olesen, Jonas Bjerring; Ruwald, Martin Huth

    2012-01-01

    Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary int...

  6. Adherence and Coagulation Assays in Dabigatran-treated Patients With Atrial Fibrillation

    Science.gov (United States)

    2017-09-12

    Atrial Fibrillation; Medication Adherence; Blood Coagulation Tests; Anticoagulants; Circulating, Hemorrhagic Disorder; Drug Effect; Drug Use; Drug Toxicity; Drug Intolerance; Blood Clot; Blood Coagulation Disorder; Laboratory Problem; Bleeding; Thrombosis

  7. Very early-onset lone atrial fibrillation patients have a high prevalence of rare variants in genes previously associated with atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Morten S; Andreasen, Laura; Jabbari, Javad

    2014-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. Currently, 14 genes important for ion channel function, intercellular signalling, and homeostatic control have been associated with AF.......Atrial fibrillation (AF) is the most common cardiac arrhythmia. Currently, 14 genes important for ion channel function, intercellular signalling, and homeostatic control have been associated with AF....

  8. Radiofrequency Atrial Fibrillation Ablation Technique in Patients with Mitral Valve Surgery and Left Atrial Reduction Procedures

    Directory of Open Access Journals (Sweden)

    Pouya Nezafati1

    2015-10-01

    Full Text Available Background: About half of all patients who undergo mitral valve surgery suffer from atrial fibrillation (AF. Cox described the surgical cut-and-sew Maze procedure, which is an effective surgical method but has some complications. This study was designed to evaluate the efficacy of a substitution method of radiofrequency ablation (RFA for patients undergoing mitral valve surgery with AF.Methods: We evaluated 50 patients, comprising 40 men and 10 women at a mean age of 61.8 ± 7.5 years, who underwent mitral valve surgery with RFA between March 2010 and August 2013. All the patients had permanent AF with an enlarged left atrium (LA. The first indication for surgery was underlying organic lesions. Mitral valve replacement or repair was performed in the patients as a single procedure or in combination with aortic valve replacement or coronary artery bypass grafting. Radiofrequency energy was used to create continuous endocardial lesions mimicking most incisions and sutures. We evaluated the pre- and postoperative LA size, duration of aortic cross-clamping, cardiopulmonary bypass time, intensive care unit stay, and total hospital stay.Results: The mean preoperative and postoperative LA sizes were 7.5 ± 1.4 cm and 4.3 ± 0.7 cm (p value = 0.0001, respectively. The mean cardiopulmonary bypass time and the aortic cross-clamping time were 134.3 ± 33.7 minand 109.0 ± 28.4 min, respectively. The average stay at the intensive care unit was 2.1 ± 1.2 days, and the total hospital stay was 8.3 ± 2.4 days. Rebleeding was the only complication, found in one patient. There was no early or late mortality. Eighty-two percent of the patients were discharged in normal sinus rhythm. Five other patients had normal sinus rhythm at 6months' follow-up, and the remaining 4 patients did not have a normal sinus rhythm after 6 months.Conclusion: Radiofrequency ablation, combined with LA reduction, is an effective option for the treatment of permanent AF concomitant with

  9. ROCKET AF adds more concerns about Digoxin safety in patients with atrial fibrillation

    OpenAIRE

    Elmaghawry, Mohamed

    2015-01-01

    In a recent article in the Journal, we have reviewed the adverse cardiovascular outcomes observed with digoxin use in the PALLAS study. 1 The PALLAS study was designed to determine if dronedarone would reduce major vascular events in patients with permanent atrial fibrillation (AF). 2 However the study was stopped early because of safety reasons, as a significant number of patients on the dronedarone arm reached the co-primary end point composite of stroke, myocardial infarction, systemic emb...

  10. Deglutition Syncope Associated With Ventricular Asystole in a Patient With Permanent Atrial Fibrillation

    Science.gov (United States)

    Lee, Ga Yeon; Chang, Bok Soon; Song, Jae-Uk; Ok, Chang Soo; Sohn, Seo-Young; Jo, Hyun Chul; Noh, Hye-Jin; Choi, Soo Hee; Kim, Jun Hyung

    2010-01-01

    Deglutition syncope is a situational syncope that is diagnosed only by a detailed history. We report deglutition syncope in a 62-year-old man, who had permanent atrial fibrillation. The patient had no structural or functional abnormalities of the esophagus. During syncopal attacks, his electrocardiography showed ventricular asystole that was sustained for 12 seconds. The patient was successfully treated by implantation of a permanent pacemaker. PMID:20182597

  11. Screening of KCNN3 in patients with early-onset lone atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Morten Sig; Jabbari, Javad; Holst, Anders G

    2011-01-01

    Aims The aim of this study was to screen KCNN3 encoding the small-conductance calcium-activated K(+) channel (SK3) in lone atrial fibrillation patients. Atrial fibrillation (AF) is the most common cardiac arrhythmia. A genome-wide association study has recently associated an intronic single......-nucleotide polymorphism (SNP) in KCNN3 with lone AF. Methods and results We sequenced the coding region and splice junctions of KCNN3 in 209 early-onset lone AF patients, screening for variations. A group of 208 healthy blood donors with normal ECGs and without cardiac symptoms were used as controls. All patients...... and controls were of Danish ethnicity. No mutations were found in the coding regions or splice sites of KCNN3. We found one known exonic synonymous SNP (rs1131820) in KCNN3 that was associated with AF. Both the genotype distribution and allele frequencies of SNP rs1131820 were significantly different between...

  12. Left atrial strain assessed by three-dimensional speckle tracking echocardiography predicts atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Mochizuki, Atsushi; Yuda, Satoshi; Fujito, Takefumi; Kawamukai, Mina; Muranaka, Atsuko; Nagahara, Daigo; Shimoshige, Shinya; Hashimoto, Akiyoshi; Miura, Tetsuji

    2017-06-01

    Several studies have shown the utility of left atrial (LA) function determined by two-dimensional or three-dimensional speckle tracking echocardiography (2D- or 3D-STE) for identifying patients with paroxysmal atrial fibrillation (AF). However, whether 3D-STE is applicable for prediction of the recurrence of AF after catheter ablation (CA) remains unknown. We examined whether any 3D-STE parameters are better than 2D-STE parameters for the prediction of AF recurrence. Forty-two patients with paroxysmal AF (58 ± 10 years old, 69% male) underwent 2D- and 3D-STE within 3 days before first-time CA. The global peak LA longitudinal, circumferential, and area strains during systole (3D-GLSs, -GCSs, and -GASs, respectively) and those just before atrial contraction (3D-GLSa, -GCSa, and -GASa, respectively) were determined by 3D-STE and standard deviations of times to peaks of regional LA strains were calculated as indices of LA dyssynchrony. In 2D-STE, global LA longitudinal strains during systole and just before atrial contraction (2D-GLSs and -GLSa) were determined. During follow-up of 441 ± 221 days, 12 patients (29%) had AF recurrence. In the univariate Cox proportional hazard analysis, age [hazard ratio (HR): 1.08, p = 0.04], 3D-GCSs (HR: 0.91, p = 0.03), and 3D-GASs (HR: 0.95, p = 0.01) were predictors of AF recurrence, though associations of recurrence with 2D-STE parameters, indices of LA synchrony, and LA volume were not significant. Multivariable analysis showed that 3D-GASs was an independent predictor of AF recurrence (HR: 0.96, p = 0.048). LA strain determined by 3D-STE is a novel and better predictor of AF recurrence after CA than that determined by 2D-STE or other known predictors.

  13. Use of Oral Anticoagulation in the Management of Atrial Fibrillation in Patients with ESRD: Pro

    Science.gov (United States)

    Ball, Timothy; Cox, Katy Mathews; Assar, Manish D.

    2016-01-01

    Warfarin has had a thin margin of benefit over risk for the prevention of stroke and systemic embolism in patients with ESRD because of higher bleeding risks and complications of therapy. The successful use of warfarin has been dependent on the selection of patients with nonvalvular atrial fibrillation at relatively high risk of stroke and systemic embolism and lower risks of bleeding over the course of therapy. Without such selection strategies, broad use of warfarin has not proven to be beneficial to the broad population of patients with ESRD and nonvalvular atrial fibrillation. In a recent meta-analysis of use of warfarin in patients with nonvalvular atrial fibrillation and ESRD, warfarin had no effect on the risks of stroke (hazard ratio, 1.12; 95% confidence interval, 0.69 to 1.82; P=0.65) or mortality (hazard ratio, 0.96; 95% confidence interval, 0.81 to 1.13; P=0.60) but was associated with increased risk of major bleeding (hazard ratio, 1.30; 95% confidence interval, 1.08 to 1.56; P<0.01). In pivotal trials, novel oral anticoagulants were generally at least equal to warfarin for efficacy and safety in nonvalvular atrial fibrillation and mild to moderate renal impairment. Clinical data for ESRD are limited, because pivotal trials excluded such patients. Given the very high risk of stroke and systemic embolism and the early evidence of acceptable safety profiles of novel oral anticoagulants, we think that patients with ESRD should be considered for treatment with chronic anticoagulation provided that there is an acceptable bleeding profile. Apixaban is currently indicated in ESRD for this application and may be preferable to warfarin given the body of evidence for warfarin and its difficulty of use and attendant adverse events. PMID:27797888

  14. Care Indicators in Patients With Atrial Fibrillation: Assessment of Sex Differences and Management of Clinical Problems.

    Science.gov (United States)

    Barón-Esquivias, Gonzalo; Gómez, Silvia; Brufau, Helena; García, Lorena; Amo, Concepción; Gutiérrez, José M; Wu, Lourdes; Salmerón, Francisco; Pinilla, Santiago; López, Víctor

    2016-04-01

    To assess sex differences and the management of clinical problems in patients with atrial fibrillation through the use of care indicators. Over a 5-month period, the study included all consecutive patients attended in the cardiology outpatient clinics of 2 tertiary hospitals with an atrial fibrillation episode or a clinical process due to atrial fibrillation. A total of 533 patients were included (56.5% women; mean age, 70.5 ± 12.2 years), of whom 24.3% were younger than 65 years. Women had significantly more clinical problems and a higher stroke risk: CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke [doubled]) (1.8 ± 1.2 vs 1.5 ± 1.1; P = .001) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 [doubled], diabetes, stroke [doubled]-vascular disease and sex category [female]) (3.7 ± 1.4 vs 2.2 ± 1.4; P = .0001). Referrals to the cardiology department were appropriate in 94% of the patients, the referral source was primary care or other hospital services in 53.8%, and echocardiography was performed or recommended in 93.4%. Treatment (antiarrhythmics and anticoagulants) was administered according to guideline recommendations. In the previous 3 months, the Rosendaal index was 48.4 ± 37.4. One in every 4 patients seeking care for problems associated with atrial fibrillation are young; women have more clinical problems and seek care more frequently than men. Patients are correctly referred to the cardiology department and most are not referred from the emergency department. Echocardiography and antiarrhythmic and anticoagulant therapy were provided according to the recommendations of clinical practice guidelines. Vitamin K antagonists for anticoagulation therapy are underused. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Anesthetic management of an AAI pacemaker patient with paroxysmal atrial fibrillation during colorectal surgery.

    Science.gov (United States)

    Lin, Jui-An; Borel, Cecil O; Wang, Wen-Been; Wong, Chih-Shung; Yeh, Chun-Chang; Yang, Chih-Ping; Wu, Ching-Tang

    2006-08-01

    Perioperative management of patients with cardiac pacemakers may be challenging because of the increasing sophistication of these devices. We report a case of a patient with paroxysmal atrial fibrillation (PAF) and with a permanent AAIR (bipolar atrial-inhibited adaptive rate) pacemaker who suffered life-threatening episodes of arrhythmias during operation. The first episode was vagally induced PAF during bowel manipulation; the second, induced by the increased pacing threshold from the external electric cardioversion and hyperkalemia. Transcutaneous pacing provided cardiac pacing and stabilized the patient during the second episode. Thorough preoperative evaluation and prophylactic placement of temporary pacing or at least transcutaneous pacing are important for the avoidance and minimization of intraoperative complications in patients with sick sinus syndrome and with an AAI (atrial inhibited) pacemaker.

  16. Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis.

    Science.gov (United States)

    Kotecha, Dipak; Holmes, Jane; Krum, Henry; Altman, Douglas G; Manzano, Luis; Cleland, John G F; Lip, Gregory Y H; Coats, Andrew J S; Andersson, Bert; Kirchhof, Paulus; von Lueder, Thomas G; Wedel, Hans; Rosano, Giuseppe; Shibata, Marcelo C; Rigby, Alan; Flather, Marcus D

    2014-12-20

    Atrial fibrillation and heart failure often coexist, causing substantial cardiovascular morbidity and mortality. β blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. We therefore meta-analysed individual-patient data to assess the efficacy of β blockers in patients with heart failure and sinus rhythm compared with atrial fibrillation. We extracted individual-patient data from ten randomised controlled trials of the comparison of β blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph. The primary outcome was all-cause mortality. Analysis was by intention to treat. Outcome data were meta-analysed with an adjusted Cox proportional hazards regression. The study is registered with Clinicaltrials.gov, number NCT0083244, and PROSPERO, number CRD42014010012. 18,254 patients were assessed, and of these 13,946 (76%) had sinus rhythm and 3066 (17%) had atrial fibrillation at baseline. Crude death rates over a mean follow-up of 1·5 years (SD 1·1) were 16% (2237 of 13,945) in patients with sinus rhythm and 21% (633 of 3064) in patients with atrial fibrillation. β-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm (hazard ratio 0·73, 0·67-0·80; pFarmaceutica Internazionale (administrative support grant). Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. [Relationship between E/Em ratio and exercise capacity in patients with atrial fibrillation].

    Science.gov (United States)

    Chen, Shaomin; He, Rong; Li, Weihong; Feng, Xinheng; Li, Zhaoping; Chen, Baoxia; Liu, Shuwang; Gao, Wei

    2014-09-23

    To explore the relationship between the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) and exercise capacity in patients with atrial fibrillation. A total of 94 consecutive patients with non-valvular atrial fibrillation and preserved left ventricular ejection fraction admitted into our department from December 2011 to June 2013 were included. Echocardiography and cardiopulmonary exercise test were performed. According to E/Em, they were divided into two groups of normal E/Em (E/Em ≤ 9) and elevated E/Em (E/Em>9). The parameters of exercise capacity, including VO2max/kg, anaerobic threshold/kg (AT/kg) and exercise time duration were compared between two groups. And the determinants of VO2max/kg were identified by multivariate regression analysis. The number of patients was 57(60.6%) with normal E/Em and 37 (39.4%) with elevated E/Em. As compared to those with normal E/Em, the patients with elevated E/Em had lower VO₂max/kg [(26 ± 4) vs (20 ± 4) ml × min⁻¹ × kg⁻¹, P Em (r = -0.535, P Em was independently associated with exercise capacity in patients with atrial fibrillation.

  18. [Anticoagulation in atrial fibrillation - an update].

    Science.gov (United States)

    Antz, Matthias; Hullmann, Bettina; Neufert, Christian; Vocke, Wolfgang

    2008-12-01

    The correct anticoagulation regimen for prevention of thromboembolic events is essential in patients with atrial fibrillation. However, only a minority of patients receives anticoagulation according to the guidelines. The current guidelines are intended to make the indication for anticoagulation more simple and are summarized in the present article. This includes recommendations for chronic anticoagulation, prevention of thromboembolic events after cardioversion and in ablation of atrial fibrillation.

  19. Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Lip, Gregory Y H; Olesen, Jonas B

    2015-01-01

    STUDY QUESTION: What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? METHODS: This Danish cohort study (1996......-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge...... to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. STUDY ANSWER AND LIMITATIONS: 4602...

  20. Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.

    LENUS (Irish Health Repository)

    Lobo, R

    2015-11-01

    Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.

  1. Aspirin versus warfarin in atrial fibrillation: decision analysis may help patients' choice.

    LENUS (Irish Health Repository)

    Romero-Ortuno, Roman

    2012-03-01

    the primary prevention of ischaemic stroke in chronic non-valvular atrial fibrillation (AF) typically involves consideration of aspirin or warfarin. CHA(2)DS(2)-VASc estimates annual stroke rates for untreated AF patients, which are reduced by 60% with warfarin and by 20% with aspirin. HAS-BLED estimates annual rates of major bleeding on warfarin. The latter risk with aspirin is 0.5-1.2% per year.

  2. Risk of Ischemic Stroke after Intracranial Hemorrhage in Patients with Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Michael P Lerario

    Full Text Available We aimed to estimate the risk of ischemic stroke after intracranial hemorrhage in patients with atrial fibrillation.Using discharge data from all nonfederal acute care hospitals and emergency departments in California, Florida, and New York from 2005 to 2012, we identified patients at the time of a first-recorded encounter with a diagnosis of atrial fibrillation. Ischemic stroke and intracranial hemorrhage were identified using validated diagnosis codes. Kaplan-Meier survival statistics and Cox proportional hazard analyses were used to evaluate cumulative rates of ischemic stroke and the relationship between incident intracranial hemorrhage and subsequent stroke.Among 2,084,735 patients with atrial fibrillation, 50,468 (2.4% developed intracranial hemorrhage and 89,594 (4.3% developed ischemic stroke during a mean follow-up period of 3.2 years. The 1-year cumulative rate of stroke was 8.1% (95% CI, 7.5-8.7% after intracerebral hemorrhage, 3.9% (95% CI, 3.5-4.3% after subdural hemorrhage, and 2.0% (95% CI, 2.0-2.1% in those without intracranial hemorrhage. After adjustment for the CHA2DS2-VASc score, stroke risk was elevated after both intracerebral hemorrhage (hazard ratio [HR], 2.8; 95% CI, 2.6-2.9 and subdural hemorrhage (HR, 1.6; 95% CI, 1.5-1.7. Cumulative 1-year rates of stroke ranged from 0.9% in those with subdural hemorrhage and a CHA2DS2-VASc score of 0, to 33.3% in those with intracerebral hemorrhage and a CHA2DS2-VASc score of 9.In a large, heterogeneous cohort, patients with atrial fibrillation faced a substantially heightened risk of ischemic stroke after intracranial hemorrhage. The risk was most marked in those with intracerebral hemorrhage and high CHA2DS2-VASc scores.

  3. [Electrophysiological findings and ablation strategies in patients with atrial tachyarrhythmias after left atrial circumferential ablation in the treatment of atrial fibrillation].

    Science.gov (United States)

    Chen, Ming-long; Yang, Bing; Xu, Dong-jie; Zou, Jian-gang; Shan, Qi-jun; Chen, Chun; Chen, Hong-wu; Li, Wen-qi; Cao, Ke-jiang

    2007-02-01

    To report the electrophysiological findings and the ablation strategies in patients with atrial tachyarrhythmias (ATAs) or atrial fibrillation (AF) recurrence after left atrial circumferential ablation (LACA) in the treatment of AF. 91 patients with AF had LACA procedure from April 2004 to May 2006, 19 of which accepted the second ablation procedure due to ATAs or AF recurrence. In all the 19 patients [17 male, 2 female, age 25 - 65 (53 +/- 12) years], 11 presented with paroxysmal AF before the first ablation procedure, 2 with persistent AF and 6 with permanent AF. Pulmonary vein potentials (PVP) were investigated in both sides in all the patients. Delayed PVP was identified inside the left circular line in 5 patients, in the right in 1 and both in 2 during sinus rhythm. "Gap" conduction was found and successfully closed guided by circular mapping catheter. In 3 cases, irregular left atrial tachycardia was caused by fibrillation rhythm inside the left ring via decremental "gap" conduction. Reisolation was done successfully again guided by 3-D mapping and made the left atrium in sinus rhythm but the fibrillation rhythm was still inside the left ring. Pulmonary vein tachycardia with 1:1 conduction to the left atrium presented in one case and reisolation stopped the tachycardia. No PVP was discovered in both sides in 4 patients but other tachycardias could be induced, including two right atrial scar related tachycardias, two supraventricular tachycardias mediated by concealed accessory pathway, one cavo-tricuspid isthmus dependent atrial flutter and one focal atrial tachycardia near the coronary sinus ostium. All the tachycardias in these 4 patients were successfully ablated with the help of routine and 3-D mapping techniques. In the rest 3, which were in AF rhythm, LACA was successfully done again. After a mean follow-up of 4 - 26 (11.5 +/- 8.5) months, 16 patients were symptom free without anti-arrhythmic drug therapy; 1 of them had frequent palpitation attack with

  4. Impact of Additional Transthoracic Electrical Cardioversion on Cardiac Function and Atrial Fibrillation Recurrence in Patients with Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation

    Directory of Open Access Journals (Sweden)

    Deguo Wang

    2016-01-01

    Full Text Available Backgrounds and Objective. During the procession of radiofrequency catheter ablation (RFCA in persistent atrial fibrillation (AF, transthoracic electrical cardioversion (ECV is required to terminate AF. The purpose of this study was to determine the impact of additional ECV on cardiac function and recurrence of AF. Methods and Results. Persistent AF patients received extensive encircling pulmonary vein isolation (PVI and additional line ablation. Patients were divided into two groups based on whether they need transthoracic electrical cardioversion to terminate AF: electrical cardioversion (ECV group and nonelectrical cardioversion (NECV group. Among 111 subjects, 35 patients were returned to sinus rhythm after ablation by ECV (ECV group and 76 patients had AF termination after the ablation processions (NECV group. During the 12-month follow-ups, the recurrence ratio of patients was comparable in ECV group (15/35 and NECV group (34/76 (44.14% versus 44.74%, P=0.853. Although left atrial diameters (LAD decreased significantly in both groups, there were no significant differences in LAD and left ventricular cardiac function between ECV group and NECV group. Conclusions. This study revealed that ECV has no significant impact on the maintenance of SR and the recovery of cardiac function. Therefore, ECV could be applied safely to recover SR during the procedure of catheter ablation of persistent atrial fibrillation.

  5. ROCKET AF adds more concerns about Digoxin safety in patients with atrial fibrillation.

    Science.gov (United States)

    ElMaghawry, Mohamed

    2015-01-01

    In a recent article in the Journal, we have reviewed the adverse cardiovascular outcomes observed with digoxin use in the PALLAS study.(1) The PALLAS study was designed to determine if dronedarone would reduce major vascular events in patients with permanent atrial fibrillation (AF).(2) However the study was stopped early because of safety reasons, as a significant number of patients on the dronedarone arm reached the co-primary end point composite of stroke, myocardial infarction, systemic embolism, or cardiovascular death. Data sub-analyses suggested that digoxin-dronedarone interaction was responsible for the higher arrhythmic death rate observed in the trial. These observations are consistent with several other studies that demonstrate the potential hazard of the use of digoxin in heart failure and/or atrial fibrillation. A more recent article published in the Lancet studied the use and outcomes of digoxin in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism in Atrial Fibrillation (ROCKET AF) trial.(3) The investigators concluded that digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF.

  6. ROCKET AF adds more concerns about Digoxin safety in patients with atrial fibrillation

    Science.gov (United States)

    ElMaghawry, Mohamed

    2015-01-01

    In a recent article in the Journal, we have reviewed the adverse cardiovascular outcomes observed with digoxin use in the PALLAS study.1 The PALLAS study was designed to determine if dronedarone would reduce major vascular events in patients with permanent atrial fibrillation (AF).2 However the study was stopped early because of safety reasons, as a significant number of patients on the dronedarone arm reached the co-primary end point composite of stroke, myocardial infarction, systemic embolism, or cardiovascular death. Data sub-analyses suggested that digoxin-dronedarone interaction was responsible for the higher arrhythmic death rate observed in the trial. These observations are consistent with several other studies that demonstrate the potential hazard of the use of digoxin in heart failure and/or atrial fibrillation. A more recent article published in the Lancet studied the use and outcomes of digoxin in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism in Atrial Fibrillation (ROCKET AF) trial.3 The investigators concluded that digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. PMID:26779514

  7. Percutaneous left atrial appendage closure for stroke prevention in patients with atrial fibrillation: an assessment of net clinical benefit.

    Science.gov (United States)

    Gangireddy, Sandeep R; Halperin, Jonathan L; Fuster, Valentin; Reddy, Vivek Y

    2012-11-01

    The PROTECT-AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) trial found left atrial appendage (LAA) closure an alternative to anticoagulation in selected patients with non-valvular atrial fibrillation (AF). We aim to estimate the net clinical benefit (NCB) of percutaneous LAA closure. Post hoc analysis of outcomes among 707 adults with AF in the PROTECT-AF trial and 566 in the Continued Access (CAP) registry undergoing LAA closure with the Watchman device compared with sustained anticoagulation. Outcomes were ischaemic stroke, intracranial haemorrhage, major bleeding, pericardial effusion, and death, weighted to reflect the relative impact in terms of death and disability. Net clinical benefit was calculated as the sum of annualized rates of these outcomes after intervention minus rates on warfarin. The NCB of LAA closure during 1623 person-years follow-up in the trial was 1.73%/year (95% CI: -0.54 to 4.39%/year) and during 741 patient-years in the registry was 4.97%/year (95% CI: 3.07-7.15%/year). Among patients with a history of ischaemic stroke, the NCB was greater in the registry (8.68%/year, CI: 2.82-14.92%/year) than the trial (4.30%/year, CI -2.07 to 11.25%/year). In the registry, the NCB of LAA closure increased from 2.22%/year (CI: 0.27-6.01%/year) in patients with CHADS(2) scores = 1 to 6.12%/year (CI: 3.19-8.92%/year) in those with scores ≥2. Combining rates of thrombo-embolism, intracranial haemorrhage, major adverse events, and death allows objective comparison of the benefit and risk of device therapy vs. anticoagulation in patients with AF. The NCB of LAA closure is greatest for patients at a higher risk of stroke.

  8. Dronedarone as a new treatment option for atrial fibrillation patients: pharmacokinetics, pharmacodynamics and clinical practice.

    Science.gov (United States)

    Pamukcu, Burak; Lip, Gregory Y H

    2011-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting 1 - 2% of the population. Despite several developments in antithrombotic, antiatherosclerotic and device-based cardiac therapies, few noteworthy antiarrhythmic drugs have been developed. Dronedarone, a modified analogue of amiodarone, has the pharmacological ability of blocking multiple ion channels. This overview summarizes the pharmacokinetic and pharmacodynamic properties of dronedarone, evaluates its potential application to daily clinical cardiology practice according to the evidence provided by clinical trials, and provides a future clinical perspective for the use of this drug. The readers will gain an understanding of the findings of recent trials performed with dronedarone, which will provide important information for this relatively new antiarrhythmic drug, used for the treatment of atrial fibrillation. Dronedarone provides a reasonable efficacy and safety profile. Recent clinical trials indicate that dronedarone may support maintenance of sinus rhythm, decrease hospitalizations and reduce healthcare costs even in AF patients with structural heart disease but without severe or unstable cardiac failure.

  9. Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

    LENUS (Irish Health Repository)

    Murin, Jan

    2014-01-01

    Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.

  10. Atrial fibrillation in patients with gastroesophageal reflux disease: a comprehensive review.

    Science.gov (United States)

    Roman, Crina; Bruley des Varannes, Stanislas; Muresan, Lucian; Picos, Alina; Dumitrascu, Dan L

    2014-07-28

    To analyze the potential relationship between gastroesophageal reflux disease (GERD) and the development of atrial fibrillation (AF). Using the key words "atrial fibrillation and gastroesophageal reflux", "atrial fibrillation and esophagitis, peptic", "atrial fibrillation and hernia, hiatal" the PubMed, EMBASE, Cochrane Library, OVIDSP, WILEY databases were screened for relevant publications on GERD and AF in adults between January 1972-December 2013. Studies written in languages other than English or French, studies not performed in humans, reviews, case reports, abstracts, conference presentations, letters to the editor, editorials, comments and opinions were not taken into consideration. Articles treating the subject of radiofrequency ablation of AF and the consecutive development of GERD were also excluded. Two thousand one hundred sixty-one titles were found of which 8 articles met the inclusion criteria. The presence of AF in patients with GERD was reported to be between 0.62%-14%, higher compared to those without GERD. Epidemiological data provided by these observational studies showed that patients with GERD, especially those with more severe GERD-related symptoms, had an increased risk of developing AF compared with those without GERD, but a causal relationship between GERD and AF could not be established based on these studies. The mechanisms of AF as a consequence of GERD remain largely unknown, with inflammation and vagal stimulation playing a possible role in the development of these disorders. Treatment with proton pomp inhibitors may improve symptoms related to AF and facilitate conversion to sinus rhythm. Although links between AF and GERD exist, large randomized clinical studies are required for a better understanding of the relationship between these two entities.

  11. Pitx2c increases in atrial myocytes from chronic atrial fibrillation patients enhancing IKs and decreasing ICa,L.

    Science.gov (United States)

    Pérez-Hernández, Marta; Matamoros, Marcos; Barana, Adriana; Amorós, Irene; Gómez, Ricardo; Núñez, Mercedes; Sacristán, Sandra; Pinto, Ángel; Fernández-Avilés, Francisco; Tamargo, Juan; Delpón, Eva; Caballero, Ricardo

    2016-03-01

    Atrial fibrillation (AF) produces rapid changes in the electrical properties of the atria (electrical remodelling) that promote its own recurrence. In chronic AF (CAF) patients, up-regulation of the slow delayed rectifier K(+) current (IKs) and down-regulation of the voltage-gated Ca(2+) current (ICa,L) are hallmarks of electrical remodelling and critically contribute to the abbreviation of action potential duration and atrial refractory period. Recent evidences suggested that Pitx2c, a bicoid-related homeodomain transcription factor involved in directing cardiac asymmetric morphogenesis, could play a role in atrial remodelling. However, its effects on IKs and ICa,L are unknown. Real-time quantitative polymerase chain reaction analysis showed that Pitx2c mRNA expression was significantly higher in human atrial myocytes from CAF patients than those from sinus rhythm patients. The expression of Pitx2c was positively and negatively correlated with IKs and ICa,L densities, respectively. Expression of Pitx2c in HL-1 cells increased IKs density and reduced ICa,L density. Luciferase assays demonstrated that Pitx2c increased transcriptional activity of KCNQ1 and KCNE1 genes. Conversely, its effects on ICa,L could be mediated by the atrial natriuretic peptide. Our results demonstrated for the first time that CAF increases Pitx2c expression in isolated human atrial myocytes and suggested that this transcription factor could contribute to the CAF-induced IKs increase and ICa,L reduction observed in humans. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  12. Impact of microRNA expression in human atrial tissue in patients with atrial fibrillation undergoing cardiac surgery.

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    Hiroyuki Nishi

    Full Text Available BACKGROUND: Although microRNA (miRNA regulates initiation and/or progression of atrial fibrillation (AF in canine AF models, the underlying mechanism in humans remains unclear. We speculated that certain miRNAs in atrial tissue are related to AF, and evaluated the relationship of miRNA expression in human atrial tissue in cardiac surgery patients. METHODS: Right atrial tissues from 29 patients undergoing cardiovascular surgery were divided into 3 groups [A: chronic AF or unsuccessful maze, n=6; B: successful maze, n=10; C: sinus rhythm (SR n=13]. miRNA expression was determined using high density microarrays and with Reverse transcriptase-polymerase chain reaction (RT-PCR. Fibrosis was examined using Masson trichrome staining. RESULTS: miRNA microarray analysis showed elevated miRNA-21, miRNA-23b, miRNA-199b, and miRNA-208b in AF as compared to SR groups. RT-PCR showed elevated miRNA-21 (1.9-fold and miRNA-208b (4.2-fold in AF as compared to the SR groups. miRNA-21 expression increased from Group C to A (A: 2.1-fold, B: 1.8-fold, C: 1.0-fold. Fibrosis increased from C to A (A: 43.0±12.9%, B: 21.3±6.1%, C: 11.9±3.1%. Percent fibrosis and miRNA-21 expression were correlated (r=0.508, p<0.05. The plasma levels of miRNA-21 in AF patients was significantly decreased as compared to the healthy volunteers (p<0.05. CONCLUSION: The expression of miRNA-21 in human atrial tissue was found to be related to atrial fibrosis and might affect AF occurrence, indicating its usefulness as a biomarker for cardiac surgery management.

  13. Pacing for the Suppression of Paroxysmal Atrial Fibrillation in an 87-year-old Patient

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    Adel El-Bialy

    2003-04-01

    Full Text Available Background: Sinus node dysfunction, atrioventricular (AV block and atrial fibrillation (AF are associated with advanced age. Required therapy commonly includes pacemaker implantation. Methods: We report the course of therapy for an 87-year-old with symptomatic sinus node dysfunction and paroxysmal atrial fibrillation who was intolerant of drug therapy. Results: The patient received a pacemaker for treatment of sick sinus syndrome. She continued to have symptomatic episodes of AF and was intolerant of pharmacologic therapy despite adequate rate support provided by the pacemaker. The AF suppression algorithm in the pacemaker was enabled, resulting in the elimination all AF episodes effectively eliminating the need for antiarrhythmic medication. If this continues to stabilize her atrium, withdrawal of anticoagulation therapy is anticipated. Conclusions: The clinical presentation of sinus node dysfunction and related conduction abnormalities is common in the elderly. Pharmacologic management is often a challenge in the presence of the advanced age and concomitant disease processes. In individuals who have paroxysmal atrial fibrillation or are likely to develop this and who need a pacemaker for standard indications, the availability of an AF Suppression™ algorithm may facilitate their management without needed to use medications or being able to utilize lower doses of those medications.

  14. Non-valvular atrial fibrillation: impact of apixaban on patient outcomes

    Directory of Open Access Journals (Sweden)

    Ioannou A

    2017-11-01

    Full Text Available Adam Ioannou,1 Irene Tsappa,2 Sofia Metaxa,3 Constantinos G Missouris2,3 1Cardiology Department, Royal Free NHS Foundation Trust, London, UK; 2Cardiology Department, Medical School, University of Cyprus, Nicosia, Cyprus; 3Cardiology Department, Frimley Health NHS Foundation Trust, London, UK Abstract: Atrial fibrillation is the most common arrhythmia worldwide, and carries a significantly increased risk of thromboembolic stroke. Initially, vitamin K antagonists were used as stroke prophylaxis; but more recently, a group of drugs known as novel oral anticoagulants have been developed. Apixaban belongs to this group of drugs, and is a factor Xa inhibitor that has emerged as a popular pharmacological agent worldwide. In this review, we will provide an overview of the pivotal trials in the development of apixaban, while also critically evaluating the new emerging real-world data, and discussing the effectiveness, safety, economic viability and future prospects of apixaban and how it impacts on patient outcomes in those with non-valvular atrial fibrillation. Keywords: apixaban, atrial fibrillation, warfarin, stroke, bleeding

  15. Prevention of atrial fibrillation by inter-atrial septum pacing guided by electrophysiological testing, in patients with delayed interatrial conduction.

    Science.gov (United States)

    Manolis, A G; Katsivas, A G; Vassilopoulos, C; Koutsogeorgis, D; Louvros, N E

    2002-04-01

    Interatrial septum (IAS) pacing seems efficient in synchronizing atrial depolarization in patients (pts) with delayed inter-atrial conduction, but its clinical role in preventing atrial tachyarrhythmias is still debated. This study was conducted in order to evaluate the clinical efficacy of IAS pacing guided by pace mapping of the IAS, as an alternative treatment modality in pts with drug refractory paroxysmal atrial fibrillation (PAF). We evaluated 29 pts (13 male, 16 female, 60 +/- 11 years), with drug refractory PAF, normal sinus node function and prolonged inter-atrial conduction time (P wave 142 +/- 10 ms). Multipolar catheters were inserted and the electrograms from the high right atrium (HRA) and proximal, middle and distal coronary sinus (CS) were recorded. The IAS was paced from multiple sites. The site of IAS where the timing between HRA and distal CS was AAIR (75-140 bpm) mode, with random selection of the order and after discontinuation of antiarrhythmic treatment. During the fourth period, the same AAIR mode was assessed, but antiarrhythmic drugs were also administered. We compared the arrhythmia free interval among the four periods. The proportion of atrial paced beats in AAIR pacing mode plus antiarrhythmics was significantly higher compared with the drug-free period in AAIR mode (57 +/- 9% and 49 +/- 9% respectively, P=0017) and with AAT pacing mode (44 +/- 10%,(, PAAIR mode. These intervals did not differ significantly from the pre-implantation period (24.1 +/- 6.3 days). The arrhythmia free interval in AAIR pacing in combination with antiarrhythmic drug therapy was 38.7 +/- 8.1 days and this was significantly longer than the previous periods (P<0.05). Atrial septal pacing in combination with antiarrhythmic drug therapy reduced the incidence of PAF in pts with prolonged inter-atrial conduction times. Pace mapping of the IAS is an attractive technique to assess the shortest atrial activation time between HRA and distal CS. Whether placement of the

  16. Prevalence and electrophysiological characteristics of typical atrial flutter in patients with atrial fibrillation and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Hayashi, Takekuni; Fukamizu, Seiji; Hojo, Rintaro; Komiyama, Kota; Tanabe, Yasuhiro; Tejima, Tamotsu; Nishizaki, Mitsuhiro; Hiraoka, Masayasu; Ako, Junya; Momomura, Shin-Ichi; Sakurada, Harumizu

    2013-12-01

    Chronic obstructive pulmonary disease (COPD) is one of the important underlying diseases of atrial fibrillation (AF). However, the prevalence and electrophysiological characteristics of typical atrial flutter (AFL) in patients with AF and COPD remain unknown. The purpose of the present study was to investigate those characteristics. We investigated 181 consecutive patients who underwent catheter ablation of AF. Twenty-eight patients were diagnosed with COPD according to the Global Initiatives for Chronic Obstructive Lung Disease (GOLD) criteria. Forty patients with no lung disease served as a control group. We analysed the electrophysiological characteristics in these groups. Typical AFL was more common in the COPD group (19/28, 68%) than in the non-COPD group (13/40, 33%; P = 0.006). The prevalence of AFL increased with the severity of COPD: 4 (50%) of 8 patients with GOLD1, 13 (72%) of 18 patients with GOLD2, and 2 (100%) of 2 patients with GOLD3. Atrial flutter cycle length and conduction time from the coronary sinus (CS) ostium to the low lateral right atrium (RA) during CS ostium pacing before and after the cavotricuspid isthmus ablation were significantly longer in the COPD group than in the non-COPD group (285 vs. 236, 71 vs. 53, 164 vs. 134 ms; P = 0.009, 0.03, 0.002, respectively). In COPD patients with AF, conduction time of RA was prolonged and typical AFL was commonly observed.

  17. Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients.

    Science.gov (United States)

    Mattioli, A V; Farinetti, A; Miloro, C; Pedrazzi, P; Mattioli, G

    2011-06-01

    Coffee and caffeine are widely consumed in Western countries. Little information is available on the influence of coffee and caffeine consumption on atrial fibrillation (AF) in hypertensive patients. We sought to investigate the relationship between coffee consumption and atrial fibrillation with regard to spontaneous conversion of arrhythmia. A group of 600 patients presenting with a first known episode of AF was investigated, and we identified 247 hypertensive patients. The prevalence of nutritional parameters was assessed with a food frequency questionnaire. Coffee and caffeine intake were specifically estimated. Left ventricular hypertrophy was evaluated by electrocardiogram (ECG) and echocardiogram. Coffee consumption was higher in normotensive patients. High coffee consumers were more frequent in normotensive patients compared with hypertensive patients. On the other hand, the intake of caffeine was similar in hypertensive and normotensive patients, owing to a higher intake in hypertensive patients from sources other than coffee. Within normotensive patients, we report that non-habitual and low coffee consumers showed the highest probability of spontaneous conversion (OR 1.93 95%CI 0.88-3.23; p=0.001), whereas, within hypertensive patients, moderate but not high coffee consumers had the lowest probability of spontaneous conversion (OR 1.13 95%CI 0.67-1.99; p=0.05). Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia. Copyright © 2009 Elsevier B.V. All rights reserved.

  18. Stroke as the First Manifestation of Atrial Fibrillation.

    Science.gov (United States)

    Jaakkola, Jussi; Mustonen, Pirjo; Kiviniemi, Tuomas; Hartikainen, Juha E K; Palomäki, Antti; Hartikainen, Päivi; Nuotio, Ilpo; Ylitalo, Antti; Airaksinen, K E Juhani

    2016-01-01

    Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003-2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.

  19. Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

    DEFF Research Database (Denmark)

    Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang

    2005-01-01

    Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D......±15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. I patient had atrial fibrillation episodes and I patient had atrial fibrillation...... attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective....

  20. Clinical Impact of Asymptomatic Presentation Status in Patients with Paroxysmal and Sustained Atrial Fibrillation

    DEFF Research Database (Denmark)

    Esato, Masahiro; Chun, Yeung-Hwa; An, Yoshimori

    2017-01-01

    BACKGROUND: The clinical characteristics and outcomes of asymptomatic patients with paroxysmal or persistent/permanent atrial fibrillation (AF) are largely unknown. METHODS: The Fushimi AF Registry is a community-based prospective survey of AF patients who visited the participating medical...... institutions in Fushimi-ku, Japan. We investigated the clinical characteristics and outcomes of asymptomatic versus symptomatic patients in the paroxysmal (n=1,837) and persistent/permanent (as sustained: n=1,912) AF subgroups. RESULTS: In the paroxysmal AF (PAF) group, asymptomatic patients were older...

  1. Clinical profile and therapeutic management of patients with atrial fibrillation in Greece: results from the Registry of Atrial Fibrillation to Investigate New Guidelines (RAFTING).

    Science.gov (United States)

    Farmakis, Dimitrios; Pipilis, Athanasios; Antoniou, Anna; Kaliambakos, Sotirios; Goudevenos, John; Anastasiou-Nana, Maria; Pyrgakis, Vlassios; Parcharidis, Georgios; Lekakis, John

    2013-01-01

    Atrial fibrillation (AF) is the most common arrhythmia with significant morbidity, including a 5-fold increase in stroke risk. The management of AF, including antithrombotic therapy (AT), varies considerably among countries. Representative data concerning AF features and management in Greece are generally lacking. The Registry of Atrial Fibrillation To Investigate New Guidelines (RAFTING) is a country-wide prospective observational study of AF in Greece that enrolled consecutive patients with a diagnosis of AF in emergency departments of 31 hospitals of different types according to the population's geographical distribution. RAFTING enrolled 1127 patients, 51% females, aged 71 ± 12 years. Paroxysmal AF was present in 54% of patients and newly diagnosed AF in 28%; 68% of patients with a previous AF history had undergone a median of 4 cardioversions. A high rate of comorbidities was present, including arterial hypertension in 75% and heart failure in 40%. The median CHADS2 and CHA2DS2VASc scores were 2 and 3, respectively; AT had been prescribed in 87% of non-newly diagnosed patients, with warfarin being prescribed in 56% of them. Among all patients on warfarin, INR values were within therapeutic range in 34% of cases during inhospital measurement. Hospital admission occurred in 82% of cases, with in-hospital mortality 0.8%. RAFTING provides updated insights into the current features and management of AF in Greece. The majority of patients have a sufficiently high risk to warrant oral anticoagulation and further attempts to comply with the existing guidelines are warranted.

  2. New risk factors for atrial fibrillation : causes of 'not-so-lone atrial fibrillation'

    NARCIS (Netherlands)

    Schoonderwoerd, Bas A.; Smit, Marcelle D.; Pen, Lucas; Van Gelder, Isabelle C.

    Atrial fibrillation (AF) is a prevalent arrhythmia in patients with cardiovascular disease. The classical risk factors for developing AF include hypertension, valvular disease, (ischaemic) cardiomyopathy, diabetes mellitus, and thyroid disease. In some patients with AF, no underlying

  3. Amiodarone and mortality among elderly patients with acute myocardial infarction with atrial fibrillation.

    Science.gov (United States)

    Kilborn, Michael J; Rathore, Saif S; Gersh, Bernard J; Oetgen, William J; Solomon, Allen J

    2002-12-01

    Amiodarone has been shown to be safe in patients with acute myocardial infarction (AMI) who are at risk for sudden cardiac death. However, there is limited data concerning the safety of amiodarone in patients who experience AMI complicated by atrial fibrillation. To determine the safety of amiodarone therapy, we conducted a retrospective analysis of elderly patients hospitalized with AMI who experienced atrial fibrillation and had survived to hospital discharge (n = 17,597). Amiodarone prescribed at discharge was evaluated for its association with short-term and long-term mortality in crude and adjusted analyses employing propensity score methods. Of the 17,597 patients, 550 patients (3.1%) were prescribed amiodarone, 2317 patients (13.2%) were prescribed other antiarrhythmic agents (excluded from analysis), and 14,730 (83.7%) were prescribed no antiarrhythmic medication at discharge. Thirty-day mortality rates were similar for patients prescribed amiodarone and those not prescribed amiodarone (6.8% amiodarone vs 5.4% no amiodarone, P =.21), but mortality at 1 year was higher among patients prescribed amiodarone (35.6% vs 31.6%, P =.001). However, amiodarone was not associated with mortality at 30 days (odds ratio 0.80, 95% CI 0.53-1.20) or at long-term follow-up (mean duration 612 days, hazard ratio 1.04, 95% CI 0.92-1.18) after multivariable modeling. Amiodarone was not independently associated with short-term or long-term mortality in elderly patients discharged after a hospitalization for AMI complicated by atrial fibrillation. Although our data suggest that amiodarone may be safe to use in this population, randomized controlled trial data are needed to confirm this finding.

  4. Chronic obstructive pulmonary disease in patients with atrial fibrillation: Insights from the ARISTOTLE trial.

    Science.gov (United States)

    Durheim, Michael T; Cyr, Derek D; Lopes, Renato D; Thomas, Laine E; Tsuang, Wayne M; Gersh, Bernard J; Held, Claes; Wallentin, Lars; Granger, Christopher B; Palmer, Scott M; Al-Khatib, Sana M

    2016-01-01

    Comorbid chronic obstructive pulmonary disease (COPD) is associated with poor outcomes among patients with cardiovascular disease. The risks of stroke and mortality associated with COPD among patients with atrial fibrillation are not well understood. We analyzed patients from ARISTOTLE, a randomized trial of 18,201 patients with atrial fibrillation comparing the effects of apixaban versus warfarin on the risk of stroke or systemic embolism. Using Cox proportional hazards models, we assessed the associations between comorbid COPD and risk of stroke or systemic embolism and of mortality, adjusting for treatment allocation, smoking history and other risk factors. COPD was present in 1950 (10.8%) of 18,134 patients with data on pulmonary disease history. After multivariable adjustment, COPD was not associated with risk of stroke or systemic embolism (adjusted HR 0.85 [95% CI 0.60, 1.21], p=0.356). However, COPD was associated with a higher risk of all-cause mortality (adjusted HR 1.60 [95% CI 1.36, 1.88], p<0.001) and both cardiovascular and non-cardiovascular mortality. The benefit of apixaban over warfarin on stroke or systemic embolism was consistent among patients with and without COPD (HR 0.92 [95% CI 0.52, 1.63] versus 0.78 [95% CI 0.65, 0.95], interaction p=0.617). COPD was independently associated with increased risk of cardiovascular and non-cardiovascular mortality among patients with atrial fibrillation, but was not associated with risk of stroke or systemic embolism. The effect of apixaban on stroke or systemic embolism in COPD patients was consistent with its effect in the overall trial population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Traumatic events involving elderly patients treated with anticoagulants for atrial fibrillation: the downside of stroke prevention

    Directory of Open Access Journals (Sweden)

    Alessandro Riccardi

    2016-08-01

    Full Text Available A group of oral anticoagulant-treated patients affected by permanent atrial fibrillation was evaluated after their access to the emergency room as a result of a traumatic accident. In these patients, the re-evaluation of their risk of thromboembolism and bleeding was performed together with the evaluation of their risk of falling and institutionalization. Results show that the emergency department identifies a cohort of very elderly frail patients, who should be carefully reconsidered for anticoagulant therapy after a traumatic event.

  6. Preadmission oral anticoagulant therapy and clinical outcome in patients hospitalised with acute stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Ottosen, Tobias Pilgaard; Svendsen, Marie Louise; Hansen, Morten Lock

    2014-01-01

    INTRODUCTION: Information about the effect of preadmission oral anticoagulant therapy (OAT) on stroke outcome in patients with atrial fibrillation (AF) is scarce. A systematic review was done of the existing data on the association between preadmission OAT and stroke outcome in patients with AF....... METHOD: We performed a systematic search in the PubMed Database, the Embase Database and the Cochrane Database of Systematic Reviews identifying 13 studies that met the inclusion criteria. RESULTS: The studies included a total of 18,523 patients with AF and admission with stroke. Of these, 1,169 had...

  7. Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Hess, Connie N; Peterson, Eric D; Peng, S Andrew

    2015-01-01

    BACKGROUND: Antithrombotic therapy for acute myocardial infarction (MI) with atrial fibrillation (AF) among higher risk older patients treated with percutaneous coronary intervention (PCI) remains unclear. OBJECTIVES: This study sought to determine appropriate antithrombotic therapy for acute MI...... patients with AF treated with PCI. METHODS: We examined 4,959 patients ≥65 years of age with acute MI and AF who underwent coronary stenting (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). The primary effectiveness outcome was 2-year major adverse cardiac...

  8. Screening for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Freedman, Ben; Camm, A. John; Calkins, Hugh

    2017-01-01

    in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health......Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed...... or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace...

  9. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan (China); Guo, Ying-Kun [Sichuan University, Department of Radiology, West China Second University Hospital, Chengdu (China)

    2017-02-15

    To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

  10. Safe, effective and durable epicardial left atrial appendage clip occlusion in patients with atrial fibrillation undergoing cardiac surgery: first long-term results from a prospective device trial

    OpenAIRE

    Emmert, Maximilian Y.; Puippe, Gilbert; Baumüller, Stephan; Alkadhi, Hatem; Landmesser, Ulf; Plass, Andre; Bettex, Dominique; Scherman, Jacques; Grünenfelder, Jürg; Genoni, Michele; Falk, Volkmar; Salzberg, Sacha P.

    2017-01-01

    OBJECTIVES Atrial fibrillation (AF) is a significant risk factor for embolic stroke originating from the left atrial appendage (LAA). This is the first report of long-term safety and efficacy data on LAA closure using a novel epicardial LAA clip device in patients undergoing cardiac surgery. METHODS Forty patients with AF were enrolled in this prospective ‘first-in-man' trial. The inclusion criterion was elective cardiac surgery in adult patients with AF for which a concomitant ablation proce...

  11. Efficacy and Safety Outcomes of Direct Oral Anticoagulants and Amiodarone in Patients with Atrial Fibrillation.

    Science.gov (United States)

    Lupercio, Florentino; Romero, Jorge; Peltzer, Bradley; Maraboto, Carola; Briceno, David; Villablanca, Pedro; Ferrick, Kevin; Gross, Jay N; Kim, Soo; Fisher, John; Di Biase, Luigi; Krumerman, Andrew

    2017-12-21

    Direct oral anticoagulants (DOACs) and amiodarone are widely used in the treatment of non-valvular atrial fibrillation. The DOACs are P-glycoprotein (P-gp) and cytochrome p-450 (CYP3A4) substrates. DOAC levels may be increased by the concomitant use of potent dual P-gp/CYP3A4 inhibitors such as amiodarone, which can potentially translate into adverse clinical outcomes. We aimed to assess the efficacy and safety of drug-drug interaction by the concomitant use of DOACs and amiodarone. We performed a systematic review of MEDLINE, Cochrane and Embase limiting our search to randomized controlled trials of patients with atrial fibrillation that have compared DOACs vs warfarin for prophylaxis of stroke or systemic embolism in order to analyze the impact on stroke or systemic embolism, major bleeding and intracranial bleeding risk in patients with concomitant use of amiodarone. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method. The fixed effects model was used due to heterogeneity (I2) trials with a total of 71,683 patients were analyzed from which 5% (n= 3,212) of patients were concomitantly on DOAC and amiodarone. We found no statistically significant difference for any of the clinical outcomes (stroke or systemic embolism (RR, 0.85; 95% CI 0.67-1.06), major bleeding (RR, 0.91; 95% CI 0.77-1.07) or intracranial bleeding (RR, 1.10; 95% CI 0.68-1.78)) among patients on DOAC and amiodarone versus DOAC without amiodarone. Based on the results of this meta-analysis, co-administration of DOACs and amiodarone, a dual P-gp/CYP3A4 inhibitor, does not appear to affect efficacy or safety outcomes in patients with atrial fibrillation. Copyright © 2017. Published by Elsevier Inc.

  12. Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients: a systematic review of randomized controlled trials.

    Science.gov (United States)

    Kanji, Salmaan; Stewart, Robert; Fergusson, Dean A; McIntyre, Lauralyn; Turgeon, Alexis F; Hébert, Paul C

    2008-05-01

    Atrial fibrillation is a common problem associated with morbidity and mortality in critically ill patients; however, evidence-based treatment recommendations are lacking. The objective of this systematic review was to evaluate the efficacy of pharmacologic rhythm control of new-onset atrial fibrillation in noncardiac, critically ill adults. Citations identified from an electronic search of Medline, the Cochrane register of controlled trials, and Embase databases (1966 to August 2006) were independently reviewed by two investigators. All prospective randomized controlled trials evaluating pharmacologic rhythm conversion regimens for new-onset atrial fibrillation in (noncardiac surgery) critically ill adult patients were included. The primary end point was atrial fibrillation resolution. Using a standardized data extraction form, data related to study design, population characteristics, pharmacologic intervention, and outcome measures were collected. Four trials met inclusion criteria from 1995 citations screened. Of the 143 evaluable patients in these trials 89 (76%) had atrial fibrillation while the remaining ones had other atrial tachyarrhythmias. Drugs evaluated for rhythm conversion included amiodarone (n = 26), procainamide (n = 14), magnesium (n = 18), flecainide (n = 15), esmolol (n = 28), verapamil (n = 15), and diltiazem (n = 27). The definition of treatment success ranged from conversion within 1 hr to conversion within 24 hrs. No study evaluated maintenance of conversion, and one study included hemodynamically unstable patients. Lack of methodologic homogeneity prevented any pooled analysis. Using the current published literature, we cannot recommend a standard treatment for atrial fibrillation in noncardiac critically ill adult patients. Clinical trials evaluating rhythm conversion in critically ill populations outside of cardiac surgery are lacking. Further trials that address goals of care in hemodynamically stable and unstable patients and utilize

  13. Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling: ENGAGE AF-TIMI 48 Analysis.

    Science.gov (United States)

    Steffel, Jan; Giugliano, Robert P; Braunwald, Eugene; Murphy, Sabina A; Mercuri, Michele; Choi, Youngsook; Aylward, Phil; White, Harvey; Zamorano, Jose Luis; Antman, Elliott M; Ruff, Christian T

    2016-09-13

    Anticoagulation is often avoided in patients with atrial fibrillation who are at an increased risk of falling. This study assessed the relative efficacy and safety of edoxaban versus warfarin in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial in patients with atrial fibrillation judged to be at increased risk of falling. We performed a pre-specified analysis of the ENGAGE AF-TIMI 48, comparing patients with versus without increased risk of falling. Nine hundred patients (4.3%) were judged to be at increased risk of falling. These patients were older (median, 77 vs. 72 years; p TIMI 48]; NCT00781391). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Net Clinical Benefit of Antithrombotic Therapy in Patients With Atrial Fibrillation and Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Bonde, Anders Nissen; Lip, Gregory Y H; Kamper, Anne-Lise

    2014-01-01

    BACKGROUND: The balance between stroke reduction and increased bleeding associated with antithrombotic therapy among patients with atrial fibrillation (AF) and chronic kidney disease (CKD) is controversial. OBJECTIVES: This study assessed the risk associated with CKD in individual CHA₂DS₂-VASc...... (Congestive heart failure; Hypertension; Age ≥75 years; Diabetes mellitus; previous Stroke, transient ischemic attack, or thromboembolism; Vascular disease; Age 65 to 74 years; Sex category) strata and the net clinical benefit of warfarin in patients with AF and CKD in a nationwide cohort. METHODS...

  15. Impact of dronedarone on hospitalization burden in patients with atrial fibrillation: results from the ATHENA study.

    Science.gov (United States)

    Torp-Pedersen, Christian; Crijns, Harry J G M; Gaudin, Christophe; Page, Richard L; Connolly, Stuart J; Hohnloser, Stefan H

    2011-08-01

    Cardiovascular (CV) hospitalization is a predictor of CV mortality and has a negative impact on patients' quality of life. The primary endpoint of A placebo-controlled, double-blind, parallel-arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENTs with Atrial fibrillation/atrial flutter (ATHENA), a composite of first CV hospitalization or death from any cause, was significantly reduced by dronedarone. This post hoc analysis evaluated the secondary endpoint of CV hospitalization and the clinical benefit of dronedarone on the number and duration of CV hospitalizations in patients with atrial fibrillation (AF). ATHENA was a double-blind, parallel group study in 4628 patients with a history of paroxysmal/persistent AF and additional risk factors, treated with placebo or dronedarone. Dronedarone treatment significantly reduced the risk of first CV hospitalization (P < 0.0001 vs. placebo), while the risk of first non-CV hospitalization was similar in both groups (P = 0.77). About half of the CV hospitalizations were AF-related, with a median duration of hospital stay of four nights. The risk of any hospitalization for AF [hazard ratio (95% confidence interval) 0.626 (0.546-0.719)] and duration of hospital stay were significantly reduced by dronedarone (P < 0.0001 vs. placebo). Dronedarone treatment reduced total hospitalizations for acute coronary syndrome (P = 0.0105) and the time between the first AF/atrial flutter recurrence and CV hospitalization/death (P = 0.0048). Hospitalization burden was significantly reduced across all levels of care (P < 0.05). Cumulative incidence data indicated that the effects of dronedarone persisted for at least 24 months. Dronedarone reduced the risk for CV hospitalization and the total hospitalization burden in this patient group. The trial is registered under ClinicalTrials.gov #NCT 00174785.

  16. Antithrombotic therapy after acute ischemic stroke in patients with atrial fibrillation.

    Science.gov (United States)

    McGrath, Emer R; Kapral, Moira K; Fang, Jiming; Eikelboom, John W; Conghaile, Aengus ó; Conghaile, Aengus O; Canavan, Michelle; O'Donnell, Martin J

    2014-12-01

    For patients with atrial fibrillation and ischemic stroke (IS), current guidelines recommend oral anticoagulation (OAC) alone for secondary prevention of IS. In a large prospective cohort of patients with acute IS and atrial fibrillation, we determine the association between antithrombotic regimen on discharge and risk of major vascular events. Prospective cohort of consecutive patients included in the Ontario Stroke Registry. Multivariable Cox proportional hazard models were used to determine the association between antithrombotic regimen on discharge and time to death or admission for recurrent IS, myocardial infarction, or major bleeding. Two thousand one hundred sixty-two patients were hospitalized atrial fibrillation and acute IS. At discharge, 8.0% were prescribed no antithrombotic therapy, 21.6% antiplatelet therapy alone, 39.3% OAC (warfarin) alone, and 31.1% combination OAC and antiplatelet therapy. Compared with OAC alone (hazard ratio [HR], 1.0), no antithrombotic therapy (HR, 1.51; 95% confidence interval, 1.23-1.86) and antiplatelet therapy (HR, 1.31; 95% confidence interval, 1.14-1.50) were associated with an increased risk of the primary composite outcome, whereas combination OAC and antiplatelet therapy was associated with a trend toward a reduced risk (HR, 0.91; 95% confidence interval, 0.80-1.04 overall and HR, 0.79; 95% confidence interval, 0.61-1.02 in those with coronary heart disease). Results were consistent in those with severe stroke: HR 1.58 (95% CI, 1.21-2.06), 1.34 (95% CI, 1.09-1.63), and 0.91 (95% CI, 0.74-1.11), respectively. Contrary to current guidelines, 30% of patients with atrial fibrillation and recent IS are not prescribed any OAC therapy on discharge, whereas a further 30% are prescribed combination OAC and antiplatelet therapy. Combination OAC and antiplatelet therapy in patients at high cardiovascular risk requires evaluation in clinical trials, particularly with the newer OACs, given their more favorable risk-benefit ratio

  17. Sequence Alterations of I(Ks Potassium Channel Genes in Kazakhstani Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Ainur Akilzhanova

    2014-12-01

    Full Text Available Introduction. Atrial fibrillation (AF is the most common sustained arrhythmia, and it results in significant morbidity and mortality. However, the pathogenesis of AF remains unclear to date. Recently, more pieces of evidence indicated that AF is a multifactorial disease resulting from the interaction between environmental factors and genetics. Recent studies suggest that genetic mutation of the slow delayed rectifier potassium channel (I(Ks may underlie AF.Objective. To investigate sequence alterations of I(Ks potassium channel genes KCNQ1, KCNE1 and KCNE2 in Kazakhstani patients with atrial fibrillation.Methods. Genomic DNA of 69 cases with atrial fibrillation and 27 relatives were analyzed for mutations in all protein-coding exons and their flanking splice site regions of the genes KCNQ1 (NM_000218.2 and NM_181798.1, KCNE1 (NM_000219.2, and KCNE2 (NM_172201.1 using bidirectional sequencing on the ABI 3730xL DNA Analyzer (Applied Biosystems, Foster City, CA, USA.Results. In total, a disease-causing mutation was identified in 39 of the 69 (56.5% index cases. Of these, altered sequence variants in the KCNQ1 gene accounted for 14.5% of the mutations, whereas a KCNE1 mutation accounted for 43.5% of the mutations and KCNE2 mutation accounted for 1.4% of the mutations. The majority of the distinct mutations were found in a single case (80%, whereas 20% of the mutations were observed more than once. We found two sequence variants in KCNQ1 exon 13 (S546S G1638A and exon 16 (Y662Y, C1986T in ten patients (14.5%. In KCNE1 gene in exon 3 mutation, S59G A280G was observed in 30 of 69 patients (43.5% and KCNE2 exon 2 T10K C29A in 1 patient (1.4%. Genetic cascade screening of 27 relatives to the 69 index cases with an identified mutation revealed 26.9% mutation carriers  who were at risk of cardiac events such as syncope or sudden unexpected death.Conclusion. In this cohort of Kazakhstani index cases with AF, a disease-causing mutation was identified in

  18. Mini-maze suffices as adjunct to mitral valve surgery in patients with preoperative atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Tieleman, RG; Grandjean, JG; Huet, RCG; Van der Maaten, JMAA; Pieper, EG; De Kam, PJ; Ebels, MSCT; Crijns, HJGM

    Mini-Maze and Mitral Valve Surgery. Introduction: After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach

  19. Fibrin Clot Permeability as a Predictor of Stroke and Bleeding in Anticoagulated Patients With Atrial Fibrillation.

    Science.gov (United States)

    Drabik, Leszek; Wołkow, Paweł; Undas, Anetta

    2017-10-01

    Formation of denser fiber networks has been reported in atrial fibrillation and ischemic stroke. In this longitudinal cohort study, we evaluated whether fibrin clot density may predict thromboembolic and bleeding risk in patients with atrial fibrillation on vitamin K antagonists. In 236 patients with atrial fibrillation receiving vitamin K antagonists treatment, we measured ex vivo plasma clot permeability (K s ), a measure of the pore size in fibrin networks. During a median follow-up of 4.3 (interquartile range, 3.7-4.8) years, annual rates of ischemic stroke or transient ischemic attack and major bleeds were 2.96% and 3.45%, respectively. In multivariate Cox regression analysis, patients with lower K s (stroke or transient ischemic attack (hazard ratio [HR], 6.55; 95% confidence interval [CI], 2.17-19.82) and major bleeds (HR, 10.65; 95% CI, 3.52-32.22). Patients with elevated K s (≥6.8 cm 2 ×10 -9 ) had an increased rate of minor bleeding compared with the remainder (11.63% per year versus 3.55% per year; P stroke or transient ischemic attack were low K s (<6.8 cm 2 ×10 - 9 ; HR, 7.24; 95% CI, 2.53-20.76), age (HR, 1.05; 95% CI, 1.01-1.10), and treatment with angiotensin-converting enzyme inhibitors (HR, 2.27; 95% CI, 1.08-4.77). Major bleeds were predicted by low K s (<6.8 cm 2 ×10 -9 ; HR, 8.48; 95% CI, 2.99-24.1) and HAS-BLED score ≥3 (HR, 2.22; 95% CI, 1.12-4.38). This study is the first to show that unfavorable fibrin properties reflected by formation of denser fibrin networks determine, in part, the efficacy and safety of anticoagulation with vitamin K antagonists in patients with atrial fibrillation. © 2017 American Heart Association, Inc.

  20. Nursing and quality of life in patients with atrial fibrillation before and after radiofrequency ablation.

    Science.gov (United States)

    Pavelková, Zdeňka; Bulava, Alan

    2014-01-01

    The importance of nursing and patient quality of life is a top concern for medical professionals. Therefore, participation by medical professionals in raising awareness and continuously supporting improvements in nursing care is an essential part of improving patient quality of life. Modern medical techniques and procedures are changing rapidly, particularly in the field of cardiology. This has resulted in changing roles and increased responsibility for nurses and confirms the necessity for changing the perception of nurses relative to their role in the medical environment and to patient care. This paper presents the results from the first phase of a research project and focuses on quality of life and problematic areas associated with the needs of patients with atrial fibrillation before and after radiofrequency catheter ablation. Atrial fibrillation is one of the most common supraventricular arrhythmias. Its incidence in the general population has risen significantly over the last twenty years. The objective of this research was to assess those areas, which are considered by patients to be problematic before therapeutic intervention. The research was realized through a quantitative survey using a modified questionnaire. Results showed that AF reduced the quality of life both physically and psychologically (i.e. increased levels of anxiety and depression). Results also showed that radiofrequency catheter ablation was able to alleviate symptoms associated with AF and was also able to increase patient quality of life.

  1. Prevention of thromboembolic events in patients with atrial fibrillation – new anticoagulants

    Directory of Open Access Journals (Sweden)

    Alexandre Holthausen Campos

    2011-09-01

    Full Text Available The authors present alternatives for the treatment of cardiacarrhythmias. Its detection is based on the use of different methods that record the cardiac electrical activity. The treatment involves intervening in the underlying disorder, antiarrhythmic drugs, stimulation and cardiac defibrillation devices, and, less often, surgery. The technological advances in the last two decades have provided greater efficiency in diagnoses and therapy. Atrial fibrilation patients will benefit from a new set of anticoagulant drugs tested in the past three years. The potential advantages include greater safety and efficacy, as well as conveniencefor not requiring frequent laboratory controls.

  2. The RecordAF study: design, baseline data, and profile of patients according to chosen treatment strategy for atrial fibrillation

    DEFF Research Database (Denmark)

    Le Heuzey, Jean-Yves; Breithardt, Günter; Camm, John

    2010-01-01

    The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation (RecordAF) is the first worldwide, 1-year observational, longitudinal study of the management of paroxysmal/persistent atrial fibrillation (AF) in recently diagnosed patients. The study was conducted at 532 sites......-control patients mainly received beta blockers (72%), except for sotalol, or cardiac glycosides (34%). Patients receiving a rhythm-control strategy were younger, had a lower resting heart rate, were more frequently symptomatic, and were more likely to have recently diagnosed AF or paroxysmal AF compared...

  3. Performance of short ECG recordings twice daily to detect paroxysmal atrial fibrillation in stroke and transient ischemic attack patients

    DEFF Research Database (Denmark)

    Poulsen, Mai Bang; Binici, Zeynep; Domínguez, Helena

    2017-01-01

    included. Patients were monitored for atrial fibrillation with five days' Holter and concurrent 30 s thumb-ECG twice daily, the latter continuing for 30 days. Inter-observer agreement for the thumb-ECG was determined. Results One hundred patients were included and 95 patients were analyzed. Paroxysmal......-ECG had a kappa value of 0.65. Conclusion Thirty days' thumb-ECG recordings twice daily for 30 s detect a high proportion of paroxysmal atrial fibrillation in a stroke or transient ischemic attack cohort. The proportion was comparable to five days' Holter monitoring but the agreement between the two...

  4. Percutaneous left atrial appendage occlusion in atrial fibrillation patients with a contraindication to oral anticoagulation: a focused review.

    Science.gov (United States)

    Nishimura, Marin; Sab, Shiv; Reeves, Ryan R; Hsu, Jonathan C

    2017-12-08

    Stroke is the most feared complication of atrial fibrillation (AF). Although oral anticoagulation with non-vitamin K antagonist and non-vitamin K antagonist oral anticoagulants (NOACs) have been established to significantly reduce risk of stroke, real-world use of these agents are often suboptimal due to concerns for adverse events including bleeding from both patients and clinicians. Particularly in patients with previous serious bleeding, oral anticoagulation may be contraindicated. Left atrial appendage occlusion (LAAO), mechanically targeting the source of most of the thrombi in AF, holds an immense potential as an alternative to OAC in management of stroke prophylaxis. In this focused review, we describe the available evidence of various LAAO devices, detailing data regarding their use in patients with a contraindication for oral anticoagulation. Although some questions of safety and appropriate use of these new devices in patients who cannot tolerate anticoagulation remain, LAAO devices offer a significant step forward in the management of patients with AF, including those patients who may not be able to be prescribed OAC at all. Future studies involving patients fully contraindicated to OAC are warranted in the era of LAAO devices for stroke risk reduction. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  5. Practical guidance for using rivaroxaban in patients with atrial fibrillation: balancing benefit and risk

    Directory of Open Access Journals (Sweden)

    Haas S

    2014-03-01

    Full Text Available Sylvia Haas,1 Christoph Bode,2 Bo Norrving,3 Alexander GG Turpie4 1Technical University Munich, Munich, Germany; 2Department of Cardiology and Angiology, University of Freiburg, Freiburg, Germany; 3Department of Clinical Neuroscience, Lund University Hospital, Lund, Sweden; 4Department of Medicine, McMaster University, Hamilton, Ontario, Canada Abstract: Rivaroxaban is a direct factor Xa inhibitor that is widely available to reduce the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation and one or more risk factors for stroke. Rivaroxaban provides practical advantages compared with warfarin and other vitamin K antagonists, including a rapid onset of action, few drug interactions, no dietary interactions, a predictable anticoagulant effect, and no requirement for routine coagulation monitoring. However, questions have emerged relating to the responsible use of rivaroxaban in day-to-day clinical practice, including patient selection, dosing, treatment of patients with renal impairment, conversion from use of vitamin K antagonists to rivaroxaban and vice versa, coagulation tests, and management of patients requiring invasive procedures or experiencing bleeding or an ischemic event. This article provides practical recommendations relating to the use of rivaroxaban in patients with nonvalvular atrial fibrillation, based on clinical trial evidence, relevant guidelines, prescribing information, and the authors' clinical experience. Keywords: novel oral anticoagulants, direct factor Xa inhibitor, peri-interventional management, practical guidance, rivaroxaban, stroke prevention

  6. Heart rate and adverse outcomes in patients with atrial fibrillation: A combined AFFIRM and AF-CHF substudy.

    Science.gov (United States)

    Andrade, Jason G; Roy, Denis; Wyse, D George; Tardif, Jean-Claude; Talajic, Mario; Leduc, Hugues; Tourigny, Julia-Cadrin; Shohoudi, Azadeh; Dubuc, Marc; Rivard, Léna; Guerra, Peter G; Thibault, Bernard; Dyrda, Katia; Macle, Laurent; Khairy, Paul

    2016-01-01

    An elevated resting heart rate has been associated with adverse cardiovascular outcomes. Its prognostic value has not specifically been examined in patients with atrial fibrillation. The purpose of this study was to assess the relationship between resting heart rate measured in sinus rhythm and in atrial fibrillation and subsequent hospitalizations and death. An analysis of individual patient-level data from subjects enrolled in the AFFIRM and AF-CHF trials was conducted to determine the impact of resting heart rate on hospitalizations and mortality. Separate analyses were performed in atrial fibrillation and sinus rhythm. A total of 7159 baseline ECGs (4848 in atrial fibrillation, 2311 in sinus rhythm) were analyzed in 5164 patients (34.8% female, age 68.2 ± 8.3 years). During mean follow-up of 40.8 ± 16.3 months, 1016 patients died (668 cardiovascular deaths), and 3150 required at least 1 hospitalization (2215 cardiovascular). An elevated baseline heart rate in sinus rhythm was associated with increased all-cause mortality [hazard ratio (HR) 1.24 per 10 bpm increase, 95% confidence interval (CI) 1.14-1.36, P 114 bpm was independently associated with all-cause (HR 1.18, 95% CI 1.06-1.31, P = .0018) and cardiovascular (HR 1.25, 95% CI 1.10-1.42, P = .0005) hospitalizations. In patients with a history of atrial fibrillation, an elevated baseline heart rate in sinus rhythm is independently associated with mortality. In contrast, the baseline heart rate in atrial fibrillation is not associated with mortality but predicts hospitalizations. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  7. Oral anticoagulant therapy and clinical outcomes in patients with atrial fibrillation: a pilot study from a single center registry.

    Science.gov (United States)

    Aksan, Gökhan; Soylu, Korhan; Demircan, Sabri; Aksoy, Olcay; Yanık, Ahmet; Gedikli, Ömer; Yüksel, Serkan; Şahin, Mahmut; Yılmaz, Özcan

    2014-10-01

    The data on the successful use of oral anticoagulation (OAC) in patients with atrial fibrillation are inconclusive. We aimed to describe the indications and the utilization patterns of OAC therapy in patients with atrial fibrillation who have been admitted to a quaternary hospital. Patients who were admitted to a quaternary hospital from January 2011 to January 2012 with atrial fibrillation were included in the study. The data on patient demographics, atrial fibrillation classification, CHA2DS2VASc scores, and the use of OAC were collected. Of the patients admitted, 301 patients met the inclusion criteria. Of these, 277 (92%) had a CHA2DS2VASc score at least 2. Of the patients who met criteria for treatment with OAC, 104 (36.6%) were not on OAC therapy. The reason for this discrepancy was tendency and history of bleeding (29.8%). Of those 180 patients who were on OAC, the time in therapeutic range was higher in those patients less than 50 years as compared with those between ages 65-74 and more than 75 (78.2 versus 42 and 36.1%, P < 0.05). The overall time in therapeutic range of patients on OAC was 47.4%. We found that approximately one-third of the patients who have indications for OAC are not being treated as per guidelines due to history of and tendency for bleeding. Furthermore, of those on OAC, only half of the patients achieved successful anticoagulation.

  8. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation : insights from the RE-LY trial

    NARCIS (Netherlands)

    Westenbrink, B. D.; Alings, M.; Connolly, S. J.; Eikelboom, J.; Ezekowitz, M. D.; Oldgren, J.; Yang, S.; Pongue, J.; Yusuf, S.; Wallentin, L.; van Gilst, W. H.

    BackgroundAnemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). ObjectivesTo investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. Patients and methodsWe retrospectively analyzed the RE-LY

  9. The use of warfarin in veterans with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Rosenbeck Karen

    2004-10-01

    Full Text Available Abstract Background Warfarin therapy is effective for the prevention of stroke in patients with atrial fibrillation. However, warfarin therapy is underutilized even among ideal anticoagulation candidates. The purpose of this study was to examine the use of warfarin in both inpatients and outpatients with atrial fibrillation within a Veterans Affairs (VA hospital system. Methods This retrospective medical record review included outpatients and inpatients with atrial fibrillation. The outpatient cohort included all patients seen in the outpatient clinics of the VA Connecticut Healthcare System during June 2000 with a diagnosis of atrial fibrillation. The inpatient cohort included all patients discharged from the VA Connecticut Healthcare System West Haven Medical Center with a diagnosis of atrial fibrillation during October 1999 – March 2000. The outcome measure was the rate of warfarin prescription in patients with atrial fibrillation. Results A total of 538 outpatients had a diagnosis of atrial fibrillation and 73 of these had a documented contraindication to anticoagulation. Among the 465 eligible outpatients, 455 (98% were prescribed warfarin. For the inpatients, a total of 212 individual patients were discharged with a diagnosis of atrial fibrillation and 97 were not eligible for warfarin therapy. Among the 115 eligible inpatients, 106 (92% were discharged on warfarin. Conclusions Ideal anticoagulation candidates with atrial fibrillation are being prescribed warfarin at very high rates within one VA system, in both the inpatient and outpatient settings; we found warfarin use within our VA was much higher than that observed for Medicare beneficiaries in our state.

  10. Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy

    DEFF Research Database (Denmark)

    Hansen, Morten Lock; Jepsen, Rikke Malene H G; Olesen, Jonas Bjerring

    2015-01-01

    AIMS: To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current (DC) cardioversion with or without oral anticoagulant coverage. METHODS AND RESULTS: A retrospective study of 16 274 patients in Denmark discharged from hospital after a first...... therapy was 2.21; 95% CI, 0.79-6.77 and 2.40; 95% CI, 1.46-3.95 with CHA2DS2-VASc score 0-1 and CHA2DS2-VASc score 2 or more, respectively. CONCLUSION: Direct current cardioversion for atrial fibrillation without oral anticoagulation is associated with a high risk of thromboembolism. Notably, the risk...

  11. Atrial fibrillation in KCNE1-null mice

    NARCIS (Netherlands)

    Temple, Joel; Frias, Patricio; Rottman, Jeffrey; Yang, Tao; Wu, Yuejin; Verheijck, E. Etienne; Zhang, Wei; Siprachanh, Chanthaphaychith; Kanki, Hideaki; Atkinson, James B.; King, Paul; Anderson, Mark E.; Kupershmidt, Sabina; Roden, Dan M.

    2005-01-01

    Although atrial fibrillation is the most common serious cardiac arrhythmia, the fundamental molecular pathways remain undefined. Mutations in KCNQ1, one component of a sympathetically activated cardiac potassium channel complex, cause familial atrial fibrillation, although the mechanisms in vivo are

  12. Left atrial thrombi and spontaneous echo contrast in patients with atrial fibrillation : Systematic analysis of a single-center experience.

    Science.gov (United States)

    Bejinariu, A G; Härtel, D U; Brockmeier, J; Oeckinghaus, R; Herzer, A; Tebbe, U

    2016-12-01

    Atrial fibrillation is associated with a high risk for thromboembolic events. Thrombi in the left atrial appendage and spontaneous echo contrast (SEC) correlate positively with this embolic risk. We studied the laboratory, echocardiographic, and epidemiologic parameters that could predict left atrial thrombi and the intensity of the SEC. Between September 2013 and June 2015 we included 372 patients with atrial fibrillation before planned electrical cardioversion (transesophageal-guided strategy) in this study. After assessing the risk of stroke and bleeding (CHA2DS2-VASc and HAS-BLED scores), we measured the concentration of the D-dimer and B-type natriuretic peptide at the time of the transesophageal echocardiography as well as the left atrial volume and the ejection fraction during transthoracic echocardiography. The ejection fraction and the CHA2DS2-VASc score were identified as independent predictors of both left atrial thrombi and SEC, whereas the left atrial volume could only predict the intensity of SEC. In contrast to the results of other studies, the biomarkers in this study failed to predict the outcome. Only the echocardiographic and epidemiologic parameters were predictors of left atrial thrombi and SEC intensity, while the studied biomarkers had no predictive power. Using clinical data and transthoracic echocardiography, we can change the therapeutic strategy in high-risk patients.

  13. Documentation of impaired coronary blood flow by TIMI frame count method in patients with atrial fibrillation.

    Science.gov (United States)

    Luo, Chufan; Wu, Xing; Huang, Zhibin; Du, Zhimin; Hao, Yuantao; Hu, Chengheng; Huang, Yong; Gao, Xiuren

    2013-08-20

    Atrial fibrillation (AF) is associated with impaired coronary flow and diminished myocardial perfusion. In the present study we aimed to evaluate coronary blood flow by means of Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) in patients with AF in the absence of obstructive coronary artery disease (CAD). This prospective study initially enrolled 166 patients with AF and 332 age- and gender-matched control subjects without AF. After diagnostic coronary angiography, TFC was assessed in the participants without obstructive CAD, with 146 in the AF group and 150 in the control group. The TFC for three major coronary arteries and the mean TFC were found to be significantly higher in AF patients compared to control subjects (34.1 ± 10.4 vs. 25.0 ± 10.4, 31.8 ± 9.7 vs. 23.7 ± 9.1, and 32.3 ± 9.5 vs. 24.1 ± 8.4 for each artery and 32.8 ± 9.2 vs. 24.3 ± 8.9 for mean TFC, pTIMI frame counts for all three coronary vessels, indicating impaired coronary blood flow, compared to the control subjects without atrial fibrillation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy.

    Science.gov (United States)

    Kim, Ki-Hun; Mohanty, Sanghamitra; Mohanty, Prasant; Trivedi, Chintan; Morris, Eli Hamilton; Santangeli, Pasquale; Bai, Rong; Al-Ahmad, Amin; Burkhardt, John David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Kim, Soo G; Di Biase, Luigi; Natale, Andrea

    2017-08-01

    Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known. This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation. A total of 146 patients on THR and 146 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model (age, sex, body mass index, and left atrium size). The presence of non-pulmonary vein (PV) triggers was disclosed by a high-dose isoproterenol challenge (up to 30 μg/min) after PV isolation. Clinical characteristics were not different between the groups. When compared to the control, non-PV triggers were significantly greater in the THR patients [112 (77%) vs. 47 (32%), P right atrium (95 vs. 56%, P sources of non-PV triggers were the interatrial septum (25 vs. 11%, P = 0.002), coronary sinus (70 vs. 52%, P = 0.01), left atrial appendage (47 vs. 34%, P = 0.03), crista terminalis/superior vena cava (11 vs. 8%, P = 0.43), and mitral valve annulus (7 vs. 5%, P = 0.45) (THR vs. control), respectively. After mean follow-up of 14.7 ± 5.2 months, success rate was lower in patients on THR therapy [94 (64.4%)] compared to patients not receiving THR therapy [110 (75.3%), log-rank test value = 0.04]. Right atrial non-PV triggers were more prevalent in AF patients treated with THR. Elimination of non-PV triggers provided better arrhythmia-free survival in the non-THR group.

  15. Preoperative Electrocardiogram Score for Predicting New-Onset Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Gu, Jiwei; Andreasen, Jan J; Melgaard, Jacob; Lundbye-Christensen, Søren; Hansen, John; Schmidt, Erik B; Thorsteinsson, Kristinn; Graff, Claus

    2017-02-01

    To investigate if electrocardiogram (ECG) markers from routine preoperative ECGs can be used in combination with clinical data to predict new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Retrospective observational case-control study. Single-center university hospital. One hundred consecutive adult patients (50 POAF, 50 without POAF) who underwent coronary artery bypass grafting, valve surgery, or combinations. Retrospective review of medical records and registration of POAF. Clinical data and demographics were retrieved from the Western Denmark Heart Registry and patient records. Paper tracings of preoperative ECGs were collected from patient records, and ECG measurements were read by two independent readers blinded to outcome. A subset of four clinical variables (age, gender, body mass index, and type of surgery) were selected to form a multivariate clinical prediction model for POAF and five ECG variables (QRS duration, PR interval, P-wave duration, left atrial enlargement, and left ventricular hypertrophy) were used in a multivariate ECG model. Adding ECG variables to the clinical prediction model significantly improved the area under the receiver operating characteristic curve from 0.54 to 0.67 (with cross-validation). The best predictive model for POAF was a combined clinical and ECG model with the following four variables: age, PR-interval, QRS duration, and left atrial enlargement. ECG markers obtained from a routine preoperative ECG may be helpful in predicting new-onset POAF in patients undergoing cardiac surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The clinical efficacy of dabigatran etexilate for preventing stroke in atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Ellis CR

    2013-07-01

    Full Text Available Christopher R Ellis, Daniel W KaiserVanderbilt Heart and Vascular Institute, Nashville, TN, USAAbstract: The use of novel oral anticoagulants (NOACs for stroke and systemic embolism prevention in the setting of specifically non valvular atrial fibrillation has provided clinicians with a realistic treatment alternative to the traditional dose-adjusted, warfarin-based anticoagulation that is targeted to a therapeutic international normalized ratio range of 2.0–3.0. We discuss the use of dabigatran in the setting of mechanical heart valves, atrial fibrillation or left atrial catheter ablation procedures, reversal of the drug in the setting of adverse bleeding events, and background on the molecular biology and development of this novel treatment for stroke reduction.Keywords: NOACs, systemic embolism, atrial fibrillation, stroke, dabigatran etexilate

  17. Psychosomatic correlations in atrial fibrillations

    Directory of Open Access Journals (Sweden)

    Vladimir Ernstovich Medvedev

    2011-01-01

    Full Text Available Patients with atrial fibrillations (AF and comorbid mental disorders were examined. Two patient groups differing in the structure of psychosomatic ratios were identified. Group 1 comprised patients with AF and signs of reactivity lability that manifested itself as psychopathological reactions to the primary manifestations of AF; Group 2 included those who had developed mental disorders mainly in end-stage cardiovascular disease (predominantly a permanent form of AF in the presence of such events as chronic heart failure (CHF. The results of the study suggest that the patients with AF have frequently anxiety and hypochondriacal disorders, which agrees with the data available in the literature. In addition, end-stage AF is marked by depressive syndromes caused by the severe course of cardiovascular diseases resulting in CHF.

  18. Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry.

    Science.gov (United States)

    Leung, Melissa; van Rosendael, Philippe J; Abou, Rachid; Ajmone Marsan, Nina; Leung, Dominic Y; Delgado, Victoria; Bax, Jeroen J

    2017-12-28

    Atrial fibrillation (AF) is an independent risk factor for ischaemic stroke. The CHA2DS2-VASc is the most widely used risk stratification model; however, echocardiographic refinement may be useful, particularly in low risk AF patients. The present study examined the association between advanced echocardiographic parameters and ischaemic stroke, independent of CHA2DS2-VASc score. One thousand, three hundred and sixty-one patients (mean age 65±12 years, 74% males) with first diagnosis of AF and baseline transthoracic echocardiogram were followed by chart review for the occurrence of stroke over a mean of 7.9 years. Left atrial (LA) volumes, LA reservoir strain, P-wave to A' duration on tissue Doppler imaging (PA-TDI, reflecting total atrial conduction time), and left ventricular (LV) global longitudinal strain (GLS) were evaluated in patients with and without stroke. The independent association of these echocardiographic parameters with the occurrence of ischaemic stroke was evaluated with Cox proportional hazard models. One-hundred patients (7%) developed an ischaemic stroke, representing an annualized stroke rate of 0.9%. The incident stroke rate in the year following the first diagnosis of AF was 2.6% in the entire population and higher than the remainder of the follow-up period. Left atrial reservoir (14.5% vs. 18.9%, P = 0.005) and conduit strains were reduced (10.5% vs. 13.5%, P = 0.013), and PA-TDI lengthened (166 ms vs. 141 ms, P Left atrial reservoir strain and PA-TDI were independently associated with risk of stroke in a model including CHA2DS2-VASc score, age, and anticoagulant use. The assessment of LA reservoir strain and PA-TDI on echocardiography after initial CHA2DS2-VASc scoring provides additional risk stratification for stroke and may be useful to guide decisions regarding anticoagulation for patients upon first diagnosis of AF.

  19. Living with Atrial Fibrillation: An Analysis of Patients' Perspectives

    Directory of Open Access Journals (Sweden)

    Meral Altiok, PhD

    2015-12-01

    Conclusions: Patients need to be provided with relevant individual training and counselling so that they lead more satisfactory lives. In addition, appropriate health appointment and monitoring systems should be developed for patients to reduce the problems associated with frequent follow-up appointments.

  20. Postoperative atrial fibrillation in patients on statins undergoing ...

    African Journals Online (AJOL)

    LW Drummond

    2013-04-02

    Apr 2, 2013 ... Results: Statins did not decrease the incidence of postoperative AF in patients undergoing isolated cardiac valve surgery [odds ratio (OR) 1.19 ... myocardial infarction, heart failure, acute kidney injury, infection, neurocognitive .... Patients with valvular heart disease were not included in the cardiac surgery ...

  1. Atrial fibrillation in fracture patients treated with oral bisphosphonates

    DEFF Research Database (Denmark)

    Abrahamsen, B; Eiken, P; Brixen, K

    2009-01-01

    increased even in patients who stopped therapy after the first packet and (ii) risks were not increased by high adherence. Bisphosphonate-exposed patients were at increased risk of hospital-treated AF [adjusted HR: 1.13 (1.01-1.26)], but the risk amongst bisphosphonate users was inversely proportional...

  2. Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction

    NARCIS (Netherlands)

    Linssen, Gerard C M; Rienstra, Michiel; Jaarsma, Trijntje; Voors, Adriaan A; van Gelder, Isabelle C; Hillege, Hans L; van Veldhuisen, Dirk J

    2011-01-01

    AIMS: Atrial fibrillation (AF) is common in heart failure (HF), but few data regarding the prognostic relevance of AF are available in HF patients with preserved left ventricular ejection fraction (HF-PEF). We aimed to study the clinical impact of AF vs. sinus rhythm (SR) in stabilized HF patients

  3. Low Incidence of Atrial Fibrillation in Patients with Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Pedersen, Kenneth Bruun; Chemnitz, Alexander; Madsen, Charlotte

    2016-01-01

    BACKGROUND: Atrial fibrillation (AF) is a major cause of stroke. Therefore, all patients with ischemic stroke or transient ischemic attack (TIA) should be examined with 12-lead electrocardiogram (ECG) and continuous monitoring to detect AF. Current guidelines recommend at least 24 h continuous ECG...... monitoring, which is primarily based on studies investigating patients with ischemic stroke. The aim of our study was to investigate the diagnostic yield of 12-lead ECG and Holter monitoring in patients with TIA. METHODS: We retrospectively investigated all patients diagnosed with TIA at Odense University...... Hospital, Denmark, from January 1, 2014 to December 31, 2014. TIA was a clinical diagnosis according to the WHO definition. Patients received admission ECG and 72-hour Holter monitoring after discharge. RESULTS: 171 patients without known AF were diagnosed with TIA. Four (2.3%) were diagnosed with AF...

  4. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Huo, Yan; Gaspar, Thomas; Pohl, Matthias

    2017-01-01

    Aims: To describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients. Methods and results: Consecutive patients who underwent...... was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1 cm2 (IQR 3.6-28.5), P = 0.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1...... of LVZ. Conclusion: In a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ...

  5. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  6. The expression levels of plasma micoRNAs in atrial fibrillation patients.

    Directory of Open Access Journals (Sweden)

    Zheng Liu

    Full Text Available BACKGROUND: MicroRNA (miRNA has been found in human blood. It has been increasingly suggested that miRNAs may serve as biomarkers for diseases. We examined the potential of circulating miRNA to serve as predictors of atrial fibrillation (AF. METHODOLOGY/PRINCIPAL FINDINGS: During the discovery stage of this project, we used massively parallel signature sequencing (MPSS to carry out an in-depth analysis of the miRNA expression profile (miRNome in 5 healthy controls, 5 patients with paroxysmal atrial fibrillation (PAF alone, and 5 patients with persistent atrial fibrillation (PersAF alone. Twenty-two specific miRNAs were found to be dysregulated in each PAF group, PersAF group, or control group. Four candidate microRNAs (miRNA-146a, miRNA-150, miRNA-19a, and miRNA-375 met our selection criteria and were evaluated in an independent cohort of 90 plasma samples using TaqMan miRNA quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR. We found miRNA-150 levels to be reduced by a factor of approximately 17 in PAF relative to controls and a factor of approximately 20 in PersAF relative to controls (P<.0001. Logistic regression analyses were carried out to evaluate the reduced miRNA-150 expression levels (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.5 to 3.57, P<0.001, age (OR 1.1, 95% CI 1.36 to 2.73, P<0.001, and Left atrial diameter (LAD (OR 1.5, 95% CI 1.36 to 1.8, P<0.001. Each was independently associated with AF. Much of the identified target genes related to AF were part of the inflammatory response system. We found that plasma levels of CRP were negatively correlated with the plasma levels of miRNA-150. CONCLUSIONS/SIGNIFICANCE: In summary, we firstly found that plasma miRNA-150 levels in from AF patients were substantially lower than that from healthy people. Circulating reduced miRNA-150 was significantly associated with AF.

  7. Increased use of oral anticoagulants in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Kasper, Gadsbøll; Stærk, Laila; Fosbøl, Emil Loldrup

    2017-01-01

    diagnosed with AF at Danish hospitals and outpatient clinics between January 2005 and June 2015. OAC initiation was assessed from prescription fills ±180 days from date of AF diagnosis. We identified a total of 108 410 patients with newly diagnosed AF. Before 2010, 40-50% initiated OAC treatment. From 2010...

  8. [Which anticoagulation therapy in old atrial fibrillation patients?].

    Science.gov (United States)

    Taieb, Jérôme

    2013-06-01

    ESC recommends treating all AF patients over 75 years old with Vitamin K antagonist or new oral anticoagulation treatments because of the benefit on ischemic events. The challenge is to deal with hemorrhagic risk which should be carefully evaluated. It increases in case of renal disturbance and low weight, especially with new oral anticoagulation therapy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Mogensen, Ulrik M.; Jhund, Pardeep S.; Abraham, William T.

    2017-01-01

    Background Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced...... regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had.......81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71...

  10. Genetic aspects of lone atrial fibrillation

    DEFF Research Database (Denmark)

    Andreasen, Laura; Nielsen, Jonas B; Olesen, Morten S

    2015-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. A subgroup of patients presents with AF without traditional risk factors and is diagnosed before the age of 60 years. Such patients are commonly referred as having "lone AF" and comprise 10-20% of all cases. A number of studies have ...

  11. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  12. Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease

    DEFF Research Database (Denmark)

    Proietti, Marco; Raparelli, Valeria; Laroche, Cécile

    2017-01-01

    in this analysis. Event rates were determined at 1-year follow-up. RESULTS: Peripheral arterial disease was recorded in 328 (11%) patients. Age (P diabetes mellitus (P = 0.0001), chronic heart failure (P ...AIMS: Peripheral arterial disease (PAD) is highly prevalent in general population. Data on the prevalence of symptomatic PAD in patients with atrial fibrillation (AF) are limited, and the impact of PAD on adverse outcomes in AF patients is controversial. Our aims were: (i) to define the prevalence.......0060), and antiplatelet drug treatment (P = 0.0001) were associated with the presence of PAD, while female gender was inversely associated (P = 0.0002). Peripheral arterial disease patients had higher absolute rates of both cardiovascular (CV) and all-cause death (both P

  13. Potassium channel gene mutations rarely cause atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nam Edwin G

    2006-08-01

    Full Text Available Abstract Background Mutations in several potassium channel subunits have been associated with rare forms of atrial fibrillation. In order to explore the role of potassium channels in inherited typical forms of the arrhythmia, we have screened a cohort of patients from a referral clinic for mutations in the channel subunit genes implicated in the arrhythmia. We sought to determine if mutations in KCNJ2 and KCNE1-5 are a common cause of atrial fibrillation. Methods Serial patients with lone atrial fibrillation or atrial fibrillation with hypertension were enrolled between June 1, 2001 and January 6, 2005. Each patient underwent a standardized interview and physical examination. An electrocardiogram, echocardiogram and blood sample for genetic analysis were also obtained. Patients with a family history of AF were screened for mutations in KCNJ2 and KCNE1-5 using automated sequencing. Results 96 patients with familial atrial fibrillation were enrolled. Eighty-three patients had lone atrial fibrillation and 13 had atrial fibrillation and hypertension. Patients had a mean age of 56 years at enrollment and 46 years at onset of atrial fibrillation. Eighty-one percent of patients had paroxysmal atrial fibrillation at enrollment. Unlike patients with an activating mutation in KCNQ1, the patients had a normal QTc interval with a mean of 412 ± 42 ms. Echocardiography revealed a normal mean ejection fraction of 62.0 ± 7.2 % and mean left atrial dimension of 39.9 ± 7.0 mm. A number of common polymorphisms in KCNJ2 and KCNE1-5 were identified, but no mutations were detected. Conclusion Mutations in KCNJ2 and KCNE1-5 rarely cause typical atrial fibrillation in a referral clinic population.

  14. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting

    Science.gov (United States)

    Bohatch Júnior, Milton Sérgio; Matkovski, Paula Dayana; Giovanni, Frederico José Di; Fenili, Romero; Varella, Everton Luz; Dietrich, Anderson

    2015-01-01

    Objective To determine the incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Methods A retrospective study with analysis of 230 medical records between January 2011 and October 2013 was conducted. Results Fifty-six (24.3%) out of the 230 patients were female. The average age of patients undergoing on-pump coronary artery bypass grafting was 59.91±8.62 years old, and off-pump was 57.16±9.01 years old (P=0.0213). The average EuroSCORE for the on-pump group was 3.37%±3.08% and for the off-pump group was 3.13%±3% (P=0.5468). Eighteen (13.43%) patients who underwent off-pump coronary artery bypass grafting developed postoperative atrial fibrillation, whereas for the onpump group, 19 (19.79%) developed this arrhythmia, with no significant difference between the groups (P=0.1955). Conclusion Off-pump coronary artery bypass grafting did not reduce the incidence of atrial fibrillation in the postoperative period. Important predictors of risk for the development of this arrhythmia were identified as: patients older than 70 years old and presence of atrial fibrillation in perioperative period in both groups, and non-use of beta-blockers drugs postoperatively in the on-pump group. PMID:26313722

  15. Time Course of Atrial Fibrillation in Patients With Congenital Heart Defects.

    Science.gov (United States)

    Teuwen, Christophe P; Ramdjan, Tanwier T T K; Götte, Marco; Brundel, Bianca J J M; Evertz, Reinder; Vriend, Joris W J; Molhoek, Sander G; Dorman, Henderikus G R; van Opstal, Jurren M; Konings, Thelma C; van der Voort, Pepijn; Delacretaz, Etienne; Houck, Charlotte; Yaksh, Ameeta; Jansz, Luca J; Witsenburg, Maarten; Roos-Hesselink, Jolien W; Triedman, John K; Bogers, Ad J J C; de Groot, Natasja M S

    2015-10-01

    The incidence of atrial fibrillation (AF) is rising in the aging patients with congenital heart defects (CHD). However, studies reporting on AF in patients with CHD are scarce. The aim of this multicenter study was to examine in a large cohort of patients with a variety of CHD: (1) the age of onset and initial treatment of AF, coexistence of atrial tachyarrhythmia and (2) progression of paroxysmal to (long-standing) persistent/permanent AF during long-term follow-up. Patients (n=199) with 15 different CHD and documented AF episodes were studied. AF developed at 49±17 years. Regular atrial tachycardia (AT) coexisting with AF occurred in 65 (33%) patients; 65% initially presented with regular AT. At the end of a follow-up period of 5 (0-24) years, the ECG showed AF in 81 patients (41%). In a subgroup of 114 patients, deterioration from paroxysm of AF to (long-standing) persistent/permanent AF was observed in 29 patients (26%) after only 3 (0-18) years of the first AF episode. Cerebrovascular accidents/transient ischemic attacks occurred in 26 patients (13%), although a substantial number (n=16) occurred before the first documented AF episode. Age at development of AF in patients with CHD is relatively young compared with the patients without CHD. Coexistence of episodes of AF and regular AT occurred in a considerable number of patients; most of them initially presented with regular AT. The fast and frequent progression from paroxysmal to (long-standing) persistent or permanent AF episodes justifies close follow-up and early, aggressive therapy of both AT and AF. © 2015 American Heart Association, Inc.

  16. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Cosedis Nielsen, Jens; Johannessen, Arne; Raatikainen, Pekka

    2012-01-01

    There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation.......There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation....

  17. Association Between Local Bipolar Voltage and Conduction Gap Along the Left Atrial Linear Ablation Lesion in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Masuda, Masaharu; Fujita, Masashi; Iida, Osamu; Okamoto, Shin; Ishihara, Takayuki; Nanto, Kiyonori; Kanda, Takashi; Sunaga, Akihiro; Tsujimura, Takuya; Matsuda, Yasuhiro; Mano, Toshiaki

    2017-08-01

    A bipolar voltage reflects a thick musculature where formation of a transmural lesion may be hard to achieve. The purpose of this study was to explore the association between local bipolar voltage and conduction gap in patients with persistent atrial fibrillation (AF) who underwent atrial roof or septal linear ablation. This prospective observational study included 42 and 36 consecutive patients with persistent AF who underwent roof or septal linear ablations, respectively. After pulmonary vein isolation, left atrial linear ablations were performed, and conduction gap sites were identified and ablated after first-touch radiofrequency application. Conduction gap(s) after the first-touch roof and septal linear ablation were observed in 13 (32%) and 19 patients (53%), respectively. Roof and septal area voltages were higher in patients with conduction gap(s) than in those without (roof, 1.23 ± 0.77 vs 0.73 ± 0.42 mV, p = 0.010; septal, 0.96 ± 0.43 vs 0.54 ± 0.18 mV, p = 0.001). Trisected regional analyses revealed that the voltage was higher at the region with a conduction gap than at the region without. Complete conduction block across the roof and septal lines was not achieved in 3 (7%) and 6 patients (17%), respectively. Patients in whom a linear conduction block could not be achieved demonstrated higher ablation area voltage than those with a successful conduction block (roof, 1.91 ± 0.74 vs 0.81 ± 0.51 mV, p = 0.001; septal, 1.15 ± 0.56 vs 0.69 ± 0.31 mV, p = 0.006). In conclusion, a high regional bipolar voltage predicts failure to achieve conduction block after left atrial roof or septal linear ablation. In addition, the conduction gap was located at the preserved voltage area. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

    DEFF Research Database (Denmark)

    Olesen, J B; Lip, G Y H; Hansen, P R

    2011-01-01

    Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme...

  19. Cost-effectiveness of a nurse-led integrated chronic care approach versus usual care in patients with atrial fibrillation

    NARCIS (Netherlands)

    Hendriks, J.M.; Tomini, F.; Van Asselt, A.D.

    2012-01-01

    OBJECTIVES: A recent randomized controlled trial has demonstrated significant reductions in terms of cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation compared to usual care. The objective of the present study is to

  20. Comparison of QT dispersion during atrial fibrillation and sinus rhythm in the same patients, at normal and prolonged ventricular repolarization

    NARCIS (Netherlands)

    Houltz, B; Darpo, B; Swedberg, K; Blomstrom, P; Crijns, HJGM; Jensen, SM; Svernhage, E; Edvardsson, N

    Aims Drug-induced increase in QT dispersion has been associated with increased risk of ventricular proarrhythmia. The aim of the present study was to compare QT dispersion during atrial fibrillation and sinus rhythm in the same patients at normal and prolonged ventricular repolarization. Methods and

  1. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Begg, Gordon A; Karim, Rashed; Oesterlein, Tobias

    2017-01-01

    ) have all been suggested as possible biomarkers for this indication, but studies assessing whether peripheral levels reflect intra-cardiac levels are scarce. Methods and results: We studied 93 patients undergoing ablation for paroxysmal atrial fibrillation (AF) (n = 63) or non-paroxysmal AF (n = 30...

  2. Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease longitudinal dissociation

    NARCIS (Netherlands)

    M.A. Allessie (Maurits); N.M.S. de Groot (Natasja); R.P.M. Houben (Richard); U. Schotten (Ulrich); H. Boersma (Eric); J.L. Smeets (Joep); H. Crijns (Harry)

    2010-01-01

    textabstractBackground-The electropathological substrate of persistent atrial fibrillation (AF) in humans is largely unknown. The aim of this study was to compare the spatiotemporal characteristics of the fibrillatory process in patients with normal sinus rhythm and long-standing persistent AF.

  3. Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease: longitudinal dissociation.

    NARCIS (Netherlands)

    Allessie, M.A.; Groot, N.M. de; Houben, R.P.; Schotten, U.; Boersma, E.; Smeets, J.L.R.M.; Crijns, H.J.G.M.

    2010-01-01

    BACKGROUND: The electropathological substrate of persistent atrial fibrillation (AF) in humans is largely unknown. The aim of this study was to compare the spatiotemporal characteristics of the fibrillatory process in patients with normal sinus rhythm and long-standing persistent AF. METHODS AND

  4. Hiatal Hernia Is Associated With an Increased Prevalence of Atrial Fibrillation in Young Patients

    Science.gov (United States)

    Roy, Ranjini R; Sagar, Sandeep; Bunch, T. Jared; Aman, Wahaj; Crusan, Daniel J; Srivathsan, Komandoor; Asirvatham, Samuel J; Shen, Win K; Jahangir, Arshad

    2013-01-01

    Purpose: Hiatal hernia (HH) causes protrusion of the stomach into the chest cavity, directly impinging on the left atrium and possibly increasing predisposition to atrial arrhythmogenesis. However, such association has not been fully explored. The objective was to determine if an association between HH and atrial fibrillation (AF) exists and whether there are age- and sex-related differences. Methods: Adult patients diagnosed with HH from 1976 to 2006 at Mayo Clinic Rochester, Minnesota, were evaluated for AF. The number of patients with AF and HH was compared to age- and sex-matched patients with AF reported in the general population. Long-term outcomes were compared to corresponding county and state populations. Results: During the 30-year period, 111,429 patients were diagnosed with HH (mean age 61.4 ± 13.8 years, 47.9% male) and 7,865 patients (7.1%) also had a diagnosis of AF (mean age 73.1 ± 10.5 years; 55% male). In younger patients (Hiatal hernia appears to be associated with increased frequency of AF in both men and women of all age groups, but particularly in young patients. Further studies are needed to investigate this possible association and underlying mechanism. PMID:28496881

  5. Antithrombotic treatment in patients with heart failure and associated atrial fibrillation and vascular disease

    DEFF Research Database (Denmark)

    Lamberts, Morten; Lip, Gregory Y. H.; Ruwald, Martin H.

    2014-01-01

    OBJECTIVES: The aim of this study was to investigate the impact of atrial fibrillation (AF) and antithrombotic treatment on the prognosis in patients with heart failure (HF) as well as vascular disease. BACKGROUND: HF, vascular disease, and AF are pathophysiologically related, and understanding...... antithrombotic treatment for these conditions is crucial. METHODS: In hospitalized patients with HF and coexisting vascular disease (coronary artery disease or peripheral arterial disease) followed from 1997 to 2009, AF status was categorized as prevalent AF, incident AF, or no AF. Risk of thromboembolism (TE...... differences were seen between antithrombotic therapies in TE or MI risk, whereas bleeding risk was significantly increased for VKA with and without single-antiplatelet therapy. CONCLUSIONS: In AF patients with coexisting HF and vascular disease, adding single-antiplatelet therapy to VKA therapy...

  6. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention

    DEFF Research Database (Denmark)

    Lamberts, Morten; Gislason, Gunnar H.; Olesen, Jonas Bjerring

    2013-01-01

    Objectives The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). Background The optimal......, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Results Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation.......05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. Conclusions In real-life AF patients with indication for multiple antithrombotic drugs...

  7. Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial.

    Science.gov (United States)

    González Blanco, Virginia; Pérula de Torres, Luis Ángel; Martín Rioboó, Enrique; Martínez Adell, Miguel Ángel; Parras Rejano, Juan Manuel; González Lama, Jesús; Ruiz Moruno, Javier; Martín Alvarez, Remedios; Fernández García, José Ángel; Ruiz de Castroviejo, Joaquin; Roldán Villalobos, Ana; Ruiz Moral, Roger

    2017-01-06

    The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P<.001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45). Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients. The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011). Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. Association between atrial fibrillatory rate and heart rate variability in patients with atrial fibrillation and congestive heart failure.

    Science.gov (United States)

    Corino, Valentina D A; Cygankiewicz, Iwona; Mainardi, Luca T; Stridh, Martin; Vasquez, Rafael; Bayes de Luna, Antonio; Holmqvist, Fredrik; Zareba, Wojciech; Platonov, Pyotr G

    2013-01-01

    Even if atrial fibrillatory rate (AFR) has been related to clinical outcome in patients with atrial fibrillation (AF), its relation with ventricular response has not been deeply studied. The aim of this study was to investigate the relation between AFR and RR series variability in patients with AF. Twenty-minute electrocardiograms in orthogonal leads were processed to extract AFR, using spatiotemporal QRST cancellation and time frequency analysis, and RR series in 127 patients (age 69 ± 11 years) with congestive heart failure (NYHA II-III) enrolled in the MUSIC study (MUerte Subita en Insufficiencia Cardiaca). Heart rate variability and irregularity were assessed by time domain parameters and entropy-based indices, respectively and their correlation with AFR investigated. Variability measures seem not to be related to AFR, while irregularity measures do. A significant correlation between AFR and variability parameters of heart rate variability during AF was found only in patients not treated with antiarrhythmics drugs (correlation = 0.56 P < 0.05 for pNN50), while this correlation was lost in patients taking rate- or rhythm-control drugs. A significant positive correlation between AFR and indices of RR irregularity was found, showing that a higher AFR is related to a less organized RR series (correlation = 0.33 P < 0.05 for regularity index for all patients, correlation increased in subgroups of patients treated with the same drug). These results suggest that a higher AFR is associated with a higher degree of irregularity of ventricular response that is observed regardless of the use of rate-controlling drugs. ©2012, Wiley Periodicals, Inc.

  9. Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry.

    Science.gov (United States)

    Gullón, Alejandra; Suárez, Carmen; Díez-Manglano, Jesús; Formiga, Francesc; Cepeda, José María; Pose, Antonio; Camafort, Miguel; Castiella, Jesús; Rovira, Eduardo; Mostaza, José María

    2017-03-03

    The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies. Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments. We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants. Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  10. Emergency Department Management of Atrial Fibrillation and Flutter and Patient Quality of Life at One Month Postvisit.

    Science.gov (United States)

    Ballard, Dustin W; Reed, Mary E; Singh, Nimmie; Rauchwerger, Adina S; Hamity, Courtnee A; Warton, E Margaret; Chettipally, Uli K; Mark, Dustin G; Vinson, David R

    2015-12-01

    We identify characteristics of patients with atrial fibrillation or flutter associated with favorable assessments of emergency department (ED) effectiveness and 30-day quality of life. As part of a prospective observational study of ED management and short-term outcomes of patients with nonvalvular atrial fibrillation or flutter, we adapted a disease-specific quality-of-life instrument. By telephone, we administered the Atrial Fibrillation Effect on Quality-of-life survey to patients 30 days after an ED visit in which they were treated for newly diagnosed or recent-onset atrial fibrillation or flutter and discharged home. We also asked respondents to rate the effectiveness of ED treatment. Using data prospectively collected in the ED and extracted from electronic health records, we recorded rhythm management (cardioversion attempts and type) and patient and ED treatment characteristics. Using multivariable regression, we examined the association between these characteristics and patient-reported effectiveness of ED treatment ("very effective" or not) and any atrial fibrillation or flutter quality-of-life effect. Six hundred fifty-two eligible ED patients (response rate 89%) treated between May 2011 and November 2012 completed follow-up. Of these patients, 454 (69.6%) reported that their ED treatment was "very effective" and 113 (17.3%) reported no quality-of-life influence. In multivariable analyses, there was an association between ED electrocardioversion and perceived ED effectiveness (Pscore. Respondents who were younger, women, and had worse pre-ED self-reported health (Pscore. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. Atrial fibrillation management in older heart failure patients: a complex clinical problem

    Directory of Open Access Journals (Sweden)

    Giovanni Pulignano

    2016-09-01

    Full Text Available BackgroundAtrial fibrillation (AF and heart failure (HF, two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients.MethodsPubMed was searched for studies on AF and older patients using the terms atrial fibrillation, elderly, heart failure, cognitive impairment, frailty, stroke, and anticoagulants.ResultsThe clinical picture of HF patients with AF is complex and heterogeneous with a higher prevalence of frailty, cognitive impairment, and disability. Because of the association of mental and physical impairment to non-administration of oral anticoagulants (OACs, screening for these simple variables in clinical practice may allow better strategies for intervention in this high-risk population. Since novel direct OACs (NOACs have a more favorable risk-benefit profile, they may be preferable to vitamin K antagonists (VKAs in many frail elderly patients, especially those at higher risk of falls. Moreover, NOACs are simple to administer and monitor and may be associated with better adherence and safety in patients with cognitive deficits and mobility impairments.ConclusionsLarge multicenter longitudinal studies are needed to examine the effects of VKAs and NOACs on long-term cognitive function and frailty; future studies should include geriatric conditions.

  12. Atrial fibrillation and vascular disease-a bad combination

    DEFF Research Database (Denmark)

    Bjerring Olesen, Jonas; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian

    2012-01-01

    This article provides an overview of (i) the risk of stroke associated with vascular disease (acute coronary syndromes and peripheral artery disease) in patients with atrial fibrillation, (ii) the frequent coexistence of vascular disease in patients with atrial fibrillation and, (iii......) the cardiovascular risk associated with the coexisting of the two diseases. The literature on this topic is relatively sparse, and we discuss results from both clinical trials and observational studies. There is a clear indication of an increased stroke risk associated with vascular disease in patients with atrial...... fibrillation. Indeed, patients with atrial fibrillation often had coexisting vascular disease (around 18%), and the combination of the two diseases substantially increases the risk of future cardiovascular events. The increased risk associated with peripheral artery disease in atrial fibrillation is even more...

  13. Silent Cerebral Infarction in East Asian vs. Non-Asian Atrial Fibrillation Patients

    DEFF Research Database (Denmark)

    Senoo, Keitaro; Kondo, Yusuke; Kobayashi, Yoshio

    2018-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in the ageing population in East Asia. Silent cerebral infarction (SCI) is defined as cerebral infarction in the absence of corresponding clinical symptoms, and is a highly prevalent and morbid condition in AF. SCI is increasingly...... being recognized as a risk factor for future stroke, which can lead to cognitive decline or dementia. The latter is an increasingly common health problem in East Asia.Methods and Results:We conducted a meta-analysis to compare the association of AF and SCI between East Asian and non-Asian patients. AF...... was associated with SCI in patients with no symptomatic stroke history (relative risk [RR], 2.24; 95% CI: 1.26-3.99, I2=83%; P=0.006) although the prevalence varied widely between studies (P for heterogeneitycontrols (RR, 1.85; 95...

  14. Validating the HeartQoL questionnaire in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Kristensen, Marie S; Zwisler, Ann-Dorthe; Berg, Selina K

    2016-01-01

    questionnaire, the HeartQoL, offers a single measurement instrument which may allow outcome comparisons across cardiac diseases. The aim of the study was to evaluate the psychometric properties of HeartQoL in an AF population treated with ablation by assessing its factor structure, construct validity, internal...... of patients, indicating sensitivity. CONCLUSION: The HeartQoL showed overall satisfactory psychometric properties, demonstrating it to be a valid instrument in the evaluation of HRQL in patients with AF treated with ablation. This suggests that HeartQoL may be a valuable instrument for making HRQL comparisons......BACKGROUND: Atrial fibrillation (AF) is associated with impaired health-related quality-of-life (HRQL). When assessing HRQL, disease-specific and generic instruments are used, which may hinder outcome comparisons across studies. A newly developed core ischaemic heart disease-specific HRQL...

  15. Efficacy and safety of dronedarone in the treatment of patients with atrial fibrillation.

    Science.gov (United States)

    Khan, Mohammed Hasan; Rochlani, Yogita; Aronow, Wilbert S

    2017-12-01

    Dronedarone, a derivative of amiodarone with structural modifications, was designed to have similar electrophysiological properties with a less toxic profile. Areas covered: Brief overview of the pharmacology of dronedarone followed by a summary of randomized clinical trials testing the efficacy of dronedarone in maintaining normal sinus rhythm and clinical outcomes associated with these trials. In depth discussion and commentary on trial findings which may seem contradictory at first approach and brief discussion of post-marketing surveillance studies. Expert opinion: Dronedarone is a moderately efficacious anti-arrhythmic agent which is safe for use in a carefully selected patient population, maintained in normal sinus rhythm, without advanced congestive heart failure, structural heart disease, permanent atrial fibrillation, digoxin use. It is especially useful in younger patients who lack other risk factors for cardiovascular events and, who stand to gain the most by avoiding long-term pulmonary and thyroid toxicities associated with more effective, but also significantly more toxic agents such as amiodarone.

  16. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Charles André

    2015-08-01

    Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  17. Sex differences in the treatment of patients with atrial fibrillation: population-based study in a local health district.

    Science.gov (United States)

    Riesgo, Alba; Sant, Elisenda; Benito, Luisa; Hoyo, Jordi; Miró, Oscar; Mont, Lluís; Bragulat, Ernest; Coll-Vinent, Blanca

    2011-03-01

    Differences in the treatment of atrial fibrillation between men and women were investigated by using patients in a local health district as a reference population. The study included 688 patients (359 female) who presented with atrial fibrillation. Women were older, more frequently had heart failure, and were more often functionally dependent than men. With regards to the management of atrial fibrillation, women were prescribed digoxin more frequently than men, but underwent electrical cardioversion less often, were less frequently seen by a cardiologist, and understood less about their treatment. After stratifying the findings by age and adjusting for heart failure and the degree of functional dependence, it was observed that women aged over 85 years were prescribed digoxin more often than men, while women aged under 65 years underwent cardioversion less often than men. In conclusion, gender differences observed in the treatment of atrial fibrillation cannot be fully explained by differences in clinical characteristics between men and women in the population. Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  18. Atrial fibrillation in an adolescent--the agony of ecstasy.

    Science.gov (United States)

    Madhok, Ashish; Boxer, Robert; Chowdhury, Devyani

    2003-10-01

    Ecstasy (MDMA), a popular drug of abuse among teenagers, is thought to be "relatively" safe. A case of atrial fibrillation following the ingestion of ecstasy in a previously well adolescent is presented. Emergency room physicians should consider ecstasy abuse in the differential diagnosis of young patients presenting with atrial fibrillation.

  19. Oral antiarrhythmic drugs in converting recent onset atrial fibrillation

    NARCIS (Netherlands)

    Deneer, Vera H. M.; Borgh, Marieke B. I.; Kingma, J. Herre; Lie-A-Huen, Loraine; Brouwers, Jacobus R. B. J.

    2004-01-01

    AIM: This article reviews clinical studies on oral antiarrhythmic drugs in converting recent onset atrial fibrillation. An oral loading dose of an antiarrhythmic drug for cardioversion of atrial fibrillation could be an option, due to its simplicity, both for patients admitted to outpatient

  20. [Radiofrequency ablation of long standing persistent atrial fibrillation and post-incisional macroreentrant right atrial tachycardia in patient with advanced biventricular heart failure--case raport].

    Science.gov (United States)

    Zakrzewska, Joanna; Derejko, Paweł; Szufladowicz, Ewa; Bodalski, Robert; Orczykowski, Michał; Przybylski, Andrzej; Szumowski, Lukasz; Michałek, Piotr; Walczak, Franciszek

    2008-11-01

    We present a case of a 54 year old male with a long-standing atrial fibrillation (AF) who was scheduled for cardiac transplantation due to the progression of heart failure. Previous treatment included pacemaker implantation, mitral valvuloplasty, a-v node modification using RF ablation, and pharmacological therapy. This time the patient underwent complex AF ablation which consisted of pulmonary vein isolation, mitral and left atrial roof line creation, cavo-tricuspid isthmus ablation and ablation of complex fractionated atrial electrograms, which resulted in restoration of sinus rhythm. Because of the right atrial post-incisional tachycardia the patient underwent second ablation session. This complex invasive approach occurred successful. The patient remains in sinus rhythm with improved left ventricular function and better NYHA class over a 12-month follow-up.

  1. Comparison of antiarrhythmics used in patients with paroxysmal atrial fibrillation: subanalysis of J-RHYTHM Study.

    Science.gov (United States)

    Aizawa, Yoshiyasu; Kohsaka, Shun; Suzuki, Shinya; Atarashi, Hirotsugu; Kamakura, Shiro; Sakurai, Masayuki; Nakaya, Haruaki; Fukatani, Masahiko; Mitamura, Hideo; Yamazaki, Tsutomu; Yamashita, Takeshi; Ogawa, Satoshi

    2010-01-01

    The J-RHYTHM (Japanese Rhythm Management Trial for Atrial Fibrillation) study demonstrated the benefit of rhythm-control compared with rate-control in Japanese patients with paroxysmal atrial fibrillation (AF), according to AF-specific quality of life scores. However, detailed information on prescribed antiarrhythmic agents remains unclear. Data for 419 patients enrolled in the rhythm-control arm of J-RHYTHM were analyzed. The primary endpoint was defined as a composite of total mortality, cerebral infarction, embolism, bleeding, heart failure, and physical/psychological disability. The secondary endpoint was recurrence of AF. The clinical outcome according to choice of initial antiarrhythmic agent (AA) was assessed by Kaplan-Meier survival curve, and further adjusted by Cox-regression hazard model. The primary endpoint occurred in 16.9%, 6.7%, 15.8% and 23.3% of patients assigned to class Ia, Ib, Ic and III agents (P=0.359). The rate of AF recurrence was significantly higher in patients taking a class III drug (Ia, Ib, Ic, III=20.3, 23.3, 29.1, 50.0%; P=0.002). However, after adjustment for other clinical variables, the choice of AA was not associated with recurrence of AF (class I vs III, P=0.15). The incidence of each endpoint did not differ according to the choice of AA. The class III drugs seemed to lower the sinus rhythm maintenance rate, which might be confounded by other comorbid conditions. (Circ J 2010; 74: 71 - 76).

  2. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to de...

  3. Deglutition-Induced Atrial Fibrillation

    Science.gov (United States)

    Malik, Amyn; Ali, Syed Sohail; Rahmatullah, Amin

    2005-01-01

    We present the case of 38-year-old woman who experienced palpitations on swallowing, which were later found to be atrial fibrillation. Her symptoms improved on treatment with disopyramide and verapamil. Within 9 months, she was weaned from both medications without recurrence of symptoms. PMID:16429915

  4. Atrial fibrillation: non cardiologist physicians approach

    Directory of Open Access Journals (Sweden)

    Forero-Gómez, Julián Eduardo

    2017-10-01

    Full Text Available Atrial fibrillation is the most frequent arrhythmia. Its classification according to pattern and clinical type allows to decide the therapeutic strategy to use, that most include control of symptoms and prevention of cardioembolic events. The election of the treatment depends on the presence of triggering events, risk factors for thromboembolism, risk factors for bleeding, cardiac function, patient funcionality, medication costoefectiveness and health care access. The type of anticoagulant has to be supported on the type of atrial fibrillation and the presence of contraindications, documented ineffective anticoagulation or high risk of failure to warfarin. In case of contraindications for anticoagulation this could still be used in high bleeding risk patients, when risk factors are controllable or corrected; leaving left atrial appendage closure as an option for patients that remain in high risk for bleeding events.

  5. Prediction of vascular dementia and Alzheimer's disease in patients with atrial fibrillation or atrial flutter using CHADS2 score.

    Science.gov (United States)

    Chou, Ruey-Hsing; Chiu, Chun-Chih; Huang, Chin-Chou; Chan, Wan-Leong; Huang, Po-Hsun; Chen, Yu-Chun; Chen, Tzeng-Ji; Chung, Chia-Min; Lin, Shing-Jong; Chen, Jaw-Wen; Leu, Hsin-Bang

    2016-09-01

    Atrial fibrillation (AF) is associated with an increased risk of dementia. However, limited data are available on the predictors of dementia in patients with AF. This study aimed to evaluate whether the CHADS2 score could be a useful tool for risk stratification with regard to dementia occurrence among patients with AF. AF patients were identified from the National Health Insurance sampling database, which has accumulated a total of 1,000,000 participants since 2000. After excluding patients diagnosed with dementia prior to the index day of enrollment, CHADS2 score was measured to investigate its association with the occurrence of dementia, including vascular dementia and Alzheimer's disease. During the mean follow-up period of 3.71 ± 2.78 years, 1135 dementia cases (7.36%) were identified, including 241 cases of vascular dementia and 894 cases of Alzheimer's disease. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 54% increase in the risk of vascular dementia (hazard ratio = 1.54; 95% confidence interval, 1.41-1.69; p vascular dementia as well as Alzheimer's disease in patients with AF. Copyright © 2016. Published by Elsevier Taiwan LLC.

  6. Impact of controlling atrial fibrillation on outcomes relevant to the patient: focus on dronedarone

    Directory of Open Access Journals (Sweden)

    Chahal CAA

    2012-12-01

    Full Text Available C Anwar A Chahal, Omer Ali, Ross J Hunter, Richard J SchillingDepartment of Cardiology Research, St Bartholomew's Hospital, London, United KingdomAbstract: Atrial fibrillation (AF is a substantial cause of mortality and morbidity in the Western world. It is a massive burden on health care systems, and its prevalence is expected to double over the next 20 years. Trials evaluating antiarrhythmic drugs or catheter ablation have focused on recurrence of arrhythmia, perhaps neglecting outcomes relevant to patients, such as symptoms, need for antiarrhythmic drugs, need for hospitalization, and rates of stroke and death. An association has been demonstrated between sinus rhythm and survival in several studies, and there is evidence emerging that successful catheter ablation may reduce rates of stroke and death. Similarly, dronedarone has been shown to reduce hospitalizations and death in patients with paroxysmal AF or persistent AF of recent onset, although it may cause adverse events in permanent AF. New antiarrhythmic drugs are a welcome addition to the armamentarium, since there are limitations to current antiarrhythmic drugs. In particular, sotalol, flecainide, and propafenone cannot be used safely in those with structural heart disease, and amiodarone has important adverse reactions that limit long-term use. Indeed, the use of conventional antiarrhythmic drugs may negate any survival benefit derived from maintaining sinus rhythm. Although dronedarone appears promising with respect to hard endpoints such as stroke and death in certain patients, it may not be safe for those with heart failure or those with permanent AF. Furthermore, the trials suggesting that dronedarone may impact on these endpoints were compared with placebo rather than with an active comparator group. Further "head-to-head" comparisons between dronedarone and other antiarrhythmic drugs are needed to determine whether this property is unique to dronedarone alone.Keywords: atrial

  7. Association of cardiac cachexia and atrial fibrillation in heart failure patients.

    Science.gov (United States)

    Arámbula-Garza, Estefanía; Castillo-Martínez, Lilia; González-Islas, Dulce; Orea-Tejeda, Arturo; Santellano-Juárez, Brenda; Keirns-Davies, Candace; Peláez-Hernández, Viridiana; Sánchez-Santillán, Rocío; Pineda-Juárez, Juan; Cintora-Martínez, Carlos; Pablo-Santiago, Ruth

    2016-11-15

    Cachexia is a common complication in patients with advanced heart failure (HF) associated with inflammatory response activation. Atrial fibrillation (AF) is the most frequent arrhythmia (26%), probably both exacerbate the cardiac cachexia (CC). Evaluate the association of cardiac cachexia and atrial fibrillation in heart failure patients. In a case control study, CC was diagnosed by electrical bioimpedance with vectorial analysis (BIVA). Subjects with congenital heart disease, cancer, HIV, drug use and other causes than HF were excluded. Of the 359 subjects analyzed (men: 52.9%) median age 65years (55-74). Those with CC were older [72 (61-67)] vs. without [62 (52-70) years old, p<0.01]. During follow-up 47.8% of subjects developed CC and 17.27% AF, this was significantly more frequent in cachectic patients CC (23% vs 12.11%, OR: 2.17, 95% CI: 1.19-4.01, p=0.006). Subjects, with AF had lower left ventricular ejection fraction (25.49±12.96 vs. 32.01±15.02, p=0.08), lower posterior wall thickness (10.03±2.12 vs. 11.00±2.47, p=0.007), larger diameter of the left atrium (49.87±9.84 vs. 42.66±7.56, p<0.001), and a higher prevalence of CC (85.42% vs. 69.77%, p=0.028). The 50.58% of was in NYHA class I. In NYHA III, 22.95% were in AF vs. 12.10% with not AF (p=0.027). The frequent coexistence of CC and AF as HF complications indicate greater severity of HF, regardless of its type of HF. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Myocardial Architecture and Patient Variability in Clinical Patterns of Atrial Fibrillation

    CERN Document Server

    Manani, Kishan A; Peters, Nicholas S

    2016-01-01

    Atrial fibrillation (AF) increases the risk of stroke by a factor of four to five and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF. We use a simple model of activation wavefront propagation on an anisotropic structure, mimicking heart muscle tissue, to show how variation in AF behaviour arises naturally from microstructural differences between individuals. We show that the stochastic nature of progressive transversal uncoupling of muscle strands (e.g., due to fibrosis or gap junctional remodelling), as occurs with age, results in variability in AF episode onset time, frequency, duration, burden ...

  9. Risk of atrial fibrillation in diabetes mellitus

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik L; Schjerning, Anne-Marie; Lindhardt, Tommi B

    2016-01-01

    .81-8.98) and 20.0 (19.9-20.2) in the background population and 0.13 (0.09-0.20), 2.10 (2.00-2.20), 8.41 (8.10-8.74) and 20.1 (19.4-20.8) in the diabetes group, respectively. The adjusted incidence rate ratios in the diabetes group with the background population as reference were 2.34 (1.52-3.60), 1.52 (1......AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients...... with diabetes compared to the background population in Denmark. METHODS AND RESULTS: Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes...

  10. Association rules to identify complications of cerebral infarction in patients with atrial fibrillation.

    Science.gov (United States)

    Jung, Sun-Ju; Son, Chang-Sik; Kim, Min-Soo; Kim, Dae-Joon; Park, Hyoung-Seob; Kim, Yoon-Nyun

    2013-03-01

    The purpose of this study was to find risk factors that are associated with complications of cerebral infarction in patients with atrial fibrillation (AF) and to discover useful association rules among these factors. The risk factors with respect to cerebral infarction were selected using logistic regression analysis with the Wald's forward selection approach. The rules to identify the complications of cerebral infarction were obtained by using the association rule mining (ARM) approach. We observed that 4 independent factors, namely, age, hypertension, initial electrocardiographic rhythm, and initial echocardiographic left atrial dimension (LAD), were strong predictors of cerebral infarction in patients with AF. After the application of ARM, we obtained 4 useful rules to identify complications of cerebral infarction: age (>63 years) and hypertension (Yes) and initial ECG rhythm (AF) and initial Echo LAD (>4.06 cm); age (>63 years) and hypertension (Yes) and initial Echo LAD (>4.06 cm); hypertension (Yes) and initial ECG rhythm (AF) and initial Echo LAD (>4.06 cm); age (>63 years) and hypertension (Yes) and initial ECG rhythm (AF). Among the induced rules, 3 factors (the initial ECG rhythm [i.e., AF], initial Echo LAD, and age) were strongly associated with each other.

  11. Planning and monitoring of patients for electrical cardioversion for atrial fibrillation

    NARCIS (Netherlands)

    Deuling, J. H. H.; Vermeulen, R. P.; Smit, M. D.; van der Maaten, J. M. A. A.; Boersema, H. M.; van den Heuvel, A. F. M.; Van Gelder, I. C.

    This study evaluated the waiting list for elective electrical cardioversion (ECV) for persistent atrial fibrillation (AF), focusing on when and why procedures were postponed. We compared the effects of management of the waiting list conducted by physicians versus management by nurse practitioners

  12. RIVAROXABAN IN THE PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    M. Yu. Gilyarov

    2012-01-01

    Full Text Available The possibilities of antithrombotic therapy in atrial fibrillation are highlighted. The alternative antithrombotic agents, including rivaroxaban presented along with the traditional drugs (acetyl-salicylic acid, warfarin. Efficacy and safety of rivaroxaban is considered on the basis of the results of the ROCKET-AF study.

  13. Managing antithrombotic therapy in patients with both atrial fibrillation and coronary heart disease

    NARCIS (Netherlands)

    Thompson, P.L.; Verheugt, F.W.A.

    2014-01-01

    PURPOSE: Atrial fibrillation (AF) and coronary heart disease (CHD) commonly occur together. Previous consensus guidelines were published before the wide availability of novel oral anticoagulants (NOACs) and newer P2Y12 antiplatelet agents. We examine recent evidence to guide management in 3

  14. Catheter ablation of persistent atrial fibrillation in a patient with dextrocardia.

    Science.gov (United States)

    Xue, Zeng-Ming; Sang, Cai-Hua; Dong, Jian-Zeng; Ma, Chang-Sheng

    2012-05-01

    Dextrocardia is a rare anomaly where the heart is located on the right side of the chest instead of the normal left side. Ablation of atrial fibrillation (AF) with such an inverted anatomy may be challenging for the manipulation of the catheters. Here we report a case of dextrocardia who underwent ablation for persistent AF guided by image integration system.

  15. Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF) - study design.

    Science.gov (United States)

    Marrouche, Nassir F; Brachmann, Johannes

    2009-08-01

    Electrical isolation of the pulmonary veins by catheter ablation is an emerging treatment modality for the treatment of atrial fibrillation (AF) and is increasingly used in patients with heart failure. The catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation trial (CASTLE-AF) is a randomized evaluation of ablative treatment of atrial fibrillation in patients with left ventricular dysfunction. The primary endpoint is the composite of all-cause mortality or worsening of heart failure requiring unplanned hospitalization using a time to first event analysis. Secondary endpoints are all-cause mortality, cardiovascular mortality, cerebrovascular accidents, worsening of heart failure requiring unplanned hospitalization, unplanned hospitalization due to cardiovascular reason, all-cause hospitalization, quality of life, number of therapies (shock and antitachycardia pacing) delivered by the implantable cardioverter-defibrillator (ICD), time to first ICD therapy, number of device-detected ventricular tachycardia and ventricular fibrillation episodes, AF burden, AF free interval, left ventricular function, exercise tolerance, and percentage of right ventricular pacing. CASTLE-AF will randomize 420 patients for a minimum of 3 years at 48 sites in the United States, Europe, Australia, and South America.

  16. Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Yoshida, Kuniko; Obokata, Masaru; Kurosawa, Koji; Sorimachi, Hidemi; Kurabayashi, Masahiko; Negishi, Kazuaki

    2016-10-01

    Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS2 score, CHA2DS2-VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA2DS2-VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. © 2016 American Heart Association, Inc.

  17. Atrial fibrillation - discharge

    Science.gov (United States)

    Auricular fibrillation - discharge; A-fib - discharge; AF - discharge; Afib - discharge ... Avoid salty and fatty foods. Stay away from fast-food restaurants. ... how to check your pulse, and check it every day. It is better ...

  18. Continuous vs episodic prophylactic treatment with amiodarone for the prevention of atrial fibrillation : a randomized trial

    NARCIS (Netherlands)

    Ahmed, Sheba; Rienstra, Michiel; Crijns, Harry J. G. M.; Links, Thera P.; Wiesfeld, Ans C. P.; Hillege, Hans L.; Bosker, Hans A.; Lok, Dirk J. A.; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    2008-01-01

    Context Amiodarone effectively suppresses atrial fibrillation but causes many adverse events. Objective To compare major events in patients randomized to receive episodic amiodarone treatment with those who received continuous amiodarone treatment while still aiming to prevent atrial fibrillation.

  19. Patient values and preferences for antithrombotic therapy in atrial fibrillation. A Narrative Systematic Review.

    Science.gov (United States)

    Loewen, Peter S; Ji, Angela Tianshu; Kapanen, Anita; McClean, Alison

    2017-06-02

    Guidelines recommend that patients' values and preferences should be considered when selecting stroke prevention therapy for atrial fibrillation (SPAF). However, doing so is difficult, and tools to assist clinicians are sparse. We performed a narrative systematic review to provide clinicians with insights into the values and preferences of AF patients for SPAF antithrombotic therapy. Narrative systematic review of published literature from database inception. 1) What are patients' AF and SPAF therapy values and preferences? 2) How are SPAF therapy values and preferences affected by patient factors? 3) How does conveying risk information affect SPAF therapy preferences? and 4) What is known about patient values and preferences regarding novel oral anticoagulants (NOACs) for SPAF? Twenty-five studies were included. Overall study quality was moderate. Severe stroke was associated with the greatest disutility among AF outcomes and most patients value the stroke prevention efficacy of therapy more than other attributes. Utilities, values, and preferences about other outcomes and attributes of therapy are heterogeneous and unpredictable. Patients' therapy preferences usually align with their values when individualised risk information is presented, although divergence from this is common. Patients value the attributes of NOACs but frequently do not prefer NOACs over warfarin when all therapy-related attributes are considered. In conclusion, patients' values and preferences for SPAF antithrombotic therapy are heterogeneous and there is no substitute for directly clarifying patients' individual values and preferences. Research using choice modelling and tools to help clinicians and patients clarify their SPAF therapy values and preferences are needed.

  20. Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial.

    Science.gov (United States)

    Pol, Tymon; Held, Claes; Westerbergh, Johan; Lindbäck, Johan; Alexander, John H; Alings, Marco; Erol, Cetin; Goto, Shinya; Halvorsen, Sigrun; Huber, Kurt; Hanna, Michael; Lopes, Renato D; Ruzyllo, Witold; Granger, Christopher B; Hijazi, Ziad

    2018-02-01

    Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow-up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; PURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2018 The Authors and Bristol‐Myers Squibb. Published on behalf of the American Heart Association, Inc., by Wiley.

  1. Multimorbidity in Older Adults with Atrial Fibrillation.

    Science.gov (United States)

    Chen, Michael A

    2016-05-01

    Older adults with atrial fibrillation often have multiple comorbid conditions, including common geriatric syndromes. Pharmacologic therapy, whether for rate control or rhythm control, can result in complications related to polypharmacy in patients who are often on multiple medications for other conditions. Because of uncertainty about the relative risks and benefits of rate versus rhythm control (including antiarrhythmic or ablation therapy), anticoagulation, and procedural treatments (eg, ablation, left atrial appendage closure, pacemaker placement) in older patients with multimorbidity, shared decision-making is essential. However, this may be challenging in patients with cognitive dysfunction, high fall risk, or advanced comorbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Echocardiographic Risk Factors for Stroke and Outcomes in Patients With Atrial Fibrillation Anticoagulated With Apixaban or Warfarin.

    Science.gov (United States)

    Vinereanu, Dragos; Lopes, Renato D; Mulder, Hillary; Gersh, Bernard J; Hanna, Michael; de Barros E Silva, Pedro G M; Atar, Dan; Wallentin, Lars; Granger, Christopher B; Alexander, John H

    2017-12-01

    Few data exist on the long-term outcomes of patients with spontaneous echo contrast (SEC), left atrial/left atrial appendage (LA/LAA) thrombus, and complex aortic plaque (CAP), in patients with atrial fibrillation receiving oral anticoagulation. We explored the relationship between these 3 echocardiographic findings and clinical outcomes, and the comparative efficacy and safety of apixaban and warfarin for each finding. Patients from the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) with SEC, LA/LAA thrombus, or CAP diagnosed by either transthoracic or transesophageal echocardiography were compared with patients with none of these findings on transesophageal echocardiography. A total of 1251 patients were included: 217 had SEC, 127 had LA/LAA thrombus, 241 had CAP, and 746 had none. The rates of stroke/systemic embolism were not significantly different among patients with and without these echocardiographic findings (hazard ratio, 0.96; 95% confidence interval, 0.25-3.60 for SEC; hazard ratio, 1.27; 95% confidence interval, 0.23-6.86 for LA/LAA thrombus; hazard ratio, 2.21; 95% confidence interval, 0.71-6.85 for CAP). Rates of ischemic stroke, myocardial infarction, cardiovascular death, and all-cause death were also not different between patients with and without these findings. For patients with either SEC or CAP, there was no evidence of a differential effect of apixaban over warfarin. For patients with LA/LAA thrombus, there was also no significant interaction, with the exception of all-cause death and any bleeding where there was a greater benefit of apixaban compared with warfarin among patients with no LA/LAA thrombus. In anticoagulated patients with atrial fibrillation and risk factors for stroke, echocardiographic findings do not seem to add to the risk of thromboembolic events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2017 American Heart Association, Inc.

  3. Efficiency of radiofrequency ablation of pulmonary vein ostium for patients with atrial fibrillation and metabolics

    Directory of Open Access Journals (Sweden)

    E. L. Zaslavskaya

    2016-01-01

    Full Text Available The aim of this study is determination of predictors of efficiency of radiofrequency ablation (RFA in patients with atrial fibrillation (AF and metabolic syndrome (MS. Material and methods. 98 patients with AF (78 patients with AF and MS (IDF, 2005 and 20 patients without MS have been examined. Comparison groups included 50 patients with MS without arrhythmia and 50 practically healthy subjects. RFA was performed with Carto 3 navigation system. Follow-up period after RFA was 12 months. Epicardial fat thickness (EFT was measured with help of echo-cardiography. Results: patients with AF relapse had more MS components than those with effective procedure (3.21±1.18 and 1.73±1.14, accordingly, p<0.001. Initially, EFT of patients with AF relapse after RFA was larger that in patients without arrhythmia after exposure. EFT in patients with AF more than3.5 mmincreases probability of arrhythmia relapse in 1.87 times (OR: 1.87, 95 % CI 1.03 — 3.41, р = 0.04. Conclusion: determination of EFT with echo-cardiogaphy can be used in estimation of AF relapse risk after RFA.

  4. Suitability, Efficacy, and Safety of Vernakalant for New Onset Atrial Fibrillation in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Alain Rudiger

    2014-01-01

    Full Text Available Objectives. This study investigates the suitability, safety, and efficacy of vernakalant in critically ill patients with new onset atrial fibrillation (AF after cardiac surgery. Methods. Patients were screened for inclusion and exclusion criteria according to the manufacturers’ recommendations. Included patients were treated with 3 mg/kg of vernakalant over 10 min and, if unsuccessful, a second dose of 2 mg/kg. Blood pressure was measured continuously for 2 hours after treatment. Results. Of the 191 patients screened, 159 (83% were excluded, most importantly due to hemodynamic instability (59%. Vernakalant was administered to 32 (17% of the screened patients. Within 6 hours, 17 (53% patients converted to sinus rhythm. Blood pressure did not decrease significantly 10, 30, 60, and 120 minutes after the vernakalant infusion. However, 11 patients (34% experienced a transient decrease in mean arterial blood pressure <60 mmHg. Other adverse events included nausea (n=1 and bradycardia (n=2. Conclusions. Applying the strict inclusion and exclusion criteria provided by the manufacturer, only a minority of postoperative ICU patients with new onset AF qualified for vernakalant. Half of the treated patients converted to sinus rhythm. The drug was well tolerated, but close heart rate and blood pressure monitoring remains recommended.

  5. Pretreatment with ACE inhibitors improves acute outcome of electrical cardioversion in patients with persistent atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Van Veldhuisen Dirk J

    2005-01-01

    Full Text Available Abstract Background Persistent atrial fibrillation (AF is difficult to treat. In the absence of class I or III antiarrhythmic drugs sinus rhythm is maintained in only 30% of patients during the first year after electrical cardioversion (ECV. One of the remodeling processes induced by AF is fibrosis, which relates to inducibility and maintenance of AF. The renin-angiotensin system may play a important role in this. The aim of this study was to investigate the role of angiotensin-converting enzyme (ACE inhibitor use on efficacy of ECV, and occurrence of subacute recurrences. Methods One hundred-seven consecutive patients with persistent AF underwent ECV. In twenty-eight (26% patients ACE inhibitors had been started before initiation of the present episode of AF ('pre-treated' patients. Results ECV was successful in 96% of patients who were on ACE inhibitors before start of the present episode of AF compared to 80% of the patients not pre-treated (p = 0.04. After 1 month of follow-up 49% of the pre-treated patients and 50% of those not pre-treated with ACE inhibition were still in sinus rhythm (p=ns. Multivariate analysis showed that pre-treatment with ACE inhibitors and a smaller left atrial size were independent predictors of successful ECV (OR = 5.8, C.I. 1.3–26.1, and OR = 5.6, C.I. 1.2–25.3, respectively. Conclusions Pre-treatment with ACE inhibitors may improve acute success of ECV but does not prevend AF recurrences.

  6. Incidence and risk factors of atrial fibrillation in Asian COPD patients

    Directory of Open Access Journals (Sweden)

    Liao KM

    2017-08-01

    Full Text Available Kuang-Ming Liao,1 Chung-Yu Chen2,3 1Department of Internal Medicine, Chi Mei Medical Center Chiali, Tainan, 2Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, 3Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China Objective: To investigate the incidence and risk factors of atrial fibrillation (AF in Asian chronic obstructive pulmonary disease (COPD patients. Patients and methods: We selected a study population older than 40 years with a COPD diagnosis and who had used at least one inhaled bronchodilator medication between 1998 and 2012. The date of the index COPD diagnosis was defined as the index date. We excluded patients with a history of AF, significant mitral valve disease, disorders of the thyroid gland, or ischemic heart disease before the index date. We followed all patients from the index date to the day of AF occurrence, the day of death, or the date of December 31, 2013. The baseline of comorbidities was identified before the index date. Comorbidities included hypertension, diabetes mellitus, end-stage renal disease, congenital heart failure, stroke, peripheral arterial occlusive disease, and malignancy. Results: We included 6,208 COPD patients and 12,409 patients without COPD. The incidence of AF was higher in COPD patients than in those without COPD. The adjusted hazard ratio (HR for AF among those with COPD was 2.23 with a 95% confidence interval (CI of 1.98–2.51 compared to those without COPD. After multiple analyses, patients with hypertension (HR 1.43 [95% CI =1.26–1.62] or heart failure (HR 2.36 [95% CI =1.81–3.08] were found to have a significantly higher incidence of AF than those without these conditions. Conclusion: It is important for physicians to monitor, prevent, and provide early intervention for AF in COPD patients with hypertension or heart failure. Keywords: atrial fibrillation, COPD, incidence

  7. Anticoagulation in atrial fibrillation. Is there a gap in care for ambulatory patients?

    Science.gov (United States)

    Putnam, Wayne; Nicol, Kelly; Anderson, David; Brownell, Brenda; Chiasson, Meredith; Burge, Frederick I.; Flowerdew, Gordon; Cox, Jafna

    2004-01-01

    OBJECTIVE: Atrial fibrillation (AF) substantially increases risk of stroke. Evidence suggests that anticoagulation to reduce risk is underused (a "care gap"). Our objectives were to clarify measures of this gap in care by including data from family physicians and to determine why eligible patients were not receiving anticoagulation therapy. DESIGN: Telephone survey of family physicians regarding specific patients in their practices. SETTING: Nova Scotia. PARTICIPANTS: Ambulatory AF patients not taking warfarin who had risk factors that made anticoagulation appropriate. MAIN OUTCOME MEASURES: Proportion of patients removed from the care gap; reasons given for not giving the remainder anticoagulants. RESULTS: Half the patients thought to be in the care gap had previously unknown contraindications to anticoagulation, lacked a clear indication for anticoagulation, or were taking warfarin. Patients' refusal and anticipated problems with compliance and monitoring were among the reasons for not giving patients anticoagulants. CONCLUSION: Adding data from primary care physicians significantly narrowed the care gap. Attention should focus on the remaining reasons for not giving eligible patients anticoagulants. PMID:15508374

  8. Novel oral anticoagulants in patients with chronic kidney disease and atrial fibrillation.

    Science.gov (United States)

    Stamellou, Eleni; Floege, Jürgen

    2017-12-01

    Atrial fibrillation (AF) is the most frequent arrhythmia in common clinical practice and its prevalence is markedly increased among patients with chronic kidney disease (CKD). The presence of CKD increases the incidence of AF and vice versa. Both AF and CKD increase the risk of stroke or systemic thromboembolism and oral anticoagulation is the mainstay for thromboembolic event prevention in patients with AF. Novel oral anticoagulants (NOACs) are nowadays often used in patients with AF and CKD, but they display a variable degree of renal elimination and the risk of accumulation and bleeding increases among patients with CKD in particular as kidney disease progresses. While recent data have demonstrated that patients with Stage 3 CKD benefit even more from oral anticoagulation therapies in comparison with patients with normal renal function, relatively little is known about the best choice of anticoagulation in patients with advanced and, in particular, end-stage renal disease, as these patients were excluded from all pivotal Phase 3 NOACs trials. This review summarizes current knowledge on the efficacy and safety of these agents in individuals with CKD and provides CKD stage-specific recommendations. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  9. Feasibility and efficacy of electrical cardioversion after cardiac resynchronization implantation in patients with permanent atrial fibrillation.

    Science.gov (United States)

    Turco, Pietro; D'Onofrio, Antonio; Stabile, Giuseppe; Solimene, Francesco; La Rocca, Vincenzo; Vecchione, Filippo; Iuliano, Assunta; Marrazzo, Natale; De Vivo, Stefano; Cavallaro, Ciro; Bianchi, Valter; Agresta, Alessia; Ciardiello, Carmine; De Simone, Antonio

    2012-12-01

    Patients with permanent atrial fibrillation (AF) who undergo cardiac resynchronization therapy (CRT) may spontaneously recover sinus rhythm during follow-up. We tested the feasibility and efficacy of electrical cardioversion attempted after 3 months of CRT in patients with permanent AF and measured the long-term maintenance of sinus rhythm. Twenty-eight consecutive patients with permanent AF in whom CRT defibrillators had been implanted were scheduled for internal electrical cardioversion after 3 months (group A) and were compared with a control group of 27 patients (group B). In group A, 22 patients (79 %) were eligible for cardioversion; sinus rhythm was restored in 18 (82 %) of these, with no procedural complications. After 12 months, 16 patients (58 %) in group A were in sinus rhythm, compared with one group B patient who spontaneously recovered sinus rhythm (4 %, p defibrillator after 3 months of CRT, was associated with a high rate of sinus rhythm resumption on long-term follow-up and with a better echocardiographic response to CRT than that seen in patients treated according to a rate control strategy.

  10. Developing a Complex Educational–Behavioural Intervention: The TREAT Intervention for Patients with Atrial Fibrillation

    Science.gov (United States)

    Clarkesmith, Danielle E.; Pattison, Helen M.; Borg Xuereb, Christian; Lane, Deirdre A.

    2016-01-01

    This article describes the theoretical and pragmatic development of a patient-centred intervention for patients with atrial fibrillation (AF). Theoretical models (Common Sense Model, Necessity-Concerns Framework), clinical frameworks, and AF patient feedback contributed to the design of a one-off hour-long behaviour-change intervention package. Intervention materials consisted of a DVD, educational booklet, diary and worksheet, which were patient-centred and easy to administer. The intervention was evaluated within a randomised controlled trial. Several “active theoretical ingredients” were identified (for e.g., where patients believed their medication was less harmful they spent more time within the therapeutic range (TTR), with general harm scores predicting TTR at 6 months). Allowing for social comparison and adopting behaviour change techniques enabled accurate patient understanding of their condition and medication. The process of developing the intervention using theory-derived content and evaluation tools allowed a greater understanding of the mechanisms by which this intervention was successful. Alleviating concerns about treatment medication by educating patients can help to improve adherence. This process of intervention development could be adopted for a range of chronic illnesses and treatments. Critical elements should include the use of: (1) clinical guidelines; (2) appropriate theoretical models; (3) patient input; and (4) appropriate evaluation tools. PMID:27417598

  11. Expression of platelet-bound stromal cell-derived factor-1 in patients with non-valvular atrial fibrillation and ischemic heart disease.

    Science.gov (United States)

    Stellos, Konstantinos; Rahmann, A; Kilias, A; Ruf, M; Sopova, K; Stamatelopoulos, K; Jorbenadze, R; Weretka, S; Geisler, T; Gawaz, M; Weig, H-J; Bigalke, B

    2012-01-01

    Blood cell infiltration and inflammation are involved in atrial remodelling during atrial fibrillation (AF) although the exact mechanisms of inflammatory cell recruitment remain poorly understood. Platelet-bound stromal cell-derived factor-1 (SDF-1) is increased in cases of ischemic myocardium and regulates recruitment of CXCR4(+) cells on the vascular wall. Whether platelet-bound SDF-1 expression is differentially influenced by non-valvular paroxysmal or permanent atrial fibrillation (AF) in patients with stable angina pectoris (SAP) or acute coronary syndrome (ACS) has not been reported so far. A total of 1291 consecutive patients with coronary artery disease (CAD) undergoing coronary angiography were recruited. Among the patients with SAP, platelet-bound-SDF-1 is increased in patients with paroxysmal AF compared with SR or to persistent/permanent AF (P disease. Further in vivo studies are required to elucidate the role of SDF-1 in atrial remodeling and the atrial fibrillation course.

  12. Temperature-Controlled Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Iwasawa, Jin; Koruth, Jacob S; Petru, Jan; Dujka, Libor; Kralovec, Stepan; Mzourkova, Katerina; Dukkipati, Srinivas R; Neuzil, Petr; Reddy, Vivek Y

    2017-08-01

    Saline irrigation improved the safety of radiofrequency (RF) ablation, but the thermal feedback for energy titration is absent. To allow temperature-controlled irrigated ablation, a novel irrigated RF catheter was designed with a diamond-embedded tip (for rapid cooling) and 6 surface thermocouples to reflect tissue temperature. High-resolution electrograms (EGMs) from the split-tip electrode allowed rapid lesion assessment. The authors evaluated the preclinical and clinical performance of this catheter for pulmonary vein (PV) isolation. Using the DiamondTemp (DT) catheter, pigs (n = 6) underwent discrete atrial ablation in a temperature control mode (60°C/50 W) until there was ∼80% EGM amplitude reduction. In a single-center clinical feasibility study, 35 patients underwent PV isolation with the DT catheter (study group); patients were planned for PV remapping after 3 months, regardless of symptomatology. A control group included 35 patients who underwent PV isolation with a standard force-sensing catheter. Porcine lesion histology revealed transmurality in 51 of 55 lesions (92.7%). In patients, all PVs were successfully isolated; no char or thrombus formation was observed. Compared with the control group, the study cohort had shorter mean RF application duration (26.3 ± 5.2 min vs. 89.2 ± 27.2 min; p PV reconduction (0 of 35 vs. 5 of 35; p = 0.024). At 3 months, 23 patients underwent remapping: 39 of 46 PV pairs (84.8%) remained durably isolated in 17 of these patients (73.9%). This first-in-human series demonstrated that temperature-controlled irrigated ablation produced rapid, efficient, and durable PV isolation. (ACT DiamondTemp Temperature-Controlled and Contact Sensing RF Ablation Clinical Trial for Atrial Fibrillation [TRAC-AF]; NCT02821351). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Warfarin anticoagulation in hemodialysis patients with atrial fibrillation: comparison of nephrologist-led and anticoagulation clinic-led management.

    Science.gov (United States)

    Bahbahani, Hamad; AlTurki, Ahmed; Dawas, Ahmed; Lipman, Mark L

    2018-01-08

    There is conflicting evidence of benefit versus harm for warfarin anticoagulation in hemodialysis patients with atrial fibrillation. This equipoise may be explained by suboptimal Time in Therapeutic Range (TTR), which correlates well with thromboembolic and bleeding complications. This study aimed to compare nephrologist-led management of warfarin therapy versus that led by specialized anticoagulation clinic. In a retrospective cohort of chronic hemodialysis patients from two institutions (Institution A: Nephrologist-led warfarin management, Institution B: Anticoagulation clinic-led warfarin management), we identified patients with atrial fibrillation who were receiving warfarin for thromboembolic prophylaxis. Mean TTRs, proportion of patients achieving TTR ≥ 60%, and frequency of INR testing were compared using a logistic regression model. In Institution A, 16.7% of hemodialysis patients had atrial fibrillation, of whom 36.8% were on warfarin. In Institution B, 18% of hemodialysis patients had atrial fibrillation, and 55.5% were on warfarin. The mean TTR was 61.8% (SD 14.5) in Institution A, and 60.5% (SD 15.8) in Institution B (p-value 0.95). However, the proportion of patients achieving TTR ≥ 60% was 65% versus 43.3% (Adjusted OR 2.22, CI 0.65-7.63) and mean frequency of INR testing was every 6 days versus every 13.9 days in Institutions A and B respectively. There was no statistical difference in mean TTR between nephrologist-led management of warfarin and that of clinic-led management. However, the former achieved a trend toward a higher proportion of patients with optimal TTR. This improved therapeutic results was associated with more frequent INR monitoring.

  14. Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta-Analysis

    OpenAIRE

    Demeestere, Jelle; Fieuws, Steffen; Lansberg, Maarten G.; Lemmens, Robin

    2016-01-01

    Background-Recent trials have demonstrated that extended cardiac monitoring increases the yield of paroxysmal atrial fibrillation (AF) detection in patients with cryptogenic stroke. The utility of extended cardiac monitoring is uncertain among patients with stroke caused by small and large vessel disease. We conducted a meta-analysis to estimate the yield of AF detection in this population. Methods and Results-We searched PubMed, Cochrane, and SCOPUS databases for studies on AF detection in s...

  15. Prognostic impact of hs-CRP and IL-6 in patients undergoing radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer Mads Aaris; Nilsson, Brian; Bruunsgaard, Helle

    2008-01-01

    Aim. The aim of this study was to assess the predictive value of inflammatory markers in patients with paroxysmal/ persistent atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation. Methods. Forty-six consecutive patients, mean age 55 years (range 31 - 81 yrs), with paroxysmal...... of paroxysmal or persistent AF treated with RF catheter ablation, elevated levels of IL-6 and hs-CRP before ablation are independent predictors of recurrence of AF Udgivelsesdato: 2008/12/31...

  16. Apixaban compared with parenteral heparin and/or vitamin K antagonist in patients with nonvalvular atrial fibrillation undergoing cardioversion : Rationale and design of the EMANATE trial

    OpenAIRE

    Ezekowitz, Michael D.; Pollack, Charles V; Sanders, Paul; Halperin, Jonathan L.; Spahr, Judith; Cater, Nilo; Petkun, William; Breazna, Andrei; Kirchhof, Paulus; Oldgren, Jonas

    2016-01-01

    Background: Stroke prevention in anticoagulation-nafve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. Objective: To determine outcomes in anticoagulation-naive patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillation) scheduled for cardioversion. Methods: This is a randomized, prospective, open-label, real-world study comparing apixaban to heparin plus warfarin. Early image-guided ca...

  17. Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF-TIMI 48 Trial

    DEFF Research Database (Denmark)

    Eisen, Alon; Ruff, Christian T; Braunwald, Eugene

    2017-01-01

    BACKGROUND: Digoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF). METHO...... the need to examine digoxin use, particularly when prescribed to control heart rate in patients with atrial fibrillation in a randomized trial. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391....

  18. Visualisation during ablation of atrial fibrillation - stimulating the patient's own resources: Patients' experiences in relation to pain and anxiety during an intervention of visualisation.

    Science.gov (United States)

    Nørgaard, Marianne W; Pedersen, Preben U; Bjerrum, Merete

    2015-12-01

    Going through ablation of atrial fibrillation can be accompanied by pain and discomfort when a light, conscious sedation is used. Visualisation has been shown to reduce the patients' perception of pain and anxiety during invasive procedures, when it is used together with the usual pain management. The purpose of this study was to investigate patients' experiences with visualisation in relation to pain and anxiety during an intervention consisting of visualisation, when undergoing ablation of atrial fibrillation. Qualitative interviews were conducted with 14 patients from a study population of a clinical controlled study with 147 patients. The transcribed interviews were analysed according to qualitative methodology of inductive content analysis. Four categories emerged from the interviews: 'approach to visualisation'; 'strategies of managing pain'; 'strategies of managing anxiety' and 'benefits of visualisation'. The transversal analyses revealed two overall themes which highlight the experiences of being guided in visualisation during ablation of atrial fibrillation: 'stimulation of the patients' own resources' and 'being satisfied without complete analgesia' Visualisation used during ablation of atrial fibrillation was reported as a positive experience with no serious inconvenience: It seemed that visualisation did not produce complete analgesia but the patients expressed that it provided some pain relief and supported their individual strategies in managing pain and anxiety. Our findings indicate that visualisation for acute pain during ablation of atrial fibrillation was associated not only with a decrease in experience of pain but also with high levels of treatment satisfaction and other non-pain-related benefits. © The European Society of Cardiology 2014.

  19. Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study.

    Science.gov (United States)

    Barrios, V; Egocheaga-Cabello, M I; Gállego-Culleré, J; Ignacio-García, E; Manzano-Espinosa, L; Martín-Martínez, A; Mateo-Arranz, J; Polo-García, J; Vargas-Ortega, D

    2017-05-01

    To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients' follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  20. Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk.

    Science.gov (United States)

    Fournaise, Anders; Skov, Jane; Bladbjerg, Else-Marie; Leppin, Anja

    2015-11-01

    Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk. In an observational cross-sectional study design, we surveyed 178 AF patients with a mean age of 70.6 years (SD 8.3) in stable anticoagulant treatment (65% treatment duration >12 months). Clinical stroke risk was scored through the CHA2DS2-VASc, and patients rated their perceived personal stroke risk on a 7-point Likert scale. There was no significant association between clinical stroke risk assessment and patients' stroke risk perception (rho = .025; P = .741). Approximately 60% of the high-risk patients had an unrealistic perception of their own stroke risk, and there was no significant increase in risk perception from those with a lower compared with a higher risk factor load (χ(2) = .010; P = .522). Considering possible negative implications in terms of lack of motivation for lifestyle behavior change and adequate adherence to the treatment and monitoring of vitamin K antagonist, the apparent underestimation of risk by large subgroups warrants attention and needs further investigation with regard to possible behavioral consequences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Amiodarone for the maintenance of sinus rhythm in patients with atrial fibrillation.

    Science.gov (United States)

    Howard, P A

    1995-06-01

    To discuss the role of amiodarone for the maintenance of normal sinus rhythm in patients with atrial fibrillation (AF) and review the clinical trial data evaluating the efficacy and safety of amiodarone in patients with AF. A MEDLINE search was used to identify pertinent literature. Additional references were identified from the articles obtained in the search. Key search terms were atrial fibrillation, amiodarone, and sinus rhythm. All studies available at the time the article was prepared evaluating the efficacy and safety of amiodarone in AF were included. In addition, review articles discussing the role of amiodarone in AF were selected. No large, prospective, randomized trials have been performed. Data from 8 nonrandomized and 2 randomized trials are reported. Information derived from review articles is discussed. In patients with AF, maintenance of normal sinus rhythm is desirable to eliminate symptoms, improve functional capacity, and reduce the risk of thromboembolic complications. Class IA agents traditionally have been used; however, concerns about long-term effects on mortality have focused attention on other agents such as amiodarone. A number of nonrandomized, uncontrolled trials have found amiodarone to be effective for maintaining normal sinus rhythm in patients with AF that is refractory to conventional agents. Two randomized, nonblind trials have found amiodarone's efficacy to be equal to or superior to that of class IA drugs. The findings of these trials must be weighed, however, against the significant potential for toxicity and drug interactions associated with amiodarone. Cardiovascular toxicities, including proarrhythmic effects, appear to be relatively rare. In contrast, noncardiovascular effects are common and potentially serious. Although the preliminary data using amiodarone in AF are encouraging, many questions remain unanswered. Prospective, randomized trials are needed to evaluate the long-term efficacy and safety of amiodarone in

  2. Cost-effectiveness of dronedarone in patients with atrial fibrillation in the ATHENA trial.

    Science.gov (United States)

    Berg, Jenny; Sauriol, Luc; Connolly, Stuart; Lindgren, Peter

    2013-10-01

    The ATHENA trial randomized 4628 patients with atrial fibrillation (AF) or atrial flutter, aged ≥ 70 years with risk factors or ≥ 75 years without risk factors, to receive 400 mg dronedarone twice daily or placebo in addition to standard therapy. Our objective was to evaluate the cost-effectiveness of dronedarone from a Canadian health care perspective based on resource utilization and cardiovascular hospitalization or death in ATHENA. Data on medical resource utilization (cardiovascular hospitalizations, hospitalization because of treatment-related adverse events, outpatient examinations and procedures, study drug and concomitant medications) were aggregated for all randomized patients during the entire trial period (mean 21 months). Effectiveness was measured using the total number of avoided cardiovascular hospitalizations and deaths from any cause, and projected survival and quality-adjusted survival using life tables adjusted for AF mortality and data on determinants of utility in AF. We used standard unit costs from Canada (2008), discounting costs and effects at 5% per year. Patients receiving dronedarone incurred a mean total cost (undiscounted) of CAD $7402 during the trial period, compared with CAD $6708 for patients receiving placebo. The cost of dronedarone was partly offset by savings for cardiovascular hospitalizations and concomitant medications. On average, patients taking dronedarone experienced 0.18 fewer events (cardiovascular hospitalizations or death). The cost per event avoided was CAD $3807, the cost per life-year gained was CAD $5204, and the cost per quality-adjusted life-years was CAD $7560. Compared with generally accepted thresholds, our results indicate that treatment with dronedarone as in ATHENA is cost-effective. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  3. Anticoagulation Control in Patients With Nonvalvular Atrial Fibrillation Attended at Primary Care Centers in Spain: The PAULA Study.

    Science.gov (United States)

    Barrios, Vivencio; Escobar, Carlos; Prieto, Luis; Osorio, Genoveva; Polo, José; Lobos, José María; Vargas, Diego; García, Nicolás

    2015-09-01

    To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Utilization and Predictors of Electrical Cardioversion in Patients Hospitalized for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Yogita M. Rochlani

    2016-01-01

    Full Text Available Atrial fibrillation (AF is a common arrhythmia in adults associated with thromboembolic complications. External electrical cardioversion (DCCV is a safe procedure used to convert AF to normal sinus rhythm. We sought to study factors that affect utilization of DCCV in hospitalized patients with AF. The study sample was drawn from the Nationwide Inpatient Sample (NIS of the Healthcare Cost and Utilization Project in the United States. Patients with a primary discharge diagnosis of AF that received DCCV during hospitalization in the years 2000–2010 were included. An estimated 2,810,530 patients with a primary diagnosis of AF were hospitalized between 2001 and 2010, of which 1,19,840 (4.26% received DCCV. The likelihood of receiving DCCV was higher in patients who were males, whites, privately insured, and aged < 40 years and those with fewer comorbid conditions. Higher CHADS2 score was found to have an inverse association with DCCV use. In-hospital stroke, in-hospital mortality, length of stay, and cost for hospitalization were significantly lower for patients undergoing DCCV during AF related hospitalization. Further research is required to study the contribution of other disease and patient related factors affecting the use of this procedure as well as postprocedure outcomes.

  5. Educational inequalities in mortality of patients with atrial fibrillation in Norway.

    Science.gov (United States)

    Akerkar, Rupali; Ebbing, Marta; Sulo, Gerhard; Ariansen, Inger; Igland, Jannicke; Tell, Grethe S; Egeland, Grace M

    2017-04-01

    We explored the educational gradient in mortality in atrial fibrillation (AF) patients. We prospectively followed patients hospitalized with AF as primary discharge diagnosis in the Cardiovascular Disease in Norway 2008-2012 project. The average length of follow-up was 2.4 years. Mortality by educational level was assessed by Cox proportional hazard models. Population attributable fractions (PAF) were calculated. Analyses stratified by age (≤75 and >75 years of age), and adjusted for age, gender, medical intervention, and Charlson Comorbidity Index. Of 42,138 AF patients, 16% died by end of 2012. Among younger patients, those with low education (≤10 years) had a HR of 2.3 (95% confidence interval 2.0, 2.6) for all-cause mortality relative to those with any college or university education. Similar results were observed for cardiovascular mortality. Disparities in mortality were greater among younger than older patients. A PAF of 35.9% (95% confidence interval 27.9, 43.1) was observed for an educational level of high school/vocational school or less versus higher education in younger patients. Increasing educational level associated with better prognosis suggesting underlying education-related behavioral and medical determinants of mortality. A considerable proportion of mortality within 5 years following hospital discharge could be prevented.

  6. Antiarrhythmic therapy and risk of death in patients with atrial fibrillation: a nationwide study.

    Science.gov (United States)

    Andersen, Søren Skøtt; Hansen, Morten Lock; Gislason, Gunnar H; Schramm, Tina Ken; Folke, Fredrik; Fosbøl, Emil; Abildstrøm, Steen Z; Madsen, Mette; Køber, Lars; Torp-Pedersen, Christian

    2009-07-01

    To examine the risk of death associated with antiarrhythmic drug (AAD) therapy in a nationwide unselected cohort of patients with atrial fibrillation (AF). All patients admitted with AF in Denmark from 1995 to 2004 and their subsequent use of AADs were identified by individual-level linkage of nationwide registries. Multivariable Cox proportional-hazard models with time-dependent covariates were used to analyse the risk of death associated with AAD therapy. A total of 141,500 patients were included in the study; of these 3356 (2.4%) patients received treatment with flecainide, 3745 (2.6%) propafenone, 23,346 (16.5%) sotalol, and 10,376 (7.3%) amiodarone. Annualized mortality rates were 2.54, 4.25, 5.29, and 7.42 per year per 100 person years for flecainide, propafenone, sotalol, and amiodarone, respectively. Multivariable Cox proportional-hazard models did not show increased risk of death associated with any of the AADs. Hazard ratio (95% confidence interval) for flecainide 0.38 (0.32-0.44), propafenone 0.65 (0.58-0.71), sotalol 0.65 (0.63-0.67), and amiodarone 0.94 (0.89-1.00). In an unselected cohort of patients with AF, antiarrhythmic treatment with flecainide, propafenone, sotalol, or amiodarone was not associated with increased risk of death. From a safety perspective, this indicates appropriate selection of patients for AAD therapy.

  7. Stroke prophylaxis in high-risk patients with atrial fibrillation: rhythm vs. rate control strategy.

    Science.gov (United States)

    Filippi, Alessandro; Zoni-Berisso, Massimo; Ermini, Giuliano; Landolina, Maurizio; Brignoli, Ovidio; D'Ambrosio, Gaetano; Zingarini, Gianluca; Pedrinazzi, Claudio

    2013-06-01

    "Rhythm" and "Rate" control strategies require partially different organization, and a different involvement of Specialists and General Practitioners; we verified whether the strategy assignment modified the approach to stroke prophylaxis. Survey in general practice: 233 GPs identified all patients with codified atrial fibrillation (AF) diagnosis, checked the diagnosis (ECG/hospital discharge document), and filled a structured questionnaire on stroke risk-factors, prophylactic therapy, and reasons for warfarin non prescription in CHADS ≥2 patients. Data were collected as an "aggregate." Population observed: 295,906 patients aged >14; 6,036 with confirmed AF; 5,888 with complete data about anti-thrombotic prophylaxis are analyzed here. In the "rhythm strategy" group 45.6% of the CHADS score ≥2 patients (594) were on warfarin, vs. 73.2% (1,741) in the "rate strategy" group (pcontrol vs. 30.9% in rate control group. Anti-thrombotic prophylaxis in CHADS ≥2 patients is different in subjects assigned to the Rhythm vs. the Rate control strategy, as well as reported reasons for warfarin non use. GPs do not know why warfarin is not used in a large percentage of cases, mainly in the rhythm control strategy group. Improving efforts should probably be differently tailored for patients assigned to the "rhythm" or the "rate" control strategy. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  8. The Quandary of Oral Anticoagulation in Patients With Atrial Fibrillation and Chronic Kidney Disease.

    Science.gov (United States)

    Schwartzenberg, Shmuel; Lev, Eli I; Sagie, Alexander; Korzets, Asher; Kornowski, Ran

    2016-02-01

    Compared to patients with normal renal function, the prevalence of atrial fibrillation (AF) in chronic kidney disease (CKD) is increased, as is consequently the stroke prevalence in these patients. This increased risk of stroke in patients with CKD is caused not only by the increased prevalence of AF, but also by associated co-morbidities, and inherent platelet and vascular dysfunction. Paradoxically, imbalance in the same factors also increases the bleeding risk, imposing a dilemma as to whether anticoagulation should be prescribed or deferred, particularly in patients with end-stage renal disease (ESRD), in whom the bleeding diathesis and thromboembolic predisposition are most recalcitrant. Unfortunately, it is in this vulnerable population, in whom therapeutic options are most limited, that evidence-based studies relating to stroke prophylaxis are scarce, discordant and based only on registry observations. Pending randomized controlled studies on this issue, we will review important epidemiologic data and major recent registry-based studies that the clinician has to weigh when making the best decision on the issue of the prophylactic use of warfarin in patients with CKD with AF, focusing on patients with end-stage renal disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Relation between achieved heart rate and outcomes in patients with atrial fibrillation (from the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] Study).

    Science.gov (United States)

    Cooper, Howard A; Bloomfield, Dennis A; Bush, David E; Katcher, Michael S; Rawlins, Michele; Sacco, Joseph D; Chandler, Mary

    2004-05-15

    Many patients with atrial fibrillation (AF) are treated with rate control and anticoagulation. However, the relation between the degree of heart rate (HR) control and clinical outcome is uncertain. We assessed whether lower achieved HR at rest and/or lower achieved exercise HR was associated with improved prognosis, quality of life (QoL), and functional status among patients in the AFFIRM study. Patients in the rate control arm and who were in AF at baseline and 2 months were included. Patients were grouped by quartile of achieved HR at rest (44 to 69, 70 to 78, 79 to 87, 88 to 148 beats/min) and achieved exercise HR following a 6-minute walk (53 to 82, 83 to 92, 93 to 106, 107 to 220 beats/min). QoL measurements and functional status were also analyzed. Complete data were available for 680 patients for achieved HR at rest, 349 patients for achieved exercise HR, and 118 patients for QoL. Survival free from cardiac hospitalization and overall survival were not significantly different among quartiles of achieved HR at rest (p = 0.19 and p = 0.8, respectively) or achieved exercise HR (p = 0.77 and p = 0.14, respectively). After controlling for covariates, there remained no significant relation between either achieved HR at rest or achieved exercise HR and event-free survival (hazard ratio 0.95, p = 0.35 and hazard ratio 0.98, p = 0.81) or overall survival (hazard ratio 1.03, p = 0.70 and hazard ratio 1.22, p = 0.13). Furthermore, there was no significant association between achieved HR and QoL measurements, New York Heart Association functional class, or 6-minute walking distance. After 2 months of drug titration, neither achieved HR at rest nor achieved exercise HR predicted survival free from cardiovascular hospitalization, overall survival, QoL, or functional status among patients with AF.

  10. Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Tawfik A

    2016-08-01

    Full Text Available Amy Tawfik,1,2 Joanna M Bielecki,2 Murray Krahn,1,2 Paul Dorian,3,4 Jeffrey S Hoch,1,3,5 Heather Boon,1 Don Husereau,6 Petros Pechlivanoglou2 1Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, 2Toronto Health Economics and Technology Assessment (THETA Collaborative, University of Toronto, 3Centre for Excellence in Economic Analysis Research (CLEAR, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Department of Medicine and Cardiology, University of Toronto, 5Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, 6Institute of Health Economics, Edmonton, AB, Canada Background: In the last 4 years, four novel oral anticoagulants have been developed as alternatives to warfarin and antiplatelet agents for stroke prevention in atrial fibrillation (AF patients. The objective of this review was to estimate the comparative effectiveness of all antithrombotic treatments for AF patients.Materials and methods: Data sources were Medline Ovid (1946 to October 2015, Embase Ovid (1980 to October 2015, and the Cochrane Central Register of Controlled Trials (­CENTRAL, Issue 9, 2015. Randomized controlled trials of AF patients were selected if they compared at least two of the following: placebo, aspirin, aspirin and clopidogrel combination therapy, adjusted-dose warfarin (target international normalized ratio 2.0–3.0, dabigatran, rivaroxaban, apixaban, and edoxaban. Bayesian network meta-analyses were conducted for outcomes of interest (all stroke, ischemic stroke, myocardial infarction, overall mortality, major bleeding, and intracranial hemorrhage.Results: Based on 16 randomized controlled trials of 96,826 patients, all oral anticoagulants were more effective than antiplatelet agents at reducing the risk of ischemic stroke and all strokes. Compared to warfarin, dabigatran 150 mg (rate ratio 0.65, 95% credible interval 0.52–0.82 and apixaban (rate ratio 0.82, 95% credible interval 0.69–0.97 reduced the risk of

  11. Burden of comorbidities among Japanese patients with atrial fibrillation: a case study of dyspepsia

    Directory of Open Access Journals (Sweden)

    Kinoshita Y

    2013-05-01

    Full Text Available Yoshikazu Kinoshita,1 Marco DiBonaventura,2 Bruno Rossi,3 Kazuya Iwamoto,4 Edward C Y Wang,5 Jean-Baptiste Briere51Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan; 2Health Sciences Practice, Kantar Health, New York, NY, USA; 3Market Access, 4Medical Affairs Cardiovascular and Neurology, 5Health Economics and Outcomes Research, Bayer Yakuhin Ltd, Osaka, JapanBackground: The aim of this study was to investigate the link between atrial fibrillation (AF and dyspepsia, as well as the contribution of dyspepsia to the overall burden of AF.Methods: The 2008, 2009, and 2010 Japan National Health and Wellness Survey (NHWS datasets were used in this study. The NHWS is an Internet-based survey administered to the adult population in Japan using a random stratified sampling framework to ensure demographic representativeness. The presence of dyspepsia was compared between those with and without AF. Among those with AF, the effect of dyspepsia on health status, work productivity, and activity impairment was examined, along with health care resource use using multivariable regression modeling and controlling for baseline differences.Results: Among patients with AF (n = 565, the three most commonly reported comorbidities were hypertension (38.76%, dyspepsia (37.35%, and overactive bladder (28.72%. Patients with AF had 48.59% greater odds of reporting dyspepsia than those without AF (P < 0.05. Patients with dyspepsia used more AF medications (2.05 versus 1.54 and had been diagnosed more recently (9.97 versus 10.58 years. Dyspepsia was associated with significantly worse physical health status (P < 0.05 and significantly more absenteeism, overall work impairment, activity impairment, physician visits, and emergency room visits (all P < 0.05.Conclusion: Patients with AF in Japan experience a number of comorbidities, with dyspepsia being the most common noncardiovascular comorbidity. Given the prevalence and

  12. Warfarin slows deterioration of renal function in elderly patients with chronic kidney disease and atrial fibrillation.

    Science.gov (United States)

    Chang, Chia-Chu; Liou, Hung-Hsiang; Wu, Chia-Lin; Chang, Chirn-Bin; Chang, Yu-Jun; Chiu, Ping-Fang; Huang, Ching-Hui

    2013-01-01

    The purpose of this study was to examine whether long-term use of anticoagulants in elderly patients with atrial fibrillation (AF) and chronic kidney disease (CKD) influences renal function. In this retrospective observational study, we reviewed the records of 2023 patients who attended our institution for treatment of CKD between January 2001 and September 2012. Inclusion criteria were having been under review for three months or more, age older than 60 years, permanent AF, a CHADS2 score > 2, and National Kidney Foundation Kidney Disease Outcomes Quality Initiative CKD stage 3-5. Sixty-one patients fulfilled these criteria, and were divided into those receiving antiplatelet anticoagulation (group A) and those receiving warfarin (group B). The results of laboratory investigations and estimated glomerular filtration rate (GFR) were recorded at months 3, 6, 12, and 18 from treatment initiation. We also recorded the occurrence of serious cardiovascular and neurological events, significant bleeding, and survival beyond 12 years. Of the 61 patients enrolled, 35 were in group A and 26 were in group B. The mean international normalized ratio (INR) was 1.95 ± 1.01 (goal elderly patients with CKD and AF.

  13. Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation.

    Science.gov (United States)

    Ortiz, M M; Llamas, P; Sanmartín, M; Egido, J A; Del Toro, J; Egocheaga, M I; Estévez, M S; Navarro, I M; Mira, J J

    2017-05-01

    To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. The relative effects of digoxin and diltiazem upon ventricular ectopic activity in patients with chronic atrial fibrillation.

    Science.gov (United States)

    Lewis, R V; McDevitt, D G

    1988-01-01

    In eight patients with chronic atrial fibrillation, treatment with digoxin (plasma drug concentration 1.3 to 2.0 nmol l-1) was associated with a significantly higher incidence of ventricular premature beats (VPBs) (mean 22.8 h-1) than diltiazem 120 mg three times daily (mean 6.8 h-1) (P less than 0.05). Seven out of the eight patients showed an increase in numbers of VPBs recorded over 24 h during treatment with digoxin when compared with diltiazem. The clinical importance of these results is unclear, but atrial fibrillation and ischaemic heart disease frequently co-exist, and increases in ventricular ectopy may predispose to serious ventricular arrhythmias following myocardial infarction. PMID:2460118

  15. Sex differences in management and outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events (Gulf SAFE.

    Directory of Open Access Journals (Sweden)

    Abdulla Shehab

    Full Text Available Differences in the management of atrial fibrillation (AF between men and women were investigated by using Gulf SAFE data in the Middle East. The study included 2,043 patients presenting with AF to emergency room (ER were prospectively enrolled and followed for one-year. Women were older, have higher body mass index (BMI, comorbidities, and health complications than men. With regard to management of AF, cardioversion was recommended more often for men (16.7% vs. 9.3%, and underwent electrical cardioversion (2.2% vs. 1.1%. Women were prescribed digoxin more frequently than men (25.6% vs. 17.4% and a significant number women received warfarin alone (31.1% vs. 8.7%. No difference between the sexes was noticed in One-year rates of stroke/transient ischemic attacks (TIA and all-cause of mortality after one-year follow-up (3.1% men vs. 3.3% women, and 7.5% vs. 7.4%. Older age (≥ 65 years, smoking, alcohol use, CHADS2 scores ≥5 were some of the significant risk factors in men with AF. Suboptimal use of anticoagulants, higher mortality and stroke/TIA events at one year are high but similar between the sexes. ER management revealed high use of rate control strategy and high rate of hospital admission was noticed in women.

  16. Warfarin Use in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study.

    Science.gov (United States)

    Yoon, Chang-Yun; Noh, Juhwan; Jhee, Jong Hyun; Chang, Tae Ik; Kang, Ea Wha; Kee, Youn Kyung; Kim, Hyoungnae; Park, Seohyun; Yun, Hae-Ryong; Jung, Su-Young; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Kang, Shin-Wook; Kim, Changsoo; Yoo, Tae-Hyun

    2017-09-01

    The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P =0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P =0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P =0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P =0.470). Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications. © 2017 American Heart Association, Inc.

  17. Reliability of Oscillometric Blood Pressure Monitoring in Atrial Fibrillation Patients Admitted for Electric Cardioversion.

    Science.gov (United States)

    Maselli, Monica; Giantin, Valter; Corrado, Domenico; Franchin, Alessandro; Attanasio, Francesca; Pengo, Valentina; Tramontano, Alessandra; De Toni, Pietro; Perissinotto, Egle; Manzato, Enzo

    2015-07-01

    The reliability of automated oscillometric blood pressure (BP) monitors in atrial fibrillation (AF) has been poorly investigated, only comparing different patients with AF and sinus rhythm (SR), and is a method influenced by individual characteristics. This study compared the reliability of the oscillometric device A&D TM-2430 (A&D Company, Tokyo, Japan) with that of a mercury sphygmomanometer in AF patients whose SR was restored after electric cardioversion (ECV). Three consecutive BP measurements were obtained on the day before and about 30 days after ECV in stable treatment conditions. Of the 100 patients studied, 63 reported an SR at follow-up, with a significant increase in systolic BP and a significant decrease in diastolic BP according to both devices. There were no significant differences between the systolic and diastolic biases before and after ECV using Bland Altman analysis (P > .05 each). The oscillometric device analyzed, using three repeated measurements, is reliable in measuring BP in AF patients. © 2015 Wiley Periodicals, Inc.

  18. Rivaroxaban in patients with atrial fibrillation: from ROCKET AF to everyday practice.

    Science.gov (United States)

    Barón-Esquivias, Gonzalo; Marín, Francisco; Sanmartín Fernandez, Marcelo

    2017-05-01

    Registries and non-interventional studies offer relevant and complementary information to clinical trials, since they have a high external validity. Areas covered: The information regarding the efficacy and safety of rivaroxaban compared with warfarin, or rivaroxaban alone in clinical practice was reviewed in this manuscript. For this purpose, a search on MEDLINE and EMBASE databases was performed. The MEDLINE and EMBASE search included both medical subject headings (MeSH) and keywords including: atrial fibrillation (AF) OR warfarin OR clinical practice OR ROCKET AF AND rivaroxaban. Case reports were not considered. Expert commentary: In ROCKET AF, rivaroxaban was at least as effective as warfarin for the prevention of stroke in patients with nonvalvular AF at high risk of stroke, but, importantly, with a lesser risk of intracranial, critical and fatal bleedings. A number of observational comparative and non-comparative studies, with more than 60,000 patients included treated with rivaroxaban, have analyzed the efficacy and safety of rivaroxaban in real-life patients with AF in different clinical settings. These studies have shown that in clinical practice, rates of stroke and major bleeding were consistently lower than those reported in ROCKET AF, likely due to the lower thromboembolic and bleeding risk observed in these patients.

  19. [Efficacy of rate and rhythm control strategy in patients with atrial fibrillation: meta-analysis].

    Science.gov (United States)

    Chen, Shao-jie; Yin, Yue-hui; Dong, Ying; Fan, Jin-qi; Su, Li

    2012-01-01

    The efficacy of rate and rhythm control strategies for treating atrial fibrillation (AF) patients was analyzed in this meta-analysis. Eligible trials were searched in MEDLINE, the Cochrane Library, the Clinical Trials, the Chinese VIP database up to May 31, 2010. Ten prospective randomized control trials with 7876 patients (rate control n = 3932, rhythm control n = 3944) were included for final analysis. All cause mortality (5.3% vs. 5.0%; OR: 1.03; 95%CI: 0.84 - 1.26; I(2) control group than in rhythm control group in patients with age control and rate control groups while rehospitalization rate was significantly lower in rate control group than in rhythm control group (17.56% vs. 22.98%; OR: 0.37, 95%CI: 0.19 - 0.71). This meta-analysis shows that rhythm control strategy is superior to rate control strategy for AF patients with age < 65 years in terms of reducing all cause mortality and incidence of worsening heart failure.

  20. European experience of the convergent atrial fibrillation procedure: multicenter outcomes in consecutive patients.

    Science.gov (United States)

    Geršak, Borut; Zembala, Michael O; Müller, Dirk; Folliguet, Thierry; Jan, Matevz; Kowalski, Oskar; Erler, Stefan; Bars, Clement; Robic, Boris; Filipiak, Krzysztof; Wimmer-Greinecker, Gerhard

    2014-04-01

    The objective of this collaborative, multicenter, European effort was to evaluate the outcomes of the convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation (AF) in consecutive patients at 4 European centers. Outcomes of consecutive patients, undergoing the convergent procedure at 4 European centers, were evaluated in this study. Epicardial ablation was performed before endocardial ablation. Convergent procedure outcomes were recorded by interrogation of implanted loop recorders or Holter monitors. Rhythm status and required interventions (antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 6 and 12 months after the procedure. Outcomes, monitoring type, and patient baseline characteristics were analyzed and reported. Seventy-three consecutive patients presenting with persistent AF (30.1%) or long-standing persistent AF (69.9%) underwent the convergent procedure between January 2010 and December 2011. At 6 months, 82% (56/68) were in sinus rhythm. At 12 months, 80% (53/66) were in sinus rhythm; single-procedure maintenance of sinus rhythm without postblanking period interventions was 76% (50/66); 52% (34/66) were in sinus rhythm and not receiving antiarrhythmic drugs. This multicenter European collaborative effort demonstrated that the convergent procedure is a safe and efficacious treatment option for persistent and long-standing persistent AF. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Mortality risk of long-term amiodarone therapy for atrial fibrillation patients without structural heart disease.

    Science.gov (United States)

    Qin, Dingxin; Leef, George; Alam, Mian Bilal; Rattan, Rohit; Munir, Mohamad Bilal; Patel, Divyang; Khattak, Furqan; Adelstein, Evan; Jain, Sandeep K; Saba, Samir

    2015-01-01

    Amiodarone is often prescribed in the management of atrial fibrillation (AF) but is known to cause significant end-organ toxicities. In this study, we examined the impact of amiodarone on all-cause mortality in AF patients with structurally normal hearts. We performed a retrospective cohort analysis of all AF patients with structurally normal hearts who were prescribed antiarrhythmic drugs (AAD) for rhythm control of AF at our institution from 2006 to 2013 (n = 2,077). Baseline differences between the amiodarone (AMIO: n = 403) and other AADs (NON-AMIO: n = 1,674) groups were corrected for using propensity score matching. Amiodarone use as first-line therapy decreased significantly with a higher degree of prescriber specialization in arrhythmia management (31%, 22%, and 9% for primary care physicians, general cardiologists and cardiac electrophysiologists, respectively, p amiodarone was associated with increased all-cause (HR 2.41, p = 0.012) and non-cardiac (HR 3.55, p = 0.008) mortality, but not cardiac mortality. AF recurrence and cardiac hospitalizations were similar between the two study groups. Amiodarone treatment of AF is associated with increased mortality in patients without structural heart disease and therefore should be avoided or only used as a second-line therapy, when other AF therapies fail. Adherence to guideline recommendations in the management of AF patients impacts clinical outcome.

  2. Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence.

    Science.gov (United States)

    Anaszewicz, Marzena; Budzyński, Jacek

    2017-05-01

    Obesity is a well-known atherosclerosis risk factor; however, its role and the importance of undernutrition in atrial fibrillation (AF) pathogenesis are still not well understood. The aim of this study was to present the current state of knowledge on this issue in different groups of patients. Systematic review of papers published between 1980 and 2016. The literature shows contradicting views regarding the impact of nutritional status on the risk, course, and complications of AF. On the one hand, it has been revealed that overweight, obesity, and high birth mass increase the risk of AF, and that their reduction is linked to an improved course of AF and reduced all-cause and cardiovascular mortality. On the other hand, a so-called obesity paradox has been found, which shows lower all-cause mortality in overweight patients with AF compared to those of normal weight or who are underweight. It has also been shown, although based on a small number of studies, that the relationship between nutritional status and risk of AF and its complication may be U-shaped, which means that not only patients with obesity, but also individuals with underweight, cachexia, and low birth weight may have an increased risk and poor outcome of AF. The relationship between patients' nutritional status and the course of AF has become clearer but it requires further studies examining the importance of weight reduction on AF course. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  3. Guideline Adherence of Antithrombotic Treatment Initiated by General Practitioners in Patients With Nonvalvular Atrial Fibrillation: A Danish Survey

    DEFF Research Database (Denmark)

    Brandes, Axel; Overgaard, Mikkel; Plauborg, Liane

    2013-01-01

    BackgroundThe aim of this prospective survey was to describe the demographics, stroke risk profile, and the guideline adherence of antithrombotic treatment in a Danish primary care population of patients with nonvalvular atrial fibrillation (AF). HypothesisWe hypothesized that a significant...... performed in primary care in Denmark. Further improvements may be achieved by thorough stroke risk stratification on the basis of current evidence-based guidelines....

  4. Effect of lower on-treatment systolic blood pressure on the risk of atrial fibrillation in hypertensive patients

    DEFF Research Database (Denmark)

    Okin, Peter M; Hille, Darcy A; Larstorp, Anne Cecilie K

    2015-01-01

    UNLABELLED: There is a well-established association between hypertension and atrial fibrillation (AF); indeed, even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive BP control may reduce the risk of new AF. However, w...... whether targeting hypertensive patients without AF to lower SBP goals can reduce the burden of new AF in this high-risk population. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00338260....

  5. Care transitions in anticoagulation management for patients with atrial fibrillation: an emphasis on safety.

    Science.gov (United States)

    Deitelzweig, Steven

    2013-01-01

    Thromboprophylaxis with oral anticoagulants is an important but underused element of atrial fibrillation (AF) treatment. Reduction of stroke risk by anticoagulants comes at the price of bleeding risk. Patients with AF receiving anticoagulants require heightened attention with transition from one care setting to another. This review of the literature focuses on issues specific to the anticoagulation treatment of patients with AF. Patients presenting for emergency care of anticoagulant-related bleeding should be triaged for the severity and source of the bleeding using appropriate measures, such as discontinuing the oral anticoagulant, administering vitamin K when appropriate to reverse warfarin-induced bleeding, or administering clotting factors for emergent bleeding. Reversal of oral anticoagulants in patients admitted to the hospital for surgery can be managed similarly to patients with bleeding, depending on the urgency of the surgical procedure. Patients with AF who are admitted for conditions unrelated to AF should be assessed for adequacy of stroke risk prophylaxis and bleeding risk. Newly diagnosed AF should be treated in nearly all patients with either warfarin or a newer anticoagulant. Patient education is critically important with all anticoagulants. Close adherence to the prescribed regimen, regular international normalized ratio testing for warfarin, and understanding the stroke risk conferred by AF and aging are goals for all patients receiving oral anticoagulants. Detailed handoff from the hospitalist to the patient's primary care physician is required for good continuity of care. Monitoring by an anticoagulation clinic is the best arrangement for most patients. The elderly, particularly frail or debilitated patients who are transferring to long-term care, need a detailed transfer of information between settings, education for the patient and family, and medication reconciliation. Communication and coordination of care among outpatient, emergency

  6. Left Atrial Mechanical Function and Aortic Stiffness in Middle-aged Patients with the First Episode of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Alev Kilicgedik

    2017-01-01

    Conclusion: The association between aortic stiffness with reduced atrial strain and the key role of AoPP in the development of AF should be considered when treating nonvalvular AF patients with normal LA sizes.

  7. [Prevalence of atrial fibrillation and related factors in hospitalized old patients: ESFINGE study].

    Science.gov (United States)

    López Soto, Alfonso; Formiga, Francesc; Bosch, Xavier; García Alegría, Javier

    2012-03-17

    Atrial fibrillation (AF) is the commonest rhythm abnormality and it increases with ageing. The main objective of this study was to assess the prevalence of AF in hospitalized old patients as well as its characteristics and related clinical and therapeutic factors. Prospective, multicenter, observational study in patients aged ≥ 70 years with AF, who had been hospitalized in Internal Medicine or Geriatrics wards. All variables studied were obtained from the patients' clinical records. Out of 3,319 evaluable patients, 922 had an AF, which represents a prevalence of 31.3% (CI 95%; 29.7-32.9). The mean age was 82 years (6.1; 69.9-101.8) and 57% were women. 88.7% of patients (818 p) had an AF before admission. AF was long-standing persistent or permanent in 728 cases (89.1%) and it was the first episode (paroxysmal or persistent) in 51 patients (6.2%). There was a clear etiology of AF in only 4.1% cases. Congestive heart failure was the commonest reason for hospitalization in our patients. Regarding the cardiovascular risk factors, 80.3% patients were hypertensive, 36.4% had dyslipemia, 38.2% had diabetes and 5% were active smokers. Associated diseases included renal insufficiency (38.1%) and chronic obstructive pulmonary disease (38.2%); in addition, 188 patients (20.4%) had suffered from cerebrovascular accidents. Finally, 67.4% patients had received antiarrhythmic drugs for their FA. Although 86.1% had received thromboembolic prevention therapy, only 54.1% were under oral anticoagulation. Finally, 6.9% patients had antiarrhythmic drugs-related side effects. Over one third of hospitalized patients older than 70 years have AF, which is generally relapsing and permanent. Heart failure is the commonest reason for hospitalization in these patients and about 40% have an associated disease. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  8. Aortic stiffness in lone atrial fibrillation: a novel risk factor for arrhythmia recurrence.

    Directory of Open Access Journals (Sweden)

    Dennis H Lau

    Full Text Available BACKGROUND: Recent community-based research has linked aortic stiffness to the development of atrial fibrillation. We posit that aortic stiffness contributes to adverse atrial remodeling leading to the persistence of atrial fibrillation following catheter ablation in lone atrial fibrillation patients, despite the absence of apparent structural heart disease. Here, we aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation. METHODS: We studied 68 consecutive lone atrial fibrillation patients who underwent catheter ablation procedure for atrial fibrillation and 50 healthy age- and sex-matched community controls. We performed radial artery applanation tonometry to obtain central measures of aortic stiffness: pulse pressure, augmentation pressure and augmentation index. Following ablation, arrhythmia recurrence was monitored at months 3, 6, 9, 12 and 6 monthly thereafter. RESULTS: Compared to healthy controls, lone atrial fibrillation patients had significantly elevated peripheral pulse pressure, central pulse pressure, augmentation pressure and larger left atrial dimensions (all P<0.05. During a mean follow-up of 2.9±1.4 years, 38 of the 68 lone atrial fibrillation patients had atrial fibrillation recurrence after initial catheter ablation procedure. Neither blood pressure nor aortic stiffness indices differed between patients with and without atrial fibrillation recurrence. However, patients with highest levels (≥75(th percentile of peripheral pulse pressure, central pulse pressure and augmentation pressure had higher atrial fibrillation recurrence rates (all P<0.05. Only central aortic stiffness indices were associated with lower survival free from atrial fibrillation using Kaplan-Meier analysis. CONCLUSION: Aortic stiffness is an important risk factor in patients with lone atrial fibrillation and contributes to higher atrial

  9. Impact of controlling atrial fibrillation on outcomes relevant to the patient: focus on dronedarone

    OpenAIRE

    Chahal CAA; Ali O; Hunter RJ; RJ, Schilling

    2012-01-01

    C Anwar A Chahal, Omer Ali, Ross J Hunter, Richard J SchillingDepartment of Cardiology Research, St Bartholomew's Hospital, London, United KingdomAbstract: Atrial fibrillation (AF) is a substantial cause of mortality and morbidity in the Western world. It is a massive burden on health care systems, and its prevalence is expected to double over the next 20 years. Trials evaluating antiarrhythmic drugs or catheter ablation have focused on recurrence of arrhythmia, perhaps neglecting out...

  10. Gender, Race, and Health Insurance Status in Patients Undergoing Catheter Ablation for Atrial Fibrillation.

    Science.gov (United States)

    Patel, Nileshkumar; Deshmukh, Abhishek; Thakkar, Badal; Coffey, James O; Agnihotri, Kanishk; Patel, Achint; Ainani, Nitesh; Nalluri, Nikhil; Patel, Nilay; Patel, Nish; Patel, Neil; Badheka, Apurva O; Kowalski, Marcin; Hendel, Robert; Viles-Gonzalez, Juan; Noseworthy, Peter A; Asirvatham, Samuel; Lo, Kaming; Myerburg, Robert J; Mitrani, Raul D

    2016-04-01

    Catheter ablation for atrial fibrillation (AF) has emerged as a popular procedure. The purpose of this study was to examine whether there exist differences or disparities in ablation utilization across gender, socioeconomic class, insurance, or race. Using the Nationwide Inpatient Sample (2000 to 2012), we identified adults hospitalized with a principal diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code-37.34). We stratified patients by race, insurance status, age, gender, and hospital characteristics. A hierarchical multivariate mixed-effect model was created to identify the independent predictors of AF ablation. Among an estimated total of 3,508,122 patients (extrapolated from 20% Nationwide Inpatient Sample) hospitalized with a diagnosis of AF in the United States from the year 2000 to 2012, 102,469 patients (2.9%) underwent catheter ablations. The number of ablations was increased by 940%, from 1,439 in 2000 to 15,090 in 2012. There were significant differences according to gender, race, and health insurance status, which persisted even after adjustment for other risk factors. Female gender (0.83 [95% CI 0.79 to 0.87; p race (0.64 [95% CI 0.56 to 0.72; p gender, race, and insurance status that persisted over time. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Left lateral decubitus position on patients with atrial fibrillation and congestive heart failure

    Science.gov (United States)

    Varadan, Vijay K.; Kumar, Prashanth S.; Ramasamy, Mouli

    2017-04-01

    Congestive Heart Failure (CHF) is a cardiovascular disease that affects about 5.7 million people in the US. The most prevalent comorbidity to CHF is Atrial Fibrillation (AF). These two pathologies present in a mutually worsening manner in that patients diagnosed with CHF are more likely to develop AF and patients who are diagnosed with AF are more likely to develop CHF. The underlying pathophysiological mechanisms have been studied for several years and the most recent efforts are in the cellular and molecular basis. In this paper, we focus on manifestation of CHF and AF symptoms as influenced by the posture assumed by a patient. We consider three postures - Left lateral decubitus, right lateral decubitus and supine. We review the clinical evidence gathered thus far relating enhanced sympathetic activity to the left lateral decubitus and supine positions with equivalent evidence on the enhanced vagal activity when the right lateral decubitus posture is assumed. We conclude with a compilation of all the hypotheses on the mechanism by which the right lateral decubitus posture alleviates the symptoms of CHF and AF, and future avenues for investigation.

  12. Atrial defibrillation threshold in humans minutes after atrial fibrillation induction; "A stitch in time saves nine".

    Science.gov (United States)

    Vardas, P E; Manios, E G; Kanoupakis, E M; Dermitzaki, D N; Mavrakis, H E; Kallergis, E M

    2001-09-01

    To assess the effects of atrial fibrillation duration on the defibrillation threshold in atrial fibrillation patients seconds or minutes after initiation of the arrhythmia. Nineteen patients with recurrent symptomatic atrial fibrillation were evaluated. After programmed induction of atrial fibrillation, the defibrillation threshold was assessed after two sequential periods of arrhythmia in the same patient: an "ultrashort" period of 30 s duration and a "short" period, which lasted 10 min. After the specified period, internal cardioversion was attempted using a balloon-guided catheter that allows the delivery of biphasic shocks between one electrode array placed in the left pulmonary artery and a proximal electrode array on the lateral right atrial wall. The defibrillation threshold was assessed with energy steps of 0.5 J with a starting level of 0.5 J. Mean time from induction to successful defibrillation was 92+/-30 s after the "ultrashort" period of atrial fibrillation and 910+/-86 s after the short period. The defibrillation threshold was significantly greater after 10 min of atrial fibrillation than after 30 s of arrhythmia (2.32+/-0.61 J vs 1.31+/-0.66 J, Pdefibrillation threshold. Prolongation of atrial fibrillation over minutes in patients with paroxysmal arrhythmia increases the energy requirements for successful defibrillation. Copyright 2001 The European Society of Cardiology.

  13. The issue of care for patients before and after intervention treatment for atrial fibrillation

    OpenAIRE

    PEŠKOVÁ, Petra

    2011-01-01

    The topic of my diploma thesis is: ?The Questions of the Care of Patients before and after the Intervention for Ventricular Fibrillation ?. The diploma thesis defines three objectives. The first objective finds out the information level of patients about nursing care before and after the intervention for ventricular fibrillation. The second objective was to find out the most frequent problems in connection with the intervention for ventricular fibrillation. The third objective aims at surveyi...

  14. Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke

    DEFF Research Database (Denmark)

    Christensen, L M; Krieger, D W; Højberg, S

    2014-01-01

    BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial fibrilla......BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial...

  15. Apixaban in patients with atrial fibrillation and prior coronary artery disease: insights from the ARISTOTLE trial.

    Science.gov (United States)

    Bahit, Maria Cecilia; Lopes, Renato D; Wojdyla, Daniel M; Hohnloser, Stefan H; Alexander, John H; Lewis, Basil S; Aylward, Philip E; Verheugt, Freek W A; Keltai, Matyas; Diaz, Rafael; Hanna, Michael; Granger, Christopher B; Wallentin, Lars

    2013-12-10

    A substantial portion of patients with atrial fibrillation (AF) also have coronary artery disease (CAD) and are at risk for coronary events. Warfarin is known to reduce these events, but increase the risk of bleeding. We assessed the effects of apixaban compared with warfarin in AF patients with and without prior CAD. In ARISTOTLE, 18,201 patients with AF were randomized to apixaban or warfarin. History of CAD was defined as documented CAD, prior myocardial infarction, and/or history of coronary revascularization. We analyzed baseline characteristics and clinical outcomes of patients with and without prior CAD and compared outcomes by randomized treatment using Cox models. A total of 6639 (36.5%) patients had prior CAD. These patients were more often male, more likely to have prior stroke, diabetes, and hypertension, and more often received aspirin at baseline (42.2% vs. 24.5%). The effects of apixaban were similar among patients with and without prior CAD on reducing stroke or systemic embolism and death from any cause (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.71-1.27, P for interaction=0.12; HR 0.96, 95% CI 0.81-1.13, P for interaction=0.28). Rates of myocardial infarction were numerically lower with apixaban than warfarin among patients with and without prior CAD. The effect of apixaban on reducing major bleeding and intracranial hemorrhage was consistent in patients with and without CAD. In patients with AF, apixaban more often prevented stroke or systemic embolism and death and caused less bleeding than warfarin, regardless of the presence of prior CAD. Given the common occurrence of AF and CAD and the higher rates of cardiovascular events and death, our results indicate that apixaban may be a better treatment option than warfarin for these high-risk patients. © 2013.

  16. Left Atrial Appendage Thrombi Formation in Japanese Non-Valvular Atrial Fibrillation Patients During Anticoagulation Therapy - Warfarin vs. Direct Oral Anticoagulants.

    Science.gov (United States)

    Kawabata, Mihoko; Goya, Masahiko; Sasaki, Takeshi; Maeda, Shingo; Shirai, Yasuhiro; Nishimura, Takuro; Yoshitake, Takakatsu; Shiohira, Shinya; Isobe, Mitsuaki; Hirao, Kenzo

    2017-04-25

    Atrial fibrillation (AF) is a common cardiac arrhythmia, associated with increased cardiovascular morbidity and mortality including thromboembolic events. The aims of this study were to assess the prevalence of left atrial appendage (LAA) thrombi in Japanese non-valvular atrial fibrillation (NVAF) patients undergoing preprocedural transesophageal echocardiography (TEE) during anticoagulation therapy, and to compare the efficacy of warfarin and direct oral anticoagulants (DOAC).Methods and Results:This retrospective study reviewed records of 559 consecutive NVAF patients (445 men; age, 62±11 years) undergoing preprocedural TEE following at least 3 weeks of anticoagulation therapy. Of these, 275 patients had non-paroxysmal AF (49%). LAA thrombus was observed in 15 patients (2.7%). The prevalence of LAA thrombi was similar between the DOAC group (2.6%) and the warfarin group (2.8%, P=0.86). No patients with CHA2DS2-VASc score=0, or paroxysmal AF without prior stroke or transient ischemic attack, had LAA thrombi. On univariate analysis, non-paroxysmal AF, structural heart disease, antiplatelet therapy, larger left atrium, higher brain natriuretic peptide (BNP), reduced LAA flow, and higher CHA2DS2-VASc score were all associated with LAA thrombi. On multivariate analysis, BNP ≥173 pg/mL remained the only independent predictor of LAA thrombi. LAA thrombi were found in 2.7% of Japanese NVAF patients scheduled for procedures despite ongoing oral anticoagulation therapy. Incidence of thrombi was similar for patients on DOAC and on warfarin.

  17. Type of Atrial Fibrillation and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Shaul, Aviv A; Kornowski, Ran; Bental, Tamir; Vaknin-Assa, Hana; Assali, Abid; Golovchiner, Gregory; Kadmon, Ehud; Codner, Pablo; Orvin, Katia; Strasberg, Boris; Barsheshet, Alon

    2016-09-01

    There are limited data available regarding the relationship between atrial fibrillation (AF) clinical type, oral anticoagulation (OAC) treatment, and clinical outcome after transcatheter aortic valve replacement (TAVR). The study was designed to evaluate this relationship. We analyzed data from the Rabin Medical Center TAVR registry, including 319 consecutive patients who underwent TAVR from 2008 to 2014. Patients were divided into three groups based on their history of AF: sinus rhythm (SR), paroxysmal AF (PAF), or nonparoxysmal AF (NPAF). There were 211 (66%), 56 (18%), and 52 (16%) patients in the SR, PAF, and NPAF groups, respectively. The cumulative risk for stroke or death at 2 years was highest among patients with NPAF (38%), but similarly low in PAF (15%) and SR patients (16%, P < 0.001). By multivariate analysis, patients with NPAF demonstrated a significantly higher risk of stroke or death (HR = 2.76, 95% CI 1.63-4.66, P < 0.001), as compared with SR. In contrast, patients with PAF had a similar risk of stroke or death compared with SR (HR = 0.80, P = 0.508). Patients with NPAF not treated with OAC demonstrated an 8.3-fold (P < 0.001) increased risk of stroke or death, whereas patients with PAF not treated with OAC had a similar risk of stroke or death compared with the SR group (HR = 1.25, P = 0.569). History of NPAF, but not PAF, is associated with a significant increased risk of stroke or death compared with sinus rhythm in patients undergoing TAVR. © 2016 Wiley Periodicals, Inc.

  18. Comparison of benefit between dabigatran and warfarin among patients with atrial fibrillation: A systematic review

    Directory of Open Access Journals (Sweden)

    Amal K Sulieman

    2016-01-01

    Full Text Available Warfarin is recognized as the standard antithrombotic agent for stroke prevention. However, new oral anticoagulant such as dabigatran constitutes huge improvement to compensate for the limitation of warfarin. A literature review was performed to compare and contrast the overall benefit of dabigatran and warfarin among patients with atrial fibrillation. We utilized HighWire as the data source for randomized controlled trials based on inclusion and exclusion criteria (from January 2007 to September 2013. Descriptive and quantitative information related to stroke and major bleeding were extracted from each trial. After a comprehensive screening of 298 search results, 17 studies which enrolled a total of 127,594 patients were included. Warfarin was found to have higher mean event rates for incidence of stroke, major bleeding, and net clinical benefit compared to dabigatran 110 mg and dabigatran 150 mg. Dabigatran 110 mg has higher rate of stroke and net clinical benefit than dabigatran 150 mg with less major hemorrhage. Overall, dabigatran had higher efficacy and safety profile than warfarin. Further research is required to determine the clinical feasibility of dabigatran in real-life practice.

  19. Health Literacy and Atrial Fibrillation: Relevance and Future Directions for Patient-centred Care

    Science.gov (United States)

    Aronis, Konstantinos N; Edgar, Brittany; Lin, Wendy; Martins, Maria Auxiliadora Parreiras; Paasche-Orlow, Michael K; Magnani, Jared W

    2017-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia with significant clinical outcomes, and is associated with high medical and social costs. AF is complicated for patients because of its specialised terminology, long-term adherence, symptom monitoring, referral to specialty care, array of potential interventions and potential for adversity. Health literacy is a frequently under-recognised, yet fundamental, component towards successful care in AF. Health literacy is defined as the capacity to obtain, process and understand health information, and has had markedly limited study in AF. However, health literacy could contribute to how patients interpret symptoms, navigate care, and participate in treatment evaluation and decision-making. This review aims to summarise the clinical importance and essential relevance of health literacy in AF. We focus here on central aspects of AF care that are most related to self-care, including understanding the symptoms of AF, shared decision-making, adherence and anticoagulation for stroke prevention. We discuss opportunities to enhance AF care based on findings from the literature on health literacy, and identify important gaps. Our overall objective is to articulate the importance and relevance of integrating health literacy in the care of individuals with AF. PMID:28936235

  20. Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome.

    Science.gov (United States)

    McLellan, Alex J A; Prabhu, Sandeep; Voskoboinik, Alex; Wong, Michael C G; Walters, Tomos E; Pathik, Bhupesh; Morris, Gwilym M; Nisbet, Ashley; Lee, Geoffrey; Morton, Joseph B; Kalman, Jonathan M; Kistler, Peter M

    2017-12-01

    Catheter ablation to achieve posterior left atrial wall (PW) isolation may be performed as an adjunct to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF). We aimed to determine whether routine adenosine challenge for dormant posterior wall conduction improved long-term outcome. A total of 161 patients with persistent AF (mean age 59 ± 9 years, AF duration 6 ± 5 years) underwent catheter ablation involving circumferential PVI followed by PW isolation. Posterior left atrial wall isolation was performed with a roof and inferior wall line with the endpoint of bidirectional block. In 54 patients, adenosine 15 mg was sequentially administered to assess reconnection of the pulmonary veins and PW. Sites of transient reconnection were ablated and adenosine was repeated until no further reconnection was present. Holter monitoring was performed at 6 and 12 months to assess for arrhythmia recurrence. Posterior left atrial wall isolation was successfully achieved in 91% of 161 patients (procedure duration 191 ± 49 min, mean RF time 40 ± 19 min). Adenosine-induced reconnection of the PW was demonstrated in 17%. The single procedure freedom from recurrent atrial arrhythmia was superior in the adenosine challenge group (65%) vs. no adenosine challenge (40%, P conduction was associated with an improvement in the success of catheter ablation for persistent AF.

  1. [Patients' characteristics and clinical management of atrial fibrillation in primary healthcare in Spain: FIATE Study].

    Science.gov (United States)

    Lobos-Bejarano, José María; del Castillo-Rodríguez, José Carlos; Mena-González, Amparo; Alemán-Sánchez, José J; Cabrera de León, Antonio; Barón-Esquivias, Gonzalo; Pastor-Fuentes, Agustín

    2013-10-05

    The main therapeutic objective in atrial fibrillation (AF) patients is stroke prevention. This study is aimed to determine whether the anticoagulant therapy may be appropriate regarding to the Guidelines and patients' profile in primary healthcare in Spain. A national, multicenter, cross-sectional study of AF patients attended in primary healthcare in Spain has been conducted. The study involved 185 family physicians whose patients were randomized. A total of 3,759 AF patients were randomized from the clinical records, and 2,070 were included in the study, at an average age of 74 (11) years old (50.7% female). Most of them (78%) had permanent AF and high comorbidity rates (hypertension 75%, obesity 30%, diabetes 27%, heart failure 20%, coronary heart disease 17%, and social risk 15%). Patients diagnosed in primary healthcare were more frequently asymptomatic than in hospital setting (36%; P<.001). The therapeutic strategy was based on the heart rate control in 4 out of 5 patients. Anticoagulation therapy was widely used (84%), more frequently in patients with permanent vs. non-permanent AF (91 vs. 60%, P<.001). Follow-up and monitoring was mainly performed in primary care (72%). The anticoagulation control was suboptimal, with a 66% of the international normalized ratio (INR) in therapeutic range, dropping to 33% when the last 3 available INR were included (P<.001). A high rate of patients with anticoagulant therapy in primary healthcare has been found in this research. INR control, however, remains suboptimal. Heart rate control is the most commonly used strategy. The decision about the anticoagulation should be based on the thromboembolic risk rather than in the arrhytmia type. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  2. Atrial fibrillation in patients on haemodialysis in Andalusia. Prevalence, clinical profile and therapeutic management.

    Science.gov (United States)

    Sánchez Perales, Carmen; Vázquez Sánchez, Teresa; Salas Bravo, Daniel; Ortega Anguiano, Sonia; Vázquez Ruiz de Castroviejo, Eduardo

    2017-11-09

    Atrial fibrillation (AF) represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD). To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia. We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centres in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling. A total of 2,348 patients were being treated with HD in the 5provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%); mean age 65.3±16 years; 40.9% women. Sixty-three patients (25%) had AF. Of these, 36 (14.3%) had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036-1.107; P=0.000) and greater time on HD (OR: 1.009; 95% CI: 1.004-1.014; P=0.000) were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents. AF in dialysis units is an important finding. Establishing the risk-benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  3. Association Between Dehydration and Short-Term Risk of Ischemic Stroke in Patients with Atrial Fibrillation.

    Science.gov (United States)

    Swerdel, Joel N; Janevic, Teresa M; Kostis, William J; Faiz, Ambarina; Cosgrove, Nora M; Kostis, John B

    2017-04-01

    Previous cross-sectional studies have demonstrated a higher incidence of dehydration in patients admitted for stroke suggesting a possible association. However, the temporality of the association has not been well established. We examined whether dehydration increases the risk of ischemic stroke in patients with a recent hospitalization for atrial fibrillation (AF). Data was from 1994 to 2012 from the Myocardial Infarction Data Acquisition System (MIDAS), a repository of in-patient records New Jersey hospitals, for AF hospitalizations (n = 1,282,787). Estimates for the association between AF hospitalization with/without dehydration and ischemic stroke within 30 days post-AF discharge were determined using log-linear multivariable modeling adjusting for socio-demographic factors and comorbid conditions. Within 10 days of discharge for AF, patients 18-80 years old (YO) with comorbid dehydration had a 60 % higher risk of ischemic stroke compared to AF patients without comorbid dehydration (adjusted risk ratio (ARR) 1.60, 95 % confidence interval (CI) 1.28-2.00). Eighteen- to 80-YO patients had a 34 % higher risk of ischemic stroke in days 11-20 post-AF discharge (ARR 1.34, 95 % CI 1.04, 1.74). There was no difference in the risk of stroke in 18-80-YO patients with or without prior dehydration during days 21-30 post-AF discharge. We also found no difference in the risk of ischemic stroke during any time period in patients over 80 YO. Dehydration may be a significant risk factor for ischemic stroke in patients 18-80 YO with AF.

  4. Genetics Home Reference: familial atrial fibrillation

    Science.gov (United States)

    ... to be associated with familial atrial fibrillation was KCNQ1 , which provides instructions for making a channel that ... atrial fibrillation ABCC9 GJA5 KCNA5 KCNE2 KCNH2 KCNJ2 KCNQ1 LMNA MYL4 NKX2-5 NPPA NUP155 PRKAG2 RYR2 ...

  5. Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation.

    Science.gov (United States)

    Flint, Alexander C; Conell, Carol; Ren, Xiushui; Kamel, Hooman; Chan, Sheila L; Rao, Vivek A; Johnston, S Claiborne

    2017-07-01

    Outpatient statin use reduces the risk of recurrent ischemic stroke among patients with stroke of atherothrombotic cause. It is not known whether statins have similar effects in ischemic stroke caused by atrial fibrillation (AFib). We studied outpatient statin adherence, measured by percentage of days covered, and the risk of recurrent ischemic stroke in patients with or without AFib in a 21-hospital integrated healthcare delivery system. Among 6116 patients with ischemic stroke discharged on a statin over a 5-year period, 1446 (23.6%) had a diagnosis of AFib at discharge. The mean statin adherence rate (percentage of days covered) was 85, and higher levels of percentage of days covered correlated with greater degrees of low-density lipoprotein suppression. In multivariable survival models of recurrent ischemic stroke over 3 years, after controlling for age, sex, race/ethnicity, medical comorbidities, and hospital center, higher statin adherence predicted reduced stroke risk both in patients without AFib (hazard ratio, 0.78; 95% confidence interval, 0.63-0.97) and in patients with AFib (hazard ratio, 0.59; 95% confidence interval, 0.43-0.81). This association was robust to adjustment for the time in the therapeutic range for international normalized ratio among AFib subjects taking warfarin (hazard ratio, 0.61; 95% confidence interval, 0.41-0.89). The relationship between statin adherence and reduced recurrent stroke risk is as strong among patients with AFib as it is among patients without AFib, suggesting that AFib status should not be a reason to exclude patients from secondary stroke prevention with a statin. © 2017 American Heart Association, Inc.

  6. Influence of atrial fibrillation on the mortality of patients with heart failure with preserved ejection fraction.

    Science.gov (United States)

    Franco, Jonathan; Formiga, Francesc; Cepeda, Jose; Llacer, Pau; Arévalo-Lorido, Juan; Cerqueiro, Jose; González-Franco, Alvaro; Epelde, Francesc; Manzano, Luis; Montero Pérez-Barquero, Manuel

    2017-09-01

    The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF. Prospective observational study in 1,971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one year follow-up. A total of 1,177 (59%) patients had AF, mean age 80.3 (7.8) years and 1,233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; P=.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; P=.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1,716; 95% CI 1,099-2,681; P=.018). In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. Amiodarone Use Is Associated With Increased Risk of Stroke in Patients With Nonvalvular Atrial Fibrillation

    Science.gov (United States)

    Chen, Wei-Chun; Chen, Wei-Cheng; Chen, Chih-Yu; Wu, Biing-Ru; Cheng, Wen-Chien; Lin, Kuo-Hung; Hsia, Te-Chun; Chen, Wei; Chen, Chia-Hung; Muo, Chih-Hsin; Liao, Wei-Chih; Li, Chia-Hsiang

    2015-01-01

    Abstract Atrial fibrillation (AF), the most common sustained arrhythmia requiring treatment worldwide, is one of the major causes of ischemic stroke. Although amiodarone is commonly used for rhythm control in AF, its relationship with stroke has rarely been addressed. We evaluated 16,091 patients who were diagnosed with AF (Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] 427.31 and 427.32) between 1998 and 2011; the date of AF diagnosis was set as the index date. Patients with a history of stroke (ICD-9-CM 430–438) who received amiodarone before the index date or during the following 30 days, or who experienced stroke within 30 days of receiving amiodarone were excluded. Finally, 7548 patients with AF were included in this study and divided into 2 groups according to whether they received amiodarone (Anatomical Therapeutic Chemical code C01BD01) during the study period. The risk of ischemic stroke in AF patients receiving amiodarone was 1.81-fold (95% confidence interval [CI] 1.52–2.16), 1.79-fold (95% CI 1.50–2.14), and 1.78-fold (95% CI 1.49–2.13) higher than in those who did not receive amiodarone, according to crude, Model 1, and Model 2 Cox proportional hazard regression models, respectively. In a demographically stratified analysis, the risk of ischemic stroke was significantly higher in patients aged Amiodarone treatment is associated with an increased risk of stroke in patients with AF, especially in those who have an initial low risk of stroke. Antiplatelet drugs and warfarin could reduce the stroke risk in AF patients receiving amiodarone. However, as the combination of digoxin and amiodarone increases the risk of stroke in these patients, the combination of these 2 drugs should be avoided. PMID:25984674

  8. Mental health and sleep in permanent atrial fibrillation patients from the general population.

    Science.gov (United States)

    Ariansen, Inger; Dammen, Toril; Abdelnoor, Michael; Tveit, Arnljot; Gjesdal, Knut

    2011-05-01

    Anxiety and depression has been found in atrial fibrillation (AF) patients referred to secondary care. Little is known about the level of such distress in AF patients from the general population. Permanent AF patients from the general population might have more anxiety, depression, and sleep impairment than subjects in sinus rhythm. Patients with permanent AF and controls in sinus rhythm were recruited from a 75-year-old cohort from 2 Norwegian municipalities. The main outcome variables were anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and sleep quality measured by Pittsburgh Sleep Quality Index (PSQI) score. Short Form 36 (SF-36) was also completed. Twenty-seven patients with permanent AF and 71 subjects in sinus rhythm participated. No significant score differences were found between AF patients and controls for HADS anxiety (median, inter quartile range, 3 [1, 5] vs 4 [1, 6]; HADS depression, 3 [1,6] vs 2 [1,4]; and PSQI 6 [3, 11] vs 5 [4, 8]). AF patients had significantly poorer scores for SF-36 physical functioning, physical role, general health, vitality, and social functioning compared to subjects in sinus rhythm. Elderly permanent AF patients from the general population had similar levels of anxiety, depression, and sleep quality, despite poorer physical health-related quality of life compared to controls in sinus rhythm. Copyright © 2011 Wiley Periodicals, Inc. This work was supported by unrestricted grants from the governmental Health Region South-East, Norway, and from the Stein Erik Hagen Foundation for Clinical Heart Research, Norway. The authors have no other funding, financial relationships, or conflicts of interest to disclose. 2011 Wiley Periodicals, Inc.

  9. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation.

    Science.gov (United States)

    Huo, Yan; Gaspar, Thomas; Pohl, Matthias; Sitzy, Judith; Richter, Utz; Neudeck, Sebastian; Mayer, Julia; Kronborg, Mads Brix; Piorkowski, Christopher

    2017-06-10

    To describe the extent and distribution of low voltage zones (LVZ) in a large cohort of patients undergoing ablation for paroxysmal and persistent atrial fibrillation (AF), and to explore baseline predictors of LVZ in these patients. Consecutive patients who underwent a bipolar voltage map guided AF ablation, were enrolled. Voltage maps were conducted for each patient using 3-dimensional electroanatomical mapping system and LVZ were defined as areas of bipolar voltage voltage zones was present in 58 out of 292 patients with paroxysmal and 134 out of 247 persistent AF (P < 0.001). The area of LVZ was larger in patients with persistent as compare to paroxysmal AF, 5 cm2 (IQR 3-18.6) vs. 12.1 cm2 (IQR 3.6-28.5), P = 0.026, respectively. In the multivariate analysis age (OR 1.07, 95%CI 1.05-1.10, P < 0.001), female gender (OR 2.18, 95%CI 1.38-3.43, P = 0.001), sinoatrial node dysfunction (OR 3.90, 95%CI 1.24-12.21, P = 0.020), larger surface area of left atrium pr. cm2 (OR 1.01, 95%CI 1.00-1.02, P = 0.016), and persistent AF (OR 5.03, 95%CI 3.20-7.90, P<0.001) were associated with presence of LVZ. In a large cohort of patients undergoing ablation for AF, the prevalence of LVZ was higher and LVZ areas larger in patients with persistent as compared with paroxysmal AF. The most frequent localization of LVZ was anterior wall, septum and posterior wall. Presence of LVZ was associated with higher age, female gender, larger LA surface area, and sinoatrial node dysfunction.

  10. The effects of percutaneous mitral balloon valvuloplasty on the left atrial appendage function in patients with sinus rhythm and atrial fibrillation.

    Science.gov (United States)

    Aslanabadi, Naser; Jafaripour, Iraj; Toufan, Mehrnoush; Sohrabi, Bahram; Separham, Ahmad; Madadi, Reza; Feazpour, Hossein; Asgharzadeh, Yosef; Ahmadi, Mostafa; Safaiyan, Abdolrasol; Ghafari, Samad

    2015-01-01

    Mitral stenosis (MS) causes structural and functional abnormalities of the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on left atrial function by transesophageal echocardiography (TEE). We enrolled 56 patients with severe mitral stenosis (valve area less than 1.5 CM(2)). All participants underwent mitral valvuloplasty; they also underwent transesophageal echocardiography before and at least one month after PTMC. Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrial fibrillation (AF) in remainder 28 cases. There was no significant change in the left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), or the left ventricular end systolic dimension (LVESD) before and after PTMC in both groups. However, both groups showed a significant decrease in the left atrial volume index (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejection fraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantly after PTMC in both groups with SR and AF (P<0.001 for both). Percutaneous transvenous mitral commissurotomy improves left atrial appendage function in patients with mitral stenosis irrespective of the underlying heart rhythm.

  11. P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients

    Directory of Open Access Journals (Sweden)

    Mohamed Elansary

    2014-12-01

    Conclusion: PAF is a possible etiology of patients with ischemic cerebrovascular accidents patients even in those who had normal sinus rhythm on admission. Pmax ⩾ 125 mm, Pdis ⩾ 40 mm, and LAVI ⩾ 24 are highly significant predictors of PAF with PPV of 99%, 96% and 78%, respectively, sensitivity of 98%, 94% and 89%, respectively, specificity 96%, 93% and 75%, respectively and AUC of 0.99, 0.98 and 0.87, respectively.

  12. STRATEGIES OF PROPHYLAXIS AND MANAGEMENT OF POSTOPERATIVE ATRIAL FIBRILLATION

    OpenAIRE

    Dembele, A.; Pastukhova, N.C.

    2016-01-01

    This article analyses different strategies of prophylaxis and management of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) at different periods after acute myocardial infarction (AMI). It examines the efficacy of early administration of beta-adrenergic blocking agents (metoprolol) and amiodarone (in prophylactic doses) in the diminution of the risk of postoperative atrial fibrillation in different groups of patients. The article also discerns t...

  13. Stroke and bleeding in atrial fibrillation with chronic kidney disease

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Kamper, Anne-Lise

    2012-01-01

    Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions.......Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions....

  14. ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION: NEW DATA AND NEW HORIZONS

    Directory of Open Access Journals (Sweden)

    M. Yu. Gilyarov

    2011-01-01

    Full Text Available New data and perspectives of antithrombotic therapy are highlighted in patients with atrial fibrillation. Factors of warfarin therapy efficacy, as well as the possibility of new antithrombotic drugs are considered. Special attention are paid to the direct thrombin inhibitors — dabigatran. Possibilities and usage prospects of dabigatran in patients with atrial fibrillation are discussed in detail in the light of new results of RE-LY trial.

  15. ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION: NEW DATA AND NEW HORIZONS

    Directory of Open Access Journals (Sweden)

    M. Yu. Gilyarov

    2016-01-01

    Full Text Available New data and perspectives of antithrombotic therapy are highlighted in patients with atrial fibrillation. Factors of warfarin therapy efficacy, as well as the possibility of new antithrombotic drugs are considered. Special attention are paid to the direct thrombin inhibitors — dabigatran. Possibilities and usage prospects of dabigatran in patients with atrial fibrillation are discussed in detail in the light of new results of RE-LY trial.

  16. Variation in Anticoagulant Recommendations by the Guidelines and Decision Tools among Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Anand Shewale

    2015-03-01

    Full Text Available Published atrial fibrillation (AF guidelines and decision tools offer oral anticoagulant (OAC recommendations; however, they consider stroke and bleeding risk differently. The aims of our study are: (i to compare the variation in OAC recommendations by the 2012 American College of Chest Physicians guidelines, the 2012 European Society of Cardiology (ESC guidelines, the 2014 American Heart Association (AHA guidelines and two published decision tools by Casciano and LaHaye; (ii to compare the concordance with actual OAC use in the overall study population and the population stratified by stroke/bleed risk. A cross-sectional study using the 2001–2013 Lifelink claims data was used to contrast the treatment recommendations by these decision aids. CHA2DS2-VASc and HAS-BLED algorithms were used to stratify 15,129 AF patients into nine stroke/bleed risk groups to study the variation in treatment recommendations and concordance with actual OAC use/non-use. The AHA guidelines which were set to recommend OAC when CHA2DS2-VASc = 1 recommended OAC most often (86.30% and the LaHaye tool recommended OAC the least often (14.91%. OAC treatment recommendations varied considerably when stroke risk was moderate or high (CHA2DS2-VASc > 0. Actual OAC use/non-use was highly discordant (>40% with all of the guidelines or decision tools reflecting substantial opportunities to improve AF OAC decisions.

  17. Identification of a KCNE2 gain-of-function mutation in patients with familial atrial fibrillation

    DEFF Research Database (Denmark)

    Yang, Yiqing; Xia, Min; Jin, Qingfeng

    2004-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. We first reported an S140G mutation of KCNQ1, an alpha subunit of potassium channels, in one Chinese kindred with AF. However, the molecular defects and cellular mechanisms in most patients with AF...... remain to be identified. We evaluated 28 unrelated Chinese kindreds with AF and sequenced eight genes of potassium channels (KCNQ1, HERG, KCNE1, KCNE2, KCNE3, KCNE4, KCNE5, and KCNJ2). An arginine-to-cysteine mutation at position 27 (R27C) of KCNE2, the beta subunit of the KCNQ1-KCNE2 channel responsible...... for a background potassium current, was found in 2 of the 28 probands. The mutation was present in all affected members in the two kindreds and was absent in 462 healthy unrelated Chinese subjects. Similar to KCNQ1 S140G, the mutation had a gain-of-function effect on the KCNQ1-KCNE2 channel; unlike long QT...

  18. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial.

    Directory of Open Access Journals (Sweden)

    Heli M Lahtela

    Full Text Available Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI.We assessed renal function by estimated glomerular filtration rate (eGFR and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE and bleeding events at 12 months.A total of 195 (25% patients had normal renal function (eGFR ≥90 mL/min, 290 (37% mild renal impairment (eGFR 60-89, 263 (34% moderate renal impairment (eGFR 30-59 and 33 (4% severe renal impairment (eGFR <30. Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04 and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06 compared to those with normal renal function.Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications.

  19. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial

    Science.gov (United States)

    Lahtela, Heli M.; Kiviniemi, Tuomas O.; Puurunen, Marja K.; Schlitt, Axel; Rubboli, Andrea; Ylitalo, Antti; Valencia, José; Lip, Gregory Y. H.; Airaksinen, K. E. Juhani

    2015-01-01

    Background Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI. Methods We assessed renal function by estimated glomerular filtration rate (eGFR) and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE) and bleeding events at 12 months. Results A total of 195 (25%) patients had normal renal function (eGFR ≥90 mL/min), 290 (37%) mild renal impairment (eGFR 60-89), 263 (34%) moderate renal impairment (eGFR 30–59) and 33 (4%) severe renal impairment (eGFR <30). Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04) and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06) compared to those with normal renal function. Conclusions Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications. PMID:26030623

  20. The Long-Term Multicenter Observational Study of Dabigatran Treatment in Patients With Atrial Fibrillation (RELY-ABLE) Study

    DEFF Research Database (Denmark)

    Connolly, S. J.; Wallentin, L.; Ezekowitz, M. D.

    2013-01-01

    . There is a need for longer-term follow-up of patients on dabigatran and for further data comparing the 2 dabigatran doses. Methods and Results Patients randomly assigned to dabigatran in RE-LY were eligible for the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE...... enrolled, representing 48% of patients originally randomly assigned to receive dabigatran in RE-LY and 86% of RELY-ABLE-eligible patients. Rates of stroke or systemic embolism were 1.46% and 1.60%/y on dabigatran 150 and 110 mg twice daily, respectively (hazard ratio, 0.91; 95% confidence interval, 0...

  1. Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial.

    Science.gov (United States)

    Flaker, Greg; Lopes, Renato D; Hylek, Elaine; Wojdyla, Daniel M; Thomas, Laine; Al-Khatib, Sana M; Sullivan, Renee M; Hohnloser, Stefan H; Garcia, David; Hanna, Michael; Amerena, John; Harjola, Veli-Pekka; Dorian, Paul; Avezum, Alvaro; Keltai, Matyas; Wallentin, Lars; Granger, Christopher B

    2014-10-14

    Amiodarone is an effective medication in preventing atrial fibrillation (AF), but it interferes with the metabolism of warfarin. This study sought to examine the association of major thrombotic clinical events and bleeding with the use of amiodarone in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Baseline characteristics of patients who received amiodarone at randomization were compared with those who did not receive amiodarone. The interaction between randomized treatment and amiodarone was tested using a Cox model, with main effects for randomized treatment and amiodarone and their interaction. Matching on the basis of a propensity score was used to compare patients who received and who did not receive amiodarone at the time of randomization. In ARISTOTLE, 2,051 (11.4%) patients received amiodarone at randomization. Patients on warfarin and amiodarone had time in the therapeutic range that was lower than patients not on amiodarone (56.5% vs. 63.0%; p amiodarone-treated patients had a stroke or a systemic embolism (1.58%/year vs. 1.19%/year; adjusted hazard ratio [HR]: 1.47, 95% confidence interval [CI]: 1.03 to 2.10; p = 0.0322). Overall mortality and major bleeding rates were elevated, but were not significantly different in amiodarone-treated patients and patients not on amiodarone. When comparing apixaban with warfarin, patients who received amiodarone had a stroke or a systemic embolism rate of 1.24%/year versus 1.85%/year (HR: 0.68, 95% CI: 0.40 to 1.15), death of 4.15%/year versus 5.65%/year (HR: 0.74, 95% CI: 0.55 to 0.98), and major bleeding of 1.86%/year versus 3.06%/year (HR: 0.61, 95% CI: 0.39 to 0.96). In patients who did not receive amiodarone, the stroke or systemic embolism rate was 1.29%/year versus 1.57%/year (HR: 0.82, 95% CI: 0.68 to 1.00), death was 3.43%/year versus 3.68%/year (HR: 0.93, 95% CI: 0.83 to 1.05), and major bleeding was 2.18%/year versus 3.03%/year (HR: 0.72, 95

  2. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review.

    Science.gov (United States)

    Guttmann, Oliver P; Rahman, M Shafiqur; O'Mahony, Constantinos; Anastasakis, Aris; Elliott, Perry M

    2014-03-01

    HCM is commonly associated with AF. Current guidelines for AF management omit detailed advice for HCM because of a lack of clinical prediction tools that estimate the risk of developing AF and an absence of adequately powered treatment studies. To critically review current literature on atrial fibrillation (AF) and thromboembolism in hypertrophic cardiomyopathy (HCM) and meta-analyse prevalence and incidence. PubMed and Web of Science. Studies investigating AF and stroke in HCM as primary or secondary endpoint. Two investigators independently reviewed and extracted data from the identified articles. A random effect meta-regression model and I(2) statistics were used for analysis. A population of 7381 patients (33 studies) revealed overall AF prevalence of 22.45% (95% CI 20.13% to 24.77%), I(2)=78.9% (p<0.001). Overall prevalence of thromboembolism in HCM patients with AF was 27.09% (95% CI 20.94% to 33.25%), I(2)=61.4% ( p<0.01). Overall AF incidence was 3.08% per 100 patients per year (95% CI 2.63% to 3.54%, I(2)=86.5%, p<0.001) and incidence of thromboembolism in HCM patients with AF was 3.75% per 100 patients per year (95% CI 2.88% to 4.61%), I(2)=37.9% (p=0.1). Left atrial (LA) dimension and age were common predictors for AF and thromboembolism. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62% to 41.44%) in sinus rhythm and 45.37 mm (95% CI 41.64% to 49.04%) in AF. There were no randomised controlled trials of therapy; anticoagulation was associated with lower stroke incidence but data on other interventions were limited and contradictory. AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.

  3. Outcomes in anticoagulated patients with atrial fibrillation and with mitral or aortic valve disease.

    Science.gov (United States)

    Vinereanu, Dragos; Wang, Alice; Mulder, Hillary; Lopes, Renato D; Jansky, Petr; Lewis, Basil S; Gersh, Bernard J; Avezum, Alvaro; Hanna, Michael; Held, Claes; Wallentin, Lars; Granger, Christopher B; Alexander, John H

    2018-01-19

    To assess stroke/systemic embolism, major bleeding and other outcomes, and treatment effect of apixaban versus warfarin, in patients with atrial fibrillation (AF) and different types of valvular heart disease (VHD), using data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial. There were 14 793 patients with known VHD status, categorised as having moderate or severe mitral regurgitation (MR) (n=3382), aortic regurgitation (AR) (n=842) or aortic stenosis (AS) (n=324); patients with moderate or severe mitral stenosis were excluded from the trial. Baseline characteristics, efficacy and safety outcomes were compared between each type and no significant VHD. Treatment effect was assessed using an adjusted model. Patients with MR or AR had similar rates of stroke/systemic embolism and bleeding compared with patients without MR or AR, respectively. Patients with AS had significantly higher event rates (presented as rate per 100 patient-years of follow-up) of stroke/systemic embolism (3.47 vs 1.36; adjusted HR (adjHR) 2.21, 95% CI 1.35 to 3.63), death (8.30 vs 3.53; adjHR 1.92, 95% CI 1.41 to 2.61), major bleeding (5.31 vs 2.53; adjHR 1.80, 95% CI 1.19 to 2.75) and intracranial bleeding (1.29 vs 0.51; adjHR 2.54, 95% CI 1.08 to 5.96) than patients without AS. The superiority of apixaban over warfarin on stroke/systemic embolism was similar in patients with versus without MR (HR 0.69, 95% CI 0.46 to 1.04 vs HR 0.79, 95% CI 0.63 to 1.00; interaction P value 0.52), with versus without AR (HR 0.57, 95% CI 0.27 to 1.20 vs HR 0.78, 95% CI 0.63 to 0.96; interaction P value 0.52), and with versus without AS (HR 0.44, 95% CI 0.17 to 1.13 vs HR 0.79, 95% CI 0.64 to 0.97; interaction P value 0.19). For each of the primary and secondary efficacy and safety outcomes, there was no evidence of a different effect of apixaban over warfarin in patients with any VHD subcategory. In anticoagulated patients with AF, AS is

  4. Rate vs. rhythm control and adverse outcomes among European patients with atrial fibrillation.

    Science.gov (United States)

    Purmah, Yanish; Proietti, Marco; Laroche, Cecilé; Mazurek, Michal; Tahmatzidis, Dimitrios; Boriani, Giuseppe; Novo, Salvatore; Lip, Gregory Y H

    2017-02-04

    The impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation (AF) remains controversial. Our aims were: to report use of rate and rhythm control strategies in European patients from the EURObservational Research Program AF General Pilot Registry. Secondly, to evaluate outcomes according to assigned strategies. Use of pure rate and rhythm control agents was described according to European regions. 1-year follow-up data were reported. Among rate control strategies, beta-blockers were the most commonly used drug. Proportions of patients assigned to rhythm control varied greatly between countries, and amiodarone was the most used rhythm control drug. Of the original 3119 patients, 1036 (33.2%) were assigned to rate control only and 355 (11.4%) to rhythm control only. Patients assigned to a rate control strategy were older (P rate control strategy had higher rates for any thrombo-embolic event (P = 0.0245), cardiovascular death (P = 0.0437), and all-cause death (P rate control strategy was associated with a higher risk for all-cause death (P rate control strategy was independently associated with all-cause death (P = 0.0256). A propensity matched analysis only found a trend for the association between rate control and all-cause death (P = 0.0664). In a European AF patients' cohort, a pure rate control strategy was associated with a higher risk for adverse events at 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk for all-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statistically significant, suggesting an important role of comorbidities in determining the higher risk for all-cause death.

  5. [The altered endothelial function in patients with arterial hypertension and different forms of atrial fibrillation].

    Science.gov (United States)

    Podzolkov, V I; Tarzimanova, A I; Mokhammadi, L N

    2014-01-01

    The role of endothelial function in the development of cardiovascular diseases has recently attracted attention of many researchers due to increasingly more data suggesting the relationship between endothelial dysfunction (ED) and disturbed cardiac rhythms including atrial fibrillation (AF). ED is known to precede lesions in target organs related to arterial hypertension (AH) which makes the study of endothelial function as an early marker of vascular lesions in AH and AF a topical issue. To study changes of endothelial function in patients with AH and AF. Group 1 included 84 patients with AH (inclusion criteria: essential AH and confirmed paroxysm of AF), group 2 contained 20 patients with AH and permanent AF, control group was comprised of 30 AH patients without AF. The vasomotor function of endothelium was evaluated from reactive hyperemia determined by the ultrasonic method, blood samples for biochemical analysis and determination of Willebrand factor (WF) were taken during fasting. Patients of group 2 showed significant changes of endothelium-dependent vasodilation of the brachial artery. Its diameter within 60 sec after decompression increased by 5.8 +/- 0.9% and 12.3 +/- 1.2% in groups 1 and 3 respectively (p < 0.05). In group 2, collagen-binding activity of WF increased significantly to 1500 +/-140 U/100 ml compared with 1060 +/- 120 and 840 +/- 110 in groups 2 and 3 (p < 0.05). Patients with AH and persistent AF had altered endothelial function in the form of significant decrease of endothelium-dependent vasodilation of the brachial artery and increase of collagen-binding activity of WF.

  6. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne Krarup; Høst, Nis

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal...... AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...... of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p

  7. Atrial Fibrillation in Embolic Stroke: Anticoagulant Therapy at UNTH ...

    African Journals Online (AJOL)

    Objective: The decision to commence anticoagulation in a patient with embolic stroke and atrial fibrillation (AF) is often a difficult one for many clinicians. The result can have significant impact on the patient. This study was therefore undertaken to review the use of anticoagulation in embolic stroke in the setting of atrial ...

  8. Cetirizine-Induced atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Altuğ Osken

    2016-01-01

    Full Text Available Atrial fibrillation (AF is the most common observed arrhythmia in clinical practice. In the literature, AF events associated with drug induction are available. Cetirizine is a second-generation histamine antagonist used in the treatment of allergies, angioedema, and urticaria. We wish to present an atypical case who took cetirizine medication for relieving symptoms of upper tract respiratory system infection, experienced rapid ventricular response AF and treated successfully. To best of our knowledge, this is the first case of cetirizine-induced AF.

  9. Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation.

    LENUS (Irish Health Repository)

    Radeljic, Vjekoslav

    2012-01-31

    AIM: To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS: Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average +\\/-standard deviation 23 +\\/- 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION: In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and

  10. Atrial Fibrillation after Robotic Cardiac Surgery

    OpenAIRE

    LEONARDO CANALE; STEPHANIE MICK; RAVI NAIR; TOMISLAV MIHALJEVIC; JOHANNES BONATTI

    2014-01-01

    Atrial fibrillation is a common arrhythmia after conventional open heart surgery. A minimally invasive robotic approach has the potential to lower its occurrence. We sought to review the literature on the incidence of post operative atrial fibrillation in robotic heart surgery and compare it to the incidence in conventional cardiac surgery. The types of operation investigated were: coronary artery bypass surgery, mitral valve repair, atrial septal defect closure and myxoma excision. Operation...

  11. Perioperative ascorbic acid supplementation does not reduce the incidence of postoperative atrial fibrillation in on-pump coronary artery bypass graft patients.

    Science.gov (United States)

    Antonic, Miha; Lipovec, Robert; Gregorcic, Franc; Juric, Peter; Kosir, Gorazd

    2017-01-01

    Atrial fibrillation is the most common arrhythmia following cardiac surgery. It is associated with increased hemodynamic instability, systemic embolization, and complications linked to anticoagulant therapy. Oxidative stress and consequent electrophysiological remodeling have been proposed as a cause of postoperative atrial fibrillation. Ascorbic acid supplementation was suggested as a novel and effective preventive agent. The aim of this study was to evaluate the capability of ascorbic acid to reduce the incidence of postoperative atrial fibrillation in coronary artery bypass grafting (CABG) patients. A prospective randomized single-center trial was conducted in patients scheduled for an elective on-pump CABG surgery. Subjects in the ascorbic acid group received 2g of ascorbic acid 24h and 2h before the surgery and 1g twice a day for five days after the surgery. Postoperatively, the patients were monitored for atrial fibrillation and other complications. The ascorbic acid group consisted of 52 patients and the control group included 53 patients. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of atrial fibrillation in the ascorbic acid group was 13.5% and 18.9% in the control group (p=0.314). No difference was found between groups in the time of occurrence of atrial fibrillation (3.71±1.89 vs. 2.91±1.58 days after the surgery; p=0.342). There was also no difference in the other observed postoperative complications. The results of this study do not support the effectiveness of ascorbic acid supplementation in reducing the incidence of postoperative atrial fibrillation in elective on-pump CABG patients. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  12. Use of an interdisciplinary, participatory design approach to develop a usable patient self-assessment tool in atrial fibrillation

    Directory of Open Access Journals (Sweden)

    MacCallum L

    2013-11-01

    Full Text Available Lori MacCallum,1,2 Heather McGaw,1 Nazanin Meshkat,3 Alissia Valentinis,4 Leslie Beard Ashley,5 Rajan Sacha Bhatia,3,6,7 Kaye Benson,7 Noah Ivers,6,8 Kori Leblanc,2,7 Dante Morra3,5,7 1Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, 2Leslie Dan Faculty of Pharmacy, University of Toronto, 3Department of Medicine, University of Toronto, Toronto, 4Taddle Creek Family Health Team, Toronto, 5Trillium Health Partners, Mississauga, 6Women's College Hospital, Toronto, 7Centre for Innovation in Complex Care, University Health Network, Toronto, 8Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Abstract: After identifying that significant care gaps exist within the management of atrial fibrillation (AF, a patient-focused tool was developed to help patients better assess and manage their AF. This tool aims to provide education and awareness regarding the management of symptoms and stroke risk associated with AF, while engaging patients to identify if their condition is optimally managed and to become involved in their own care. An interdisciplinary group of health care providers and designers worked together in a participatory design approach to develop the tool with input from patients. Usability testing was completed with 22 patients of varying demographics to represent the characteristics of the patient population. The findings from usability testing interviews were used to further improve and develop the tool to improve ease of use. A physician-facing tool was also developed to help to explain the tool and provide a brief summary of the 2012 Canadian Cardiovascular Society atrial fibrillation guidelines. By incorporating patient input and human-centered design with the knowledge, experience, and medical expertise of health care providers, we have used an approach in developing the tool that tries to more effectively meet patients' needs. Keywords: patient education, atrial fibrillation, care gaps

  13. Safety and efficacy of landiolol hydrochloride for prevention of atrial fibrillation after cardiac surgery in patients with left ventricular dysfunction: Prevention of Atrial Fibrillation After Cardiac Surgery With Landiolol Hydrochloride for Left Ventricular Dysfunction (PLATON) trial.

    Science.gov (United States)

    Sezai, Akira; Osaka, Shunji; Yaoita, Hiroko; Ishii, Yusuke; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi

    2015-10-01

    We previously conducted a prospective study of landiolol hydrochloride (INN landiolol), an ultrashort-acting β-blocker, and reported that it could prevent atrial fibrillation after cardiac surgery. This trial was performed to investigate the safety and efficacy of landiolol hydrochloride in patients with left ventricular dysfunction undergoing cardiac surgery. Sixty patients with a preoperative left ventricular ejection fraction of less than 35% were randomly assigned to 2 groups before cardiac surgery and then received intravenous infusion with landiolol hydrochloride (landiolol group) or without landiolol (control group). The primary end point was occurrence of atrial fibrillation as much as 1 week postoperatively. The secondary end points were blood pressure, heart rate, intensive care unit and hospital stays, ventilation time, ejection fraction, biomarkers of ischemia, and brain natriuretic peptide. Atrial fibrillation occurred in 3 patients (10%) in the landiolol group versus 12 (40%) in the control group, and its frequency was significantly lower in the landiolol group (P = .002). During the early postoperative period, levels of brain natriuretic peptide and ischemic biomarkers were significantly lower in the landiolol group than the control group. The landiolol group also had a significantly shorter hospital stay (P = .019). Intravenous infusion was not discontinued for hypotension or bradycardia in either group. Low-dose infusion of landiolol hydrochloride prevented atrial fibrillation after cardiac surgery in patients with cardiac dysfunction and was safe, with no effect on blood pressure. This intravenous β-blocker seems useful for perioperative management of cardiac surgical patients with left ventricular dysfunction. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  14. Stroke and Mortality Risk in Patients With Various Patterns of Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48).

    Science.gov (United States)

    Link, Mark S; Giugliano, Robert P; Ruff, Christian T; Scirica, Benjamin M; Huikuri, Heikke; Oto, Ali; Crompton, Andrea E; Murphy, Sabina A; Lanz, Hans; Mercuri, Michele F; Antman, Elliott M; Braunwald, Eugene

    2017-01-01

    Whether the pattern of atrial fibrillation (AF) modifies the risk/benefit of anticoagulation is controversial. In ENGAGE AF-TIMI 48 trial (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48), the factor Xa inhibitor edoxaban was noninferior to warfarin in preventing stroke or systemic embolic events and significantly reduced bleeding and cardiovascular mortality. However, detailed analyses by AF pattern have not been reported. The 21 105 patients were categorized as having paroxysmal (TIMI 48 trial, patients with paroxysmal AF suffered fewer thromboembolic events and deaths compared with those with persistent and permanent AF. The efficacy and safety profile of edoxaban as compared with warfarin was consistent across the 3 patterns of AF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391. © 2017 American Heart Association, Inc.

  15. [Adverse effects of antiarrhythmic drugs in patients with atrial fibrillation in primary care].

    Science.gov (United States)

    Benito, Luisa; Hoyo, Jordi; Montroig, Angels; Fornés, Berta; Fluxà, Guillem; Martí, David; Pedrós, Montserrat; Sisó, Antoni; Mont, Lluís; Miró, Oscar; Coll-Vinent, Blanca

    2011-09-10

    To determine the adverse effects (AE) of antiarrhythmic drugs used to treat atrial fibrillation (AF) in routine clinical practice. A retrospective, observational, population-based study of all patients diagnosed of AF requiring long-term treatment with antiarrhythmic drugs. We performed also a descriptive analysis of the type of EA, and their management (diagnostic techniques, laboratory tests, drug treatment, number of visits to health services, emergency visits, hospitalizations and surgeries). We included 400 patients. Overall, 688 treatments were started, 34 of which (4.9%) were implied in 32 EA in 30 patients. The most frequent EA were hypothyroidism (28.1%), hyperthyroidism (25%) and bradycardia (9.38%). In absolute numbers, class III drugs (Vaughan-Williams classification) were associated with a higher number of AE (p=0.001). The number of AE/100 patients-year was: class I 0.42 (0.01-1.15%), class II 2.55 (0.68-5.13%), class III 4.70 (2.98-6.64%), class IV 1.18 (0.14-2.80%), digoxin 0.41 (0.08-1.19). Individually, the drugs with a higher rate were sotalol, bisoprolol and amiodarone (5.70, 5.37 and 4.59 respectively). 93.75% of EA required visits to health services, 59.38% laboratory tests and 56.25% diagnostic techniques. The most frequent visits were scheduled for primary care (75%), followed by scheduled visits to outpatient cardiology (21.9%). 71.9% of EA were resolved without any sequel and one patient died. Antiarrhythmic drugs for the management of AF are associated with the presence of AE, mainly class III drugs. In most cases they are not serious, but imply important health resources. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  16. Novel oral anticoagulants for stroke prevention in atrial fibrillation: a focus on the older patient

    Directory of Open Access Journals (Sweden)

    Yates SW

    2013-03-01

    Full Text Available Scott W YatesCenter for Executive Medicine, Plano, TX, USAAbstract: Atrial fibrillation (AF is a common arrhythmia that is associated with an increased risk of stroke, particularly in the elderly. Traditionally, a vitamin K antagonist such as warfarin is prescribed for stroke prevention. Warfarin is effective at lowering stroke risk but has several limitations due to food restrictions, drug interactions, and a narrow therapeutic window. Various novel oral anticoagulants (NOACs are available or under development to provide alternative treatment options. This article reviews the efficacy and safety of three NOACs (dabigatran etexilate, rivaroxaban, and apixaban in addition to warfarin and aspirin, for prevention of stroke in patients with AF, focusing on the elderly population. Results of clinical trials demonstrate that the efficacy of NOACs for stroke prevention in patients with AF is as good as or better than that of warfarin. The NOACs are also associated with an equivalent or lower risk of bleeding. Regardless of the medication chosen, older patients with AF must be treated cautiously due to an increased risk of stroke and bleeding, as well as potential challenges related to drug interactions and monitoring requirements. NOACs may be suitable alternatives to warfarin for stroke prevention in older patients due to several advantages, including a faster onset of action, few drug or food interactions, and no requirement for regular monitoring. However, dose adjustments may be required for certain patients, such as those with severe renal impairment or in the setting of drug interactions.Keywords: aspirin, warfarin, dabigatran etexilate, rivaroxaban, apixaban

  17. Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation.

    Science.gov (United States)

    Luo, Nancy; Merrill, Peter; Parikh, Kishan S; Whellan, David J; Piña, Ileana L; Fiuzat, Mona; Kraus, William E; Kitzman, Dalane W; Keteyian, Steven J; O'Connor, Christopher M; Mentz, Robert J

    2017-04-04

    The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. This study examined whether outcomes with exercise training in HF vary according to AF status. HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had "other" rhythm. Patients with AF were older and had lower peak Vo2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p  0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Comparison of safety of sotalol versus amiodarone in patients with atrial fibrillation and coronary artery disease.

    Science.gov (United States)

    Piccini, Jonathan P; Al-Khatib, Sana M; Wojdyla, Daniel M; Shaw, Linda K; Horton, John R; Lokhnygina, Yuliya; Anstrom, Kevin J; DeWald, Tracy; Allen-LaPointe, Nancy; Steinberg, Benjamin A; Thomas, Kevin; Daubert, James P; Peterson, Eric D

    2014-09-01

    Sotalol is a commonly prescribed antiarrhythmic drug (AAD) used for maintaining sinus rhythm in patients with atrial fibrillation (AF). Although randomized studies have found that sotalol can significantly delay time to AF recurrence, its association with mortality is less clear, particularly among those with coronary artery disease. We examined outcomes of 2,838 patients with coronary artery disease and AF. Using Cox proportional hazards modeling, landmark analysis, and time-dependent covariates for drug therapy, we compared cumulative survival among patients treated with sotalol (n = 226), amiodarone (n = 856), or no AAD (n = 1,756). Median follow-up was 4.2 years (interquartile range [IQR] 2.0-7.4). The median age was 68 years (IQR 60-75). Compared with those treated with amiodarone or no AAD, patients treated with sotalol were less likely to be black (6% vs 13% vs 13%) and have a previous myocardial infarction (35% vs 51% vs 48%) or a left ventricular ejection fraction death compared with no drug (hazard ratio 1.53, 95% confidence interval 1.19 to 1.96, p = 0.0009), but a decreased risk of death compared with amiodarone (hazard ratio 0.72, 95% confidence interval 0.55 to 0.91, p = 0.0141). In conclusion, sotalol therapy was more frequently used in patients with fewer co-morbidities, often discontinued early in follow-up, and was associated with increased mortality compared with no AAD but decreased mortality relative to amiodarone. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF: protocol for a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Grandinetti Giuseppe

    2011-02-01

    Full Text Available Abstract Background Heart failure(HF and atrial fibrillation(AF frequently coexist in the same patient and are associated with increased mortality and frequent hospitalizations. As the concomitance of AF and HF is often associated with a poor prognosis, the prompt treatment of AF in HF patients may significantly improve outcome. Methods/design Recent implantable cardiac resynchronization (CRT devices allow electrical therapies to treat AF automatically. TRADE-HF (trial registration: NCT00345592; http://www.clinicaltrials.gov is a prospective, randomized, double arm study aimed at demonstrating the efficacy of an automatic, device-based therapy for treatment of atrial tachycardia and fibrillation(AT/AF in patients indicated for CRT. The study compares automatic electrical therapy to a traditional more usual treatment of AT/AF: the goal is to demonstrate a reduction in a combined endpoint of unplanned hospitalizations for cardiac reasons, death from cardiovascular causes or permanent AF when using automatic atrial therapy as compared to the traditional approach involving hospitalization for symptoms and in-hospital treatment of AT/AF. Discussion CRT pacemaker with the additional ability to convert AF as well as ventricular arrhythmias may play a simultaneous role in rhythm control and HF treatment. The value of the systematic implantation of CRT ICDs with the capacity to deliver atrial therapy in HF patients at risk of AF has not yet been explored. The TRADE-HF study will assess in CRT patients whether a strategy based on automatic management of atrial arrhythmias might be a valuable option to reduce the number of hospital admission and to reduce the progression the arrhythmia to a permanent form. Trial registration NCT00345592

  20. Practical regimen for amiodarone use in preventing postoperative atrial fibrillation.

    Science.gov (United States)

    Zebis, Lars R; Christensen, Thomas D; Thomsen, Henrik F; Mikkelsen, Martin M; Folkersen, Lars; Sørensen, Henrik T; Hjortdal, Vibeke E

    2007-04-01

    Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing cardiac surgery. Although postoperative atrial fibrillation is often regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including permanent or transient stroke, acute myocardial infarction, and death. This randomized, controlled, double-blinded trial included 250 eligible consecutively enrolled patients undergoing coronary artery bypass grafting (CABG). They received 300 mg of amiodarone/placebo administered intravenously over 20 minutes on the first postoperative day and an oral dose of 600 mg of amiodarone or placebo twice daily for the first 5 postoperative days. The patients in amiodarone prophylaxis experienced a reduction in risk of atrial fibrillation of 14% (95% confidence interval [CI], 5.0% to 24%), with the number needed to treat at 6.9 (95% CI, 4.2 to 20), and the results for symptomatic atrial fibrillation showed a risk reduction of 18% (95% CI, 9.4% to 26), with the number needed to treat at 5.7 (95% CI, 3.9 to 11). Of the patients who developed atrial fibrillation in the placebo group, 84% experienced a symptomatic attack versus only 43% in the amiodarone group. Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for CABG patients. It significantly diminishes the occurrence of postoperative atrial fibrillation.

  1. State of cerebral hemodynamics in patients with cognitive dysfunction associated with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    S.N. Stadnik

    2014-01-01

    Full Text Available The aim of the study was to cerebral hemodynamics in patients with cognitive dysfunction associated with atrial fibrillation (AF. Patients and methods. Fifty-six patients aged 40–75 years (the mean age was 62.7±6.3 years with nonvalvular AF caused by ischemic heart disease were examined. In 30 (53.6% patients AF was permanent; in 26 (46.4% patients, it was either persistent or paroxysmal. The exclusion criteria were as follows: past transient ischemic attacks, stroke or myocardial infarction, and severe somatic diseases. All patients with AF were evaluated for cognitive functions (using the short scale for assessing the mental status, auditory memory and associative memory (using the Schulte test, and emotional background (using the Hospital Anxiety and Depression Scale. Ultrasonography of the extracranial and intracranial vessels and registration of the average linear blood flow velocity (LBFV was performed. Results. Cognitive impairments (CI were diagnosed in 38 patients who entered the main group; patients with AF without CI comprised the control group. 82.6% of patients of the main group were diagnosed with constrictive lesion of the carotid (CA and vertebral (VA arteries of various severity; the isolated lesion of the CA was observed in 23.7% of patients, the isolated lesion of the VA in 18.4%; multiple lesions of the CA and VA in 69.4%; and the hemodynamically significant lesion, in 30.3%. In patients of the control group, constrictive lesions of the extracranial arteries were observed in 65.5% of cases. Condition of the major arteries of the head (MAH significantly affects the LBFV parameters of the intracranial arteries. In patients with multiple lesions of the CA and VA, the LBFV in the intracranial vessels was much lower than that in patients with isolated lesions of the CA and VA.The relation between the rate and severity of constrictive lesions of the MAH and the presence of AF accompanied with CI was noted in patients. Cerebral

  2. Effects of beta-blockade on atrial and atrioventricular nodal refractoriness, and atrial fibrillatory rate during atrial fibrillation in pigs

    NARCIS (Netherlands)

    van den Berg, MP; van de Ven, LLM; Witting, W; Crijns, JGM; Haaksma, J; Bel, KJ; de Langen, CDJ; Lie, KI

    1997-01-01

    Despite their widespread use in atrial fibrillation, the effects of beta-adrenoceptor blockers on atrial and atrioventricular (AV) nodal refractoriness, and atrial fibrillatory rate during atrial fibrillation have been incompletely characterised. In particular, it is unknown whether additional

  3. Atrial fibrillation in patients with sick sinus syndrome: the association with PQ-interval and percentage of ventricular pacing.

    Science.gov (United States)

    Nielsen, Jens Cosedis; Thomsen, Poul Erik B; Højberg, Søren; Møller, Mogens; Riahi, Sam; Dalsgaard, Dorthe; Mortensen, Leif S; Nielsen, Tonny; Asklund, Mogens; Friis, Elsebeth V; Christensen, Per D; Simonsen, Erik H; Eriksen, Ulrik H; Jensen, Gunnar V H; Svendsen, Jesper H; Toff, William D; Healey, Jeffrey S; Andersen, Henning R

    2012-05-01

    In the recently published DANPACE trial, incidence of atrial fibrillation (AF) was significantly higher with single-lead atrial (AAIR) pacing than with dual-chamber (DDDR) pacing. The present analysis aimed to evaluate the importance of baseline PQ-interval and percentage of ventricular pacing (VP) on AF. We analysed data on AF during follow-up in 1415 patients included in the DANPACE trial. In a subgroup of 650 patients with DDDR pacemaker, we studied whether %VP, baseline PQ-interval, and programmed atrio-ventricular interval (AVI) was associated with AF burden measured as time in mode-switch (MS) detected by the pacemaker. In the entire DANPACE study population, the incidence of AF was significantly higher in patients with baseline PQ-interval >180 ms (P180 ms (P= 0.028). No significant association was detected between %VP and %MS (Spearman's ρ 0.056, P= 0.154). %MS was not different between minimal-paced programmed AVI ≤ 100 and >100 ms (median value), respectively (P= 0.60). The present study indicates that a longer baseline PQ-interval is associated with an increased risk of AF in patients with sick sinus syndrome. Atrial fibrillation burden is not associated with the percentage of VP or the length of the programmed AVI.

  4. CHANGES IN THE LEVEL OF NATRIURETIC PEPTIDES IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH ANTIARRHYTHMIC DRUGS

    Directory of Open Access Journals (Sweden)

    V. I. Podzolkov

    2015-09-01

    Full Text Available Aim. To study the changes of plasma levels of NT-proBNP and NT-proANP in patients with persistent atrial fibrillation (AF treated with various antiarrhythmic drugs.Material and methods. Patients with persistent AF (n=123 aged 39-83 years old were included into the study. The patients were divided into 2 groups: group 1 included patients with arterial hypertension (n=61, group 2 - patients with ischemic heart disease (IHD; n=62. After sinus rhythm restoration the patients were divided into 4 subgroups. Patients of 1A subgroup used propafenone to maintain sinus rhythm during the next 6 months, while patients of 2A subgroup used amiodarone. Patients of 1B and 2B subgroups used bisoprolol to control ventricular rate. Plasma natriuretic peptide levels were evaluated in all patients during the first 3 days after the sinus rhythm restoration and 6 months after.Results. Increased levels of NT-proBNP and NT-proANP in the first days after the sinus rhythm restoration were found in patients of both groups and were associated with the episode of AF. After 6 months of treatment the reduction of NT-proBNP and NT-proANP levels was found in patients of 1A subgroup (NT-proBNP: from 160.5±15.2 pg/ml to 130.1±12.2 pg/ml; NT-proANP: from 15.3±6.4 nmol/L to 11.5±5.3 nmol/L, p<0.05 for both and of 2A subgroup (NT-proBNP: from 180.2±12.7 to 120.6±10.9 pg/ml; NT-proANP: from 17.1±7.1 to 11.8±7.2 nmol/L, p<0.05 for both. NT-proBNP and NT-proANP levels were decreasing consistently both in hypertensive patients receiving propafenone and in IHD patients taking amiodarone. No significant changes in NT-proBNP and NT-proANP levels were found in patient of subgroups 1B and 2B during the follow-up.Conclusion. Increased plasma levels of NT-proBNP and NT-proANP were found in the first days after the restoration of sinus rhythm in patients with persistent AF, and after 6 months of sinus rhythm maintenance these levels reduced significantly.

  5. Vascular disease and stroke risk in atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Lane, Deirdre A

    2012-01-01

    Vascular disease (including myocardial infarction and peripheral artery disease) has been proposed as a less well-validated risk factor for stroke in patients with atrial fibrillation. We investigated whether vascular disease is an independent risk factor of stroke/thromboembolism in atrial fibri...... fibrillation and whether adding vascular disease improves Congestive heart failure, Hypertension, Age 75 years, Diabetes, previous Stroke (CHADS(2)) risk stratification....

  6. Dynamic inversion time for improved 3D late gadolinium enhancement imaging in patients with atrial fibrillation.

    Science.gov (United States)

    Keegan, Jennifer; Gatehouse, Peter D; Haldar, Shouvik; Wage, Ricardo; Babu-Narayan, Sonya V; Firmin, David N

    2015-02-01

    High resolution three-dimensional (3D) late gadolinium enhancement (LGE) imaging is performed with single R-wave gating to minimize lengthy acquisition durations. In patients with atrial fibrillation (AF), heart rate variability results in variable magnetization recovery between sequence repeats, and image quality is often poor. In this study, we implemented and tested a dynamic inversion time (dynamic-TI) scheme designed to reduce sequence sensitivity to heart rate variations. An inversion-prepared 3D segmented gradient echo sequence was modified so that the TI varied automatically from beat-to-beat (dynamic-TI) based on the time since the last sequence repeat. 3D LGE acquisitions were performed in 17 patients prior to radio frequency ablation of persistent AF both with and without dynamic-TI. Qualitative image quality scores, blood signal-to-ghosting ratios (SGRs). and blood-myocardium contrast-to-ghosting ratios (CGRs) were compared. Image quality scores were higher with dynamic-TI than without dynamic-TI (2.2 ± 0.9 vs. 1.8 ± 1.1, P = 0.008), as were blood-myocardium CGRs (13.8 ± 7.6 vs. 8.3 ± 6.1, P = 0.003) and blood SGRs (19.6 ± 8.5 vs. 13.1 ± 8.0, P = 0.003). The dynamic-TI algorithm improves image quality of 3D LGE imaging in this difficult patient population by reducing the sequence sensitivity to RR interval variations © 2014 Wiley Periodicals, Inc.

  7. Prediction of ineffective elective cardioversion of atrial fibrillation: a retrospective multi-center patient cohort study.

    Science.gov (United States)

    Hellman, Tapio; Kiviniemi, Tuomas; Vasankari, Tuija; Nuotio, Ilpo; Biancari, Fausto; Bah, Aissa; Hartikainen, Juha; Mäkäräinen, Marianne; Airaksinen, K E Juhani

    2017-01-18

    Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown. We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV. Median number of cardioversions was one per patient with a range of 1-10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15-1.80, p 60/min (OR 1.92, CI95% 1.08-3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14-1.93, p ECV. Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.

  8. Impact of controlling atrial fibrillation on outcomes relevant to the patient: focus on dronedarone.

    Science.gov (United States)

    Chahal, C Anwar A; Ali, Omer; Hunter, Ross J; Schilling, Richard J

    2012-01-01

    Atrial fibrillation (AF) is a substantial cause of mortality and morbidity in the Western world. It is a massive burden on health care systems, and its prevalence is expected to double over the next 20 years. Trials evaluating antiarrhythmic drugs or catheter ablation have focused on recurrence of arrhythmia, perhaps neglecting outcomes relevant to patients, such as symptoms, need for antiarrhythmic drugs, need for hospitalization, and rates of stroke and death. An association has been demonstrated between sinus rhythm and survival in several studies, and there is evidence emerging that successful catheter ablation may reduce rates of stroke and death. Similarly, dronedarone has been shown to reduce hospitalizations and death in patients with paroxysmal AF or persistent AF of recent onset, although it may cause adverse events in permanent AF. New antiarrhythmic drugs are a welcome addition to the armamentarium, since there are limitations to current antiarrhythmic drugs. In particular, sotalol, flecainide, and propafenone cannot be used safely in those with structural heart disease, and amiodarone has important adverse reactions that limit long-term use. Indeed, the use of conventional antiarrhythmic drugs may negate any survival benefit derived from maintaining sinus rhythm. Although dronedarone appears promising with respect to hard endpoints such as stroke and death in certain patients, it may not be safe for those with heart failure or those with permanent AF. Furthermore, the trials suggesting that dronedarone may impact on these endpoints were compared with placebo rather than with an active comparator group. Further "head-to-head" comparisons between dronedarone and other antiarrhythmic drugs are needed to determine whether this property is unique to dronedarone alone.

  9. Clinical Outcomes and History of Fall in Patients with Atrial Fibrillation Treated with Oral Anticoagulation: Insights From the ARISTOTLE Trial.

    Science.gov (United States)

    Rao, Meena P; Vinereanu, Dragos; Wojdyla, Daniel M; Alexander, John H; Atar, Dan; Hylek, Elaine M; Hanna, Michael; Wallentin, Lars; Lopes, Renato D; Gersh, Bernard J; Granger, Christopher B

    2017-11-06

    We assessed outcomes among anticoagulated patients with atrial fibrillation and a history of falling, and whether the benefits of apixaban vs warfarin are consistent in this population. Of the 18,201 patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, 16,491 had information about history of falling-753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding. When compared with patients without a history of falling, patients with a history of falling were older, more likely to be female and to have dementia, cerebrovascular disease, depression, diabetes, heart failure, osteoporosis, fractures, and higher CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or TIA or thromboembolism, Vascular disease, Age 65-74 years, Sex category female) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol) scores. Patients with a history of falling had higher rates of major bleeding (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI], 1.05-1.84; P = .020), including intracranial bleeding (adjusted HR 1.87; 95% CI, 1.02-3.43; P = .044) and death (adjusted HR 1.70; 95% CI, 1.36-2.14; P history of falling. Among those with a history of falling, subdural bleeding occurred in 5 of 367 patients treated with warfarin and 0 of 386 treated with apixaban. Patients with atrial fibrillation and a history of falling receiving anticoagulation have a higher risk of major bleeding, including intracranial, and death. The efficacy and safety of apixaban compared with warfarin were consistent, irrespective of history of falling. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Caffeine and risk of atrial fibrillation or flutter

    DEFF Research Database (Denmark)

    Frost, Lars; Vestergaard, Peter

    2005-01-01

    BACKGROUND: It is not known whether the consumption of caffeine is associated with excess risk of atrial fibrillation. OBJECTIVE: We evaluated the risk of atrial fibrillation or flutter in association with daily consumption of caffeine from coffee, tea, cola, cocoa, and chocolate. DESIGN: We...... prospectively examined the association between the amount of caffeine consumed per day and the risk of atrial fibrillation or flutter among 47 949 participants (x age: 56 y) in the Danish Diet, Cancer, and Health Study. Subjects were followed in the Danish National Registry of Patients and in the Danish Civil...... Registration System. The consumption of caffeine was analyzed by quintiles with Cox proportional-hazard models. RESULTS: During follow-up (x: 5.7 y), atrial fibrillation or flutter developed in 555 subjects (373 men and 182 women). When the lowest quintile of caffeine consumption was used as a reference...

  11. Gastrointestinal Bleeding in Patients With Atrial Fibrillation Treated With Rivaroxaban or Warfarin: ROCKET AF Trial.

    Science.gov (United States)

    Sherwood, Matthew W; Nessel, Christopher C; Hellkamp, Anne S; Mahaffey, Kenneth W; Piccini, Jonathan P; Suh, Eun-Young; Becker, Richard C; Singer, Daniel E; Halperin, Jonathan L; Hankey, Graeme J; Berkowitz, Scott D; Fox, Keith A A; Patel, Manesh R

    2015-12-01

    Gastrointestinal (GI) bleeding is a common complication of oral anticoagulation. This study evaluated GI bleeding in patients who received at least 1 dose of the study drug in the on-treatment arm of the ROCKET AF (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial. The primary outcome was adjudicated GI bleeding reported from first to last drug dose + 2 days. Multivariable modeling was performed with pre-specified candidate predictors. Of 14,236 patients, 684 experienced GI bleeding during follow-up. These patients were older (median age 75 years vs. 73 years) and less often female. GI bleeding events occurred in the upper GI tract (48%), lower GI tract (23%), and rectum (29%) without differences between treatment arms. There was a significantly higher rate of major or nonmajor clinical GI bleeding in rivaroxaban- versus warfarin-treated patients (3.61 events/100 patient-years vs. 2.60 events/100 patient-years; hazard ratio: 1.42; 95% confidence interval: 1.22 to 1.66). Severe GI bleeding rates were similar between treatment arms (0.47 events/100 patient-years vs. 0.41 events/100 patient-years; p = 0.39; 0.01 events/100 patient-years vs. 0.04 events/100 patient-years; p = 0.15, respectively), and fatal GI bleeding events were rare (0.01 events/100 patient-years vs. 0.04 events/100 patient-years; 1 fatal events vs. 5 fatal events total). Independent clinical factors most strongly associated with GI bleeding were baseline anemia, history of GI bleeding, and long-term aspirin use. In the ROCKET AF trial, rivaroxaban increased GI bleeding compared with warfarin. The absolute fatality rate from GI bleeding was low and similar in both treatment arms. Our results further illustrate the need for minimizing modifiable risk factors for GI bleeding in patients on oral anticoagulation. Copyright © 2015 American College of Cardiology Foundation. Published by

  12. Old age, high risk medication, polypharmacy: a trilogy of risks in older patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Wang Y

    2016-06-01

    Full Text Available Background: The safety of pharmacotherapy in atrial fibrillation (AF is compounded by a trilogy of risks old age, high-risk medications (e.g., antithrombotics, antiarrhythmics, polypharmacy due to multiple patient comorbidities. However, to date, scarce study has investigated the use of polypharmacy (including potentially inappropriate medication (PIM in AF patients, and how this may contribute to their overall risk of medication misadventure. Objectives: To review the extent of polypharmacy and PIM use in older patients (65 years or older with AF. Methods: Information was extracted from a database characterising a cohort of older AF patients treated in general practice in New South Wales, Australia. Patient characteristics, number and types of drugs, the degree of PIM use were recorded. The predictors for the use of polypharmacy in older AF patients were identified. Results: Overall, 367 patients (mean age 77.8 years were reviewed, among which 94.8% used 5 medications or more and over half used 10 medications or more. Cardiovascular agents were most commonly used (98.9%, followed by antithrombotics (90.7%. Among agents deemed PIMs, digoxin (30.2% was the most frequently used, followed by benzodiazepines (19.6%, and sotalol (9.8%. AF patients using polypharmacy were more likely to have low bleeding risk (OR=10.97, representing those patients in whom high-risk antithrombotics are mostly indicated. Patients with major-polypharmacy (5-9 medications are more likely to have obstructive pulmonary diseases (OR=2.32, upper gastrointestinal diseases (OR=2.02 and poor physical function (OR=1.04, but less likely to have cognitive impairment (OR=0.27. Conclusion: Polypharmacy affects oldest AF patients, comprising medications that are indicated for AF, yet regarded as PIMs. Patients with lower risk of bleeding, obstructive pulmonary diseases, upper gastrointestinal diseases and poor physical function are also at higher risk of using higher number of

  13. Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial.

    Directory of Open Access Journals (Sweden)

    Danielle E Clarkesmith

    Full Text Available BACKGROUND: Stroke prevention in atrial fibrillation (AF, most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0 and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient's willingness to adhere to recommendations. METHOD: A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients utilising an "expert-patient" focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605 against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD 72.0 (8.2, 67.4% men, or usual care (n=51, mean age (SD 73.7 (8.1, 62.7% men, stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR; secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. MAIN FINDINGS: Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035; at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44. Knowledge increased significantly across time (F (3, 47 = 6.4; p<0.01, but there were no differences between groups (F (1, 47 = 3.3; p = 0.07. At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04. Patients' scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. CONCLUSIONS: A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients' understanding of the

  14. How prepared are pharmacists to support atrial fibrillation patients in adhering to newly prescribed oral anticoagulants?

    Science.gov (United States)

    Hamedi, Nadya; da Costa, Filipa Alves; Horne, Robert; Levitan, Michael; Begley, Amanda; Antoniou, Sotiris

    2017-12-01

    Background The New Medicines Service (NMS) was implemented in the United Kingdom in 2011 and first evaluated in 2014, showing 10% increase on adherence. Objective To assess community pharmacists' current practice, knowledge and confidence in supporting patients' adherence as part of the NMS for patients on Oral Anti-Coagulants (OACs) for stroke prevention in Atrial Fibrillation. Setting Community pharmacists in London. Method An online cross-sectional survey was sent to pharmacists from their Local Pharmaceutical Committees and advertised by the Royal Pharmaceutical Society. Analysis was undertaken in SPSs v23 considering a confidence level of 95%. Main outcome measures pharmacists reported confidence of providing the NMS on OACs; training needs and skills for supporting adherence. Results A total of 257 valid responses were analysed (6.8% response rate; {Cronbach's α = 0.676-0.892}). Data indicates that over a 2-month period, 25% of pharmacists had completed ≥6 NMS consultations for all OACs, of which 11% for new oral anticoagulants (NOACs). The key priorities in counselling items during the NMS consultation were to discuss actions to take when bleeding occurs, followed by supporting adherence. Pharmacists were more confident in their knowledge, skills and access to resources for Vitamin-K Antagonists (VKAs) than for NOACs (p < 0.005). Results also highlight pharmacists' unfamiliarity with alert cards, lower for NOACs than VKAs (p < 0.001), albeit perceived as critically important. Half the sample mentioned to use the British National Formulary as information resource. Conclusion Results suggest the provision of NMS for NOACs is low. Supporting pharmacists with tailored education and adherence support might foster dissemination.

  15. Chronic Amiodarone Therapy Impairs the Function of the Superior Sinoatrial Node in Patients with Atrial Fibrillation

    Science.gov (United States)

    Mun, Hee-Sun; Shen, Changyu; Pak, Hui-Nam; Lee, Moon-Hyoung; Lin, Shien-Fong; Chen, Peng-Sheng; Joung, Boyoung

    2014-01-01

    Background The mechanisms underlying amiodarone-induced sinoatrial node (SAN) dysfunction remain unclear, so we used 3-dimensional endocardial mapping of the right atrium (RA) to investigate. Methods and Results In a matched-cohort design, 18 patients taking amiodarone before atrial fibrillation (AF) ablation (amiodarone group) were matched for age, sex and type of AF with 18 patients who had undergone AF ablation without taking amiodarone (no-amiodarone group). The amiodarone group had a slower heart rate than the no-amiodarone group at baseline and during isoproterenol infusion. Only the amiodarone group had sick sinus syndrome (n=4, 22%, P=0.03) and abnormal (>550 ms) corrected SAN recovery time (n=5, 29%; P=0.02). The median distance from the junction of the superior vena cava (SVC) and RA to the most cranial earliest activation site (EAS) was longer in the amiodarone group than in the no-amiodarone group at baseline (20.5 vs. 10.6 mm, P=0.04) and during isoproterenol infusion (12.8 vs. 6.3 mm, P=0.03). The distance from the SVC-RA junction to the EAS negatively correlated with the P-wave amplitudes of leads II (r=−0.47), III (r=−0.60) and aVF (r=−0.56) (Pamiodarone causes superior SAN dysfunction, which results in a downward shift of the EAS and reduced P-wave amplitude in leads II, III and aVF at baseline and during isoproterenol infusion. PMID:23739532

  16. Rhythm- and Rate-Controlling Effects of Dronedarone in Patients With Atrial Fibrillation (from the ATHENA Trial)

    DEFF Research Database (Denmark)

    Page, Richard L; Connolly, Stuart J; Crijns, Harry J G M

    2011-01-01

    .i.d. for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA) demonstrated that dronedarone reduced the risk for first cardiovascular hospitalization or death from any cause. The aim of this post hoc analysis was to evaluate the rhythm......- and rate-controlling properties of dronedarone in the ATHENA trial. Patients were randomized to dronedarone 400 mg twice daily (n 2,301) or placebo (n 2,327). Electrocardiographic tracings were classified for AF or AFL or sinus rhythm. Patients with AF or AFL on every postbaseline electrocardiogram were......, dronedarone demonstrated both rhythm- and rate-controlling properties in ATHENA. These effects are likely to contribute to the reduction of important clinical outcomes observed in this trial....

  17. Regional differences in presentation and treatment of patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry.

    Science.gov (United States)

    Lip, Gregory Y H; Laroche, Cécile; Boriani, Giuseppe; Dan, Gheorghe-Andrei; Santini, Massimo; Kalarus, Zbigniew; Rasmussen, Lars Hvilsted; Oliveira, Mário Martins; Mairesse, Georges; Crijns, Harry J G M; Simantirakis, Emmanouil; Atar, Dan; Maggioni, Aldo P; Tavazzi, Luigi

    2015-02-01

    Country differences in management practices are evident, and the publication of management guidelines by the European Society of Cardiology (ESC) and other learned societies has tried to recommend a uniform evidence-based approach to management. Despite the availability of guidelines and efforts to improve implementation, differences in guideline adherence are evident, and differences between countries and regions within Europe are therefore likely. In this analysis from the baseline dataset of the EORP-AF Pilot survey, we examined regional differences in presentation and treatment of contemporary patients with atrial fibrillation (AF) in Europe, as managed by European cardiologists. We focused on a subgroup of 902 hospital admitted patients in whom no rhythm control was performed or planned. Chronic heart failure was more common in East countries (P < 0.0001) while hypertension and peripheral artery disease were more common in South countries (both P < 0.0001). Previous bleeding and chronic kidney disease were more common in South countries (both P < 0.0001). A CHA2DS2-VASc score of ≥2 was highest in East and South countries (93.0 and 95.3%, respectively) compared with 80.8% in West countries (P < 0.0001). A HAS-BLED score of ≥3 was also highest in East and South countries (18.0 and 29.2% respectively) compared with 4.8% in West countries (P < 0.0001). Oral anticoagulation (OAC) use (either as OAC or OAC plus antiplatelet therapy) in West, East, and South countries was 72.0, 74.7, and 76.2%, respectively. Only antiplatelet therapy was used in 13.6, 15.4, and 12.4%, respectively. An initial rate control strategy only was most common in South countries (77.8%) (P < 0.0001). From the systematic collection of contemporary data regarding the management and treatment of AF in nine participating member ESC countries, we provide hypothesis-generating insights into regional management practices in Europe with regard to patient characteristics and treatment options

  18. Auscultatory versus oscillometric blood pressure measurement in patients with atrial fibrillation and arterial hypertension.

    Science.gov (United States)

    Šelmytė-Besusparė, Aistėja; Barysienė, Jūratė; Petrikonytė, Dovilė; Aidietis, Audrius; Marinskis, Germanas; Laucevičius, Aleksandras

    2017-03-23

    The aim of our study was to investigate the reliability of automated oscillometric blood pressure (BP) monitoring in the presence and absence of atrial fibrillation (AF) in hypertensive patients. BP was measured and compared in 71 randomly selected patients with AF and arterial hypertension diagnosis, 4 times each by auscultatory and oscillometric (Microlife BP A6 PC with AF detection system) methods. Study included 71 patients: 36 males (mean age 67.4 years) and 35 females (70.2 years). At the time of BP measuring procedure, 36 patients were in sinus rhythm (SR) and 35 in AF. In SR patients mean systolic blood pressure (SBP) was 132 ± 17.9 mmHg with auscultatory method (AM), 137.4 ± 19.4 mmHg with oscillometric method (OM); mean diastolic BP was 77.1 ± 10.9 mmHg (AM), 78.5 ± 12.2 mmHg (OM), in AF patients mean SBP was 127.5 ± 15.1 mmHg (AM), 133.6 ± 17.4 mmHg (OM); mean diastolic BP was 81.4 ± 9.9 mmHg (AM), 83.5 ± 11.8 mmHg (OM), p = 0.037. The averages of differences for SBP and DBP in sinus rhythm group were (-5.3 mmHg (95% limits of agreement -27.2 - 16.6)) and (-1.4 mmHg (95% limits of agreement -12.8 - 10.0)), respectively. In patients with AF the averages of differences for SBP and DBP were (-6.1 mmHg (95% limits of agreement -23.9 - 11.7)) and (-2.1 mmHg (95% limits of agreement -12.9 - 8.7)), respectively. The oscillometric device validated for patients with AF on average gives 5.3 mmHg higher systolic BP values for patients with SR and 6.3 mmHg higher BP values for patients with AF. However, the limits of agreement between two methods reveal wide range of random error rates which is a questionable topic in clinical practice, as it could possibly affect the treatment of arterial hypertension in patients with AF.

  19. The relative effects of digoxin and diltiazem upon ventricular ectopic activity in patients with chronic atrial fibrillation.

    OpenAIRE

    LEWIS, R. V.; McDevitt, D G

    1988-01-01

    In eight patients with chronic atrial fibrillation, treatment with digoxin (plasma drug concentration 1.3 to 2.0 nmol l-1) was associated with a significantly higher incidence of ventricular premature beats (VPBs) (mean 22.8 h-1) than diltiazem 120 mg three times daily (mean 6.8 h-1) (P less than 0.05). Seven out of the eight patients showed an increase in numbers of VPBs recorded over 24 h during treatment with digoxin when compared with diltiazem. The clinical importance of these results is...

  20. Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

    Directory of Open Access Journals (Sweden)

    Nakanishi Kazuhiro

    2013-01-01

    Full Text Available Abstract Background Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF after cardiac surgery. Methods Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group and those who did not receive any β-blockers during surgery (control group. An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively. Results Seventeen of the 105 patients (16.2% developed postoperative atrial fibrillation: 5/57 (8.8% in the landiolol group and 12/48 (25% in the control group. There was a significant difference between the two groups (P=0.03. The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. Conclusions Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

  1. Atrial Na,K-ATPase increase and potassium dysregulation accentuate the risk of postoperative atrial fibrillation

    DEFF Research Database (Denmark)

    Tran, Cao Thach; Schmidt, Thomas Andersen; Christensen, John Brochorst

    2009-01-01

    BACKGROUND: Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial...... biopsies and plasma potassium concentrations for the development of atrial fibrillation. METHODS: Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration...... with postoperative atrial fibrillation. CONCLUSIONS: The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute...

  2. Pre-admission warfarin use in patients with acute ischemic stroke and atrial fibrillation: The appropriate use and barriers to oral anticoagulant therapy.

    Science.gov (United States)

    Partington, Sara L; Abid, Simona; Teo, Koon; Oczkowski, Wesley; O'Donnell, Martin J

    2007-01-01

    Warfarin reduces the risk of stroke in patients with atrial fibrillation. Despite strong guideline recommendations, studies continue to demonstrate the under-use of warfarin in clinical practice. To determine the prevalence and predictors of warfarin use in patients presenting with atrial fibrillation and acute ischemic stroke who do not have a documented contraindication to anticoagulants. We conducted a retrospective chart review of all patients admitted to the Hamilton General Hospital with a primary diagnosis of ischemic stroke and a coded diagnosis of atrial fibrillation between 1999 and 2004. Using a standardized data abstraction form, the following variables were recorded: baseline demographics, past medical history including risk factors for stroke and major bleeding and known predictors of warfarin under-use. In cases where warfarin was not prescribed, charts were also reviewed for documented contraindications to warfarin use. The following were considered valid contraindications to warfarin: patient refusal, non-compliance with INR monitoring, bleeding diathesis, history of major bleeding or significant alcohol consumption. In total, 196 patients with ischemic stroke and atrial fibrillation were identified. Of these patients, 106 were considered to be appropriate candidates for anticoagulation after excluding patients with no known diagnosis of atrial fibrillation prior to admission (N=59), a valid contraindication to warfarin use (N=18), a CHADS2 score heart failure (OR 3.2; 95% CI 1.1-9.0) were associated with an increased odds of warfarin use in patients without a contraindication to warfarin. While 75% of patients 85 years were prescribed warfarin on admission to hospital. early half of all patients presenting with atrial fibrillation and acute ischemic stroke who were suitable candidates for anticoagulation were not prescribed warfarin. In patients not prescribed warfarin, very few had a documented contraindication. Advanced age appears to be the

  3. Unilateral atrial fibrillation - how common is atrial divorce?

    Science.gov (United States)

    Ker, J

    2017-06-01

    Atrial fibrillation is the most common pathologic supraventricular tachycardia. It has many causes, is an expensive disease, impairs quality of life and leads to an increased risk of death. Atrial dissociation is characterised by the presence of two independent sets of P-waves. This peculiar abnormality may give rise to the scenario where one atrium is in atrial fibrillation while the other is in sinus rhythm. This is the first published case of atrial dissociation where the phenomenon is demonstrated by transmitral and transtricuspid pulsed wave Doppler.

  4. [Emergency department training on the appropriate prescription of anticoagulants in atrial fibrillation and on patient follow-up after discharge].

    Science.gov (United States)

    Valle Alonso, Joaquín; Pedraza, Jorge; García Pérez, Elisa; Muñoz, María Del Carmen; Navarro, Carmen; Urbano, María Del Mar

    2015-01-01

    The main objective was to evaluate the effect of an emergency department training intervention on the use of a protocol for prescribing anticoagulant therapy in atrial fibrillation and on following patients after discharge. Quasi-experimental pre-post study of a training intervention; the control patients were not matched but were selected consecutively before and after the intervention. All patients were over the age of 18 years, had atrial fibrillation identified by electrocardiogram, and indications for anticoagulant therapy, specifically a score of 2 or more on the CHADS2-DS2-VASc scale (cardiac failure, hypertension, age >75 years, diabetes, stroke [doubled], vascular disease, age 65-74 years, sex). The primary outcome was percentage of patients on anticoagulant therapy on discharge from the department. The secondary outcome was the percentage of patients on therapy 1 month after discharge. A total of 184 patients (86 before the intervention and 98 afterwards) were included. Training significantly increased the prescription of anticoagulants in the department (before the intervention, 32 patients [37%] vs 95 [97%] afterwards; P<.001). In the preintervention period, 26 patients (30% were on anticoagulants 1 month later; in the postintervention period, 26 (30%) were still on therapy (P<.001). This study shows that emergency staff training is effective for implementing protocols based on anticoagulant therapy guidelines.

  5. Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study.

    Science.gov (United States)

    Kochiadakis, G E; Kanoupakis, E M; Kalebubas, M D; Igoumenidis, N E; Vardakis, K E; Mavrakis, H E; Vardas, P E

    2001-01-01

    To compare the effects of sotalol and metoprolol on heart rate, during isotonic (ITE) and isometric (IME) exercise and daily activities, in digitalized patients with chronic atrial fibrillation. The study had a randomized, single-blinded, crossover design. Twenty-three patients with chronic atrial fibrillation received placebo for 4 weeks, followed by a 4-week period of treatment with sotalol and metoprolol in random order. At the end of each period, the patients were assessed with 24-h ECG monitoring, a cardiopulmonary exercise test and a handgrip manoeuvre. Both agents produced a lower heart rate than placebo at rest and at all levels of isotonic exercise (P digitalized patients with atrial fibrillation. Sotalol is superior to metoprolol at submaximal exercise, resulting in better rate control during daily activities.

  6. Brain Natriuretic Peptide Is a Powerful Predictor of Outcome in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Kenji Maruyama

    2017-03-01

    Full Text Available Background: Since stroke patients with nonvalvular atrial fibrillation (NVAF have poor outcomes in general, the prediction of outcomes following discharge is of utmost concern for these patients. We previously reported that brain natriuretic peptide (BNP levels were significantly higher in NVAF patients with larger infarcts, higher modified Rankin Scale (mRS score, and higher CHADS2 score. In the present study, we evaluated an array of variables, including BNP, in order to determine significant predictors for functional outcome in patients with NVAF after acute ischemic stroke (AIS. Methods: A total of 615 consecutive patients with AIS within 48 h of symptom onset, admitted to our hospital between April 2010 and October 2015, were retrospectively searched. Among these patients, we enrolled consecutive patients with NVAF. We evaluated the mRS score 3 months after onset of stroke and investigated associations between mRS score and the following clinical and echocardiographic variables. Categorical variables included male sex, current smoking, alcohol intake, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, peripheral artery disease, use of antiplatelet drugs, anticoagulants, or tissue plasminogen activator (tPA, and infarct size. Continuous variables included age, systolic blood pressure (SBP, diastolic blood pressure, hemoglobin, creatinine, D-dimer, brain natriuretic peptide (BNP, left atrial diameter, left ventricular ejection fraction (EF, and early mitral inflow velocity/diastolic mitral annular velocity (E/e’. We also analyzed the association of prestroke CHADS2, CHA2DS2-VASc, and R2CHADS2 scores, and National Institutes of Health Stroke Scale (NIHSS score on admission with mRS score 3 months after the onset of stroke. Patients were classified into 2 groups according to mRS score: an mRS score ≤2 was defined as good outcome, an mRS score ≥3 was defined as poor outcome. To clarify the correlations between

  7. Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis

    Directory of Open Access Journals (Sweden)

    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. Methods A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4% older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17% patients; 301 (70.82% patients were matched to a control group (no-statin group. The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. Results Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57 was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statingroup: 124 (8.9% versus 301 (3.7%, respectively; p=0.027. Conclusion Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

  8. Role of galectin 3 and epicardial fat thickness in the development of atrial fibrillation in patients with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    V. A. Ionin

    2015-01-01

    Full Text Available Objective. To evaluate the epicardial fat thickness (EFT in patients with metabolic syndrome (MS, including paroxysmal and persistent atrial fibrillation (AF. To relate EFT to the fibroid heart marker, i.e. galectin 3. Materials and methods. We examined 100 patients with MS (50 with AF, and 50 healthy persons made the control group. Serum galectin 3 was measured by ELISA method. The EFT was measured with echocardiography. Results. EFT in patients with MS was twofold higher than in healthy persons. EFT in patients with MS and AF didn't differ significantly from that in patients with MS without AF. Positive correlation between the levels of EFT and galectin 3 in serum was revealed. Serum galectin 3 and EFT were associated with atrial fibrillation in patients with MS (OR:1,27, 95% CI 1,02-1,58 and OR:1,73, 95% CI 1,37-2,19, correspondingly.Conclusion. Definition of EFT at echocardiography can be used in the assessment of risk AF in patients with MS.

  9. European Society of Cardiology smartphone and tablet applications for patients with atrial fibrillation and their health care providers.

    Science.gov (United States)

    Kotecha, Dipak; Chua, Winnie W L; Fabritz, Larissa; Hendriks, Jeroen; Casadei, Barbara; Schotten, Ulrich; Vardas, Panos; Heidbuchel, Hein; Dean, Veronica; Kirchhof, Paulus

    2018-02-01

    We are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement in the management of their condition. The health care professional app is designed as an interactive management tool incorporating the new ESC Practice Guidelines on AF and supported by the European Heart Rhythm Association (EHRA), with the aim of improving best practice approaches for the care of patients with AF. Both stand-alone apps are now freely available for Android and iOS devices though the Google Play, Amazon, and Apple stores. In this article, we outline the rationale for the design and implementation of these apps. Our objective is to demonstrate the value of integrating novel digital technology into clinical practice, with the potential for patient engagement, optimization of pharmacological and interventional therapy in AF, and ultimately to improve patient outcomes. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology.

  10. Atrial and ventricular volume and function in persistent and permanent atrial fibrillation, a magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Therkelsen, Susette Krohn; Groenning, Bjoern Aaris; Svendsen, Jesper Hastrup

    2005-01-01

    Left atrial size is independently related to cardiovascular morbidity and mortality, and atrial fibrillation (AF) is strongly associated with atrial size. Our aims were to report atrial and ventricular dimensions in patients with AF evaluated with magnetic resonance imaging (MRI), and to assess t...

  11. Alternative methods of local amiodarone delivery for atrial fibrillation prevention in patients after coronary artery bypass grafting

    OpenAIRE

    Bockeria L. A.; Canametov T.N.

    2016-01-01

    Atrial fibrillation prevention still remains unresolved issue. Oral medication therapy strategy is not high effectiveness according to the results of clinical trials. Amiodarone – an antiarrhythmic III class drug – is the most effective agent in the postoperative atrial fibrillation (AF) prevention. Clinical studies have shown good efficacy of oral and parenteral amiodarone use. However, there are some limitations of the drug use, including loading dose achievement necessity, drug...

  12. Factors associated with abrupt discontinuation of dabigatran therapy in patients with atrial fibrillation in Malaysia.

    Science.gov (United States)

    Beshir, Semira Abdi; Chee, Kok-Han; Lo, Yoke-Lin

    2016-10-01

    Background Oral anticoagulant therapy is indicated for the prevention of stroke or other thromboembolic events. Premature discontinuation of oral anticoagulants may increase the risk of thromboembolism resulting in adverse sequelae. There are sparse data on the prevalence and the predictors of dabigatran discontinuation in Malaysian patients with atrial fibrillation. Objectives Determine the reasons and identify associated factors for abrupt discontinuation of dabigatran, assess the switching pattern and the occurrence of thromboembolic events after dabigatran discontinuation. Setting A university-affiliated tertiary hospital in Kuala Lumpur, Malaysia. Methods The clinical and demographic data of a cohort who were initiated with dabigatran between 2010 and 2012 at the University of Malaya Medical Centre were reviewed until the date of death or on 31st December 2013. Those patients who discontinued dabigatran were further followed up until 31st December 2015 to determine the occurrence of any thromboembolic event. Main outcome measure Permanent discontinuation of dabigatran for more than 8 weeks. Results 26 (14 %) of a cohort of 192 patients discontinued dabigatran therapy during a median follow-up period of 20 (range 3-45) months. About one-half of the discontinuation occurred within the first 6 months of dabigatran use. The three most cited reasons for discontinuation are bleeding events (19 %), high out-of-pocket drug payment (19 %) and cardioversion (19 %). Heart failure [adjusted odds ratio 3.699 (95 % confidence interval 1.393-9.574)] or chronic kidney disease [adjusted odds ratio 5.211 (95 % confidence interval 1.068-23.475)] were found to be independent risk factors for abrupt dabigatran discontinuation. Patients who discontinued dabigatran received warfarin (38 %), antiplatelet agents (16 %) or no alternative antithrombotic therapy (46 %). Five of the 26 patients who discontinued dabigatran developed an ischaemic stroke within 3-34 months after

  13. Safety of low-dose dabigatran in patients with atrial fibrillation and mild renal insufficiency.

    Science.gov (United States)

    Fukaya, Hidehira; Niwano, Shinichi; Oikawa, Jun; Nishinarita, Ryo; Horiguchi, Ai; Nakamura, Hironori; Fujiishi, Tamami; Igarashi, Tazuru; Ishizue, Naruya; Yoshizawa, Tomoharu; Satoh, Akira; Kishihara, Jun; Murakami, Masami; Ako, Junya

    2017-03-01

    Dabigatran etexilate (DE), an effective direct oral anticoagulant for patients with atrial fibrillation (AF), should be carefully used in patients with renal insufficiency. Data on the safety of DE in Japanese "real world" patients with mildly impaired renal function are limited. We hypothesized that low-dose DE (110mg, twice daily) could be safely used in Japanese AF patients with mildly impaired renal function compared to those with preserved renal function. One hundred ninety-six consecutive AF patients taking low-dose DE were retrospectively enrolled in this study, and were divided into two groups: preserved creatinine clearance (CCr ≥50ml/min; n=127) and reduced CCr (30-49ml/min; n=69). Baseline characteristics including CHADS2, CHA2DS2-VASc, and HAS-BLED scores were evaluated. Activated partial thromboplastin time (aPTT) was measured as a surrogate marker of the anticoagulant activity of DE, which was evaluated at 661 time points in total and the data were divided into five time windows after the last DE intake. The incidence of bleeding complications was compared between the two groups of reduced and preserved CCr. Reduced CCr group showed higher age (76.9±6.3 years vs. 67.6±6.7 years), higher CHADS2 (2.6±1.4 vs. 1.8±1.2), higher CHA2DS2-VASc (4.3±1.6 vs. 3.2±1.6), and higher HAS-BLED (2.3±1.0 vs. 2.0±1.0) scores in comparison with preserved CCr group (p<0.01, respectively). There was no difference in aPTT over the entire time windows between the two groups. The incidence of total bleeding events was not significantly different between the two groups (reduced vs. preserved CCr=2/69 vs. 2/127). Low-dose DE was safe in AF patients with mildly reduced CCr. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  14. Mediterranean diet reduces thromboxane A2 production in atrial fibrillation patients.

    Science.gov (United States)

    Pignatelli, Pasquale; Pastori, Daniele; Farcomeni, Alessio; Nocella, Cristina; Bartimoccia, Simona; Vicario, Tommasa; Bucci, Tommaso; Carnevale, Roberto; Violi, Francesco

    2015-10-01

    Platelet activation plays a major role in cardiovascular events (CVEs). Mediterranean diet (Med-Diet) reduces the incidence of stroke and myocardial infarction but it is still unclear if it affects platelet activation. Aim of the study was to evaluate the effect of Med-Diet on the urinary excretion of 11-dehydro-thromboxane (Tx) B2, a marker of in vivo platelet activation, in patients with atrial fibrillation (AF). Prospective observational cohort study including 801 non-valvular AF patients on chronic treatment with warfarin/acenocumarol referring to I Medical Clinic - Atherothrombosis Center of Sapienza University of Rome, Italy, from February 2008 to December 2013. Adherence to Med-Diet was evaluated by a short nine-items dietary questionnaire. Urinary excretion of 11-dehydro-TxB2 was measured in all patients. Mean follow-up was 33.9 (±19.8) months, yielding 2223 patient/year of observation. Mean age of patients was 73.3 (±8.9) years, 43.7% were female. Median value of urinary TxB2 was 105.5 [60.0-190.0] ng/mg creatinine. We found a significant inverse correlation between total Med-Diet score and 11-dehydro-TxB2 values (Rs: -0.356, p history of stroke/TIA (β = 0.146, p = 0.003), olive oil (β = -0.130, p = 0.007), wine (β = -0.102, p = 0.036) and antiplatelet drugs (β = -0.098, p = 0.045) were independently associated to 11-dehydro-TxB2. We found no differences in the rate of ischemic or bleeding events across tertiles of Med-Diet score during follow-up. Med-Diet adherence is inversely associated to urinary excretion of 11-dehydro-TxB2, suggesting that Med-Diet may favorably affect platelet function in AF patients. Clinical Trial Registration: ClinicalTrials.gov NCT01882114. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  15. The Impact of Transforming Growth Factor-β1 Level on Outcome After Catheter Ablation in Patients With Atrial Fibrillation.

    Science.gov (United States)

    Kishima, Hideyuki; Mine, Takanao; Takahashi, Satoshi; Ashida, Kenki; Ishihara, Masaharu; Masuyama, Tohru

    2017-04-01

    Transforming growth factor-β1 (TGF-β1 ) is an important factor that induces atrial fibrosis and atrial fibrillation (AF). The purpose of this study was to evaluate the association between TGF-β1 level and clinical factors before catheter ablation (CA), and to investigate the impact of TGF-β1 level on the outcome after CA for AF. This prospective study included 151 patients (persistent AF group: n = 59, paroxysmal AF [PAF] group: n = 54, and control group: n = 38). All patients who underwent CA for AF were followed up for 12 months. The PAF group had the highest TGF-β1 levels in all patients. An early recurrence of AF (ERAF: defined as episodes of atrial tachyarrhythmia within a 3-month blanking period) was detected in 60 patients (53%). Recurrent AF after the blanking period was detected in 36 patients (32%). On multivariate analysis, low TGF-β1 level was the only independent factor associated with recurrent AF. Moreover, the AF recurrence ratio was higher in the low TGF-β1 group (< 12.56 ng/mL) than in the high TGF-β1 group (16 of 29 patients, 55% vs. 20 of 84 patients, 24%, P = 0.002 by log-rank test). PAF was associated with a higher TGF-β1 level. Moreover, lower TGF-β1 level in AF patients could be a cause of recurrent AF after CA. © 2017 Wiley Periodicals, Inc.

  16. Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention.

    Science.gov (United States)

    Lamberts, Morten; Gislason, Gunnar H; Olesen, Jonas Bjerring; Kristensen, Søren Lund; Schjerning Olsen, Anne-Marie; Mikkelsen, Anders; Christensen, Christine Benn; Lip, Gregory Y H; Køber, Lars; Torp-Pedersen, Christian; Hansen, Morten Lock

    2013-09-10

    The purpose of this study was to investigate the risk of thrombosis and bleeding according to multiple antithrombotic treatment regimens in atrial fibrillation (AF) patients after myocardial infarction (MI) or percutaneous coronary intervention (PCI). The optimal antithrombotic treatment strategy is unresolved in patients with multiple indications. A total of 12,165 AF patients hospitalized with MI and/or undergoing PCI between 2001 and 2009 were identified by nationwide registries (60.7% male; mean age 75.6 years). Risk of MI/coronary death, ischemic stroke, and bleeding according to antithrombotic treatment regimen was estimated by Cox regression models. Within 1 year, MI or coronary death, ischemic stroke, and bleeding events occurred in 2,255 patients (18.5%), 680 (5.6%), and 769 (6.3%), respectively. Relative to triple therapy (oral anticoagulation [OAC] plus aspirin plus clopidogrel), no increased risk of recurrent coronary events was seen for OAC plus clopidogrel (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.48 to 1.00), OAC plus aspirin (HR: 0.96, 95% CI: 0.77 to 1.19), or aspirin plus clopidogrel (HR: 1.17, 95% CI: 0.96 to 1.42), but aspirin plus clopidogrel was associated with a higher risk of ischemic stroke (HR: 1.50, 95% CI: 1.03 to 2.20). Also, OAC plus aspirin and aspirin plus clopidogrel were associated with a significant increased risk of all-cause death (HR: 1.52, 95% CI: 1.17 to 1.99 and HR: 1.60, 95% CI: 1.25 to 2.05, respectively). When compared to triple therapy, bleeding risk was nonsignificantly lower for OAC plus clopidogrel (HR: 0.78, 95% CI: 0.55 to 1.12) and significantly lower for OAC plus aspirin and aspirin plus clopidogrel. In real-life AF patients with indication for multiple antithrombotic drugs after MI/PCI, OAC and clopidogrel was equal or better on both benefit and safety outcomes compared to triple therapy. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Consistency of safety and efficacy of new oral anticoagulants across subgroups of patients with atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Jean-Christophe Lega

    Full Text Available AIMS: The well-known limitations of vitamin K antagonists (VKA led to development of new oral anticoagulants (NOAC in non-valvular atrial fibrillation (NVAF. The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure. METHODS AND RESULTS: All randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE and major bleeding (MB were reported according to age (≤ or >75 years, renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08 was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67-0.86] than in those with heart failure (RR = 0.90 [0.78-1.04]; Significant interaction (p = 0.01 with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0-1 (RR 0.67 CI 0.57-0.79 than in those with a score ≥2 (RR 0.85 CI 0.74-0.98. Comparison of MB in patients with (RR 0.97 CI 0.79-1.18 and without (RR 0.76 CI 0.65-0.88 diabetes mellitus showed a similar trend (p = 0.06. No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction. CONCLUSIONS: NOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.

  18. Apixaban in Comparison With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: Findings From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial.

    Science.gov (United States)

    Avezum, Alvaro; Lopes, Renato D; Schulte, Phillip J; Lanas, Fernando; Gersh, Bernard J; Hanna, Michael; Pais, Prem; Erol, Cetin; Diaz, Rafael; Bahit, M Cecilia; Bartunek, Jozef; De Caterina, Raffaele; Goto, Shinya; Ruzyllo, Witold; Zhu, Jun; Granger, Christopher B; Alexander, John H

    2015-08-25

    Apixaban is approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial included a substantial number of patients with valvular heart disease and only excluded patients with clinically significant mitral stenosis or mechanical prosthetic heart valves. We compared the effect of apixaban and warfarin on rates of stroke or systemic embolism, major bleeding, and death in patients with and without moderate or severe valvular heart disease using Cox proportional hazards modeling. Of the 18 201 patients enrolled in ARISTOTLE, 4808 (26.4%) had a history of moderate or severe valvular heart disease or previous valve surgery. Patients with valvular heart disease had higher rates of stroke or systemic embolism and bleeding than patients without valvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in patients with and without valvular heart disease in reducing stroke and systemic embolism (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.51-0.97 and HR, 0.84; 95%, CI 0.67-1.04; interaction P=0.38), causing less major bleeding (HR, 0.79; 95% CI, 0.61-1.04 and HR, 0.65; 95% CI, 0.55-0.77; interaction P=0.23), and reducing mortality (HR, 1.01; 95% CI, 0.84-1.22 and HR, 0.84; 95% CI, 0.73-0.96; interaction P=0.10). More than a quarter of the patients in ARISTOTLE with nonvalvular atrial fibrillation had moderate or severe valvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in reducing stroke or systemic embolism, causing less bleeding, and reducing death in patients with and without valvular heart disease. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2015 American Heart Association, Inc.

  19. Dronedarone for atrial fibrillation therapy.

    Science.gov (United States)

    Marzocchi, Michele; Lombardi, Federico

    2011-06-01

    Dronedarone is a new benzofuran derivative that has been developed as an antiarrhythmic agent on the basis of the amiodarone molecular structure with the intent of maintaining the same pharmacological effects while reducing thyroid and pulmonary toxicity. The drug is a multichannel blocker with antiadrenergic properties: it reduces heart rate and prolongs the action potential duration. Dronedarone is primarily metabolized by cytochrome P450; its half-life is much shorter than that of amiodarone because of a lower lipophilicity. As a consequence, only 7 days are needed to reach steady-state plasma levels. It has been tested in clinical trials both for rate and rhythm control and, even if its antiarrhythmic efficacy seems to be somehow lower than that of amiodarone, dronedarone is less often discontinued due to adverse reactions or organic toxicity. For these reasons, dronedarone can be very useful in long-term treatment of atrial fibrillation, by reducing hospitalizations and mortality.

  20. The occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. TRACE Study group. TRAndolapril Cardiac Evalution

    DEFF Research Database (Denmark)

    Pedersen, O D; Bagger, H; Køber, L

    1999-01-01

    AIMS: To investigate the occurrence and prognostic significance of atrial fibrillation/-flutter following acute myocardial infarction. METHODS AND RESULTS: The occurrence and prognostic significance of atrial fibrillation/-flutter were studied in 6676 consecutive patients with acute myocardial in...

  1. Predictors of Elevated Cardiac Enzyme Levels in Hospitalized Patients with Atrial Fibrillation and No Known Coronary Artery Disease.

    Science.gov (United States)

    Vinales, Karyne L; Najib, Mohammad Q; Marella, Punnaiah C; Katayama, Minako; Chaliki, Hari P

    2016-02-01

    We retrospectively studied the predictive capabilities of elevated cardiac enzyme levels in terms of the prognosis of patients who were hospitalized with atrial fibrillation and who had no known coronary artery disease. Among 321 patients with atrial fibrillation, 60 without known coronary artery disease had their cardiac enzyme concentrations measured during hospitalization and underwent stress testing or cardiac catheterization within 12 months before or after hospitalization. We then compared the clinical and electrocardiographic characteristics of the 20 patients who had elevated cardiac enzyme levels and the 40 patients who had normal levels. Age, sex, and comorbidities did not differ between the groups. In the patients with elevated cardiac enzyme levels, the mean concentrations of troponin T and creatine kinase-MB isoenzymes were 0.08 ± 0.08 ng/mL and 6.49 ± 4.94 ng/mL, respectively. In univariate analyses, only peak heart rate during atrial tachyarrhythmia was predictive of elevated enzyme levels (P <0.0001). Mean heart rate was higher in the elevated-level patients (146 ± 22 vs 117 ± 29 beats/min; P=0.0007). Upon multivariate analysis, heart rate was the only independent predictor of elevated levels. Coronary artery disease was found in only 2 patients who had elevated levels and in one patient who had normal levels (P=0.26). Increased myocardial demand is probably why the presenting heart rate was predictive of elevated cardiac enzyme levels. Most patients with elevated enzyme levels did not have coronary artery disease, and none died of cardiac causes during the 6-month follow-up period. To validate our findings, larger studies are warranted.

  2. [Fine-tuning of antithrombotic therapy in patients with non-valvular atrial fibrillation. The AFINVA register].

    Science.gov (United States)

    Dubois Marques, Daniela; Mora Llabata, Vicente; Pacheco Arroyo, Julián; Gasull Insertis, Salvador; Vicente Cañizares, Manuela; Roldán Torres, Ildefonso

    2017-08-31

    To determine whether antithrombotic treatment (ATT) in patients with non-valvular atrial fibrillation in a health area complies with the recommendations of current clinical guidelines. Prospective observational study. Primary Health Care Centres and Cardiology Department of a Health Department of the Valencian Community, Spain. A total of 505 patients with nonvalvular atrial fibrillation were included in the study. ATT was deemed to be inappropriate in patients with a CHA2DS2-VASc score ≥1 and who were not under oral anticoagulation, in patients treated with antivitaminK drugs, and poor control of oral anticoagulation, or with antiplatelet therapy inappropriately associated with anticoagulation, and in patients on ATT with a CHA2DS2-VASc score=0. The median age was 77.4±10years. The ATT was considered inadequate in 58% of cases. Factors independently associated with inadequate ATT were age (OR: 1.02 [1-1.04]; P=.029), hypothyroidism (OR: 1.98 [1.14-3.43]; P=.015), ischaemic heart disease (OR: 1.3 [1.15-2.59]; P=.008) and paroxysmal non-valvular AF (OR: 2.11 [1.41-3.17]; P<.0001). These data underline the high prevalence of inadequate ATT in daily practice, as well its different causes. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  3. VENTRICULAR RATE AND BLOOD PRESSURE ORTHOSTATIC REACTIONS IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION IN GENERAL CARDIOVASCULAR RISK GROUPS

    Directory of Open Access Journals (Sweden)

    L. O. Martymianova

    2016-12-01

    Full Text Available Types and prevalence of ventricular rate (VR, systolic (SBP and diastolic (DBP blood pressure (BP orthostatic reactions (OR in patients with permanent atrial fibrillation (AF in general cardiovascular risk groups (GCVR were studied in 137 patients (73 men and 64 women, aged 66.4 ± 9.9 years. VR was measured by the electrocardiography (ECG on the computer electrocardiograph «CardioLab 2000» and BP – semi-automatic tonometer Microlife BP2BIO. Changes VR, SBP and DBP in the range of ± 5 % were classified as a lack, an increase of 5 % and more – both positive and decreased by 5 % or more – as a negative OR. GCVR calculated in accordance with the scale of SCORE. Patients were classified into groups of GCVR. Statistical evaluation of the results was performed with the parametric estimate of the mean (M and standard deviation (sd and non-parametric Student's T-test and Mann-Whitney test methods. It was found that patients with AF have all three types (positive, absent, negative OR of VR, SBP and DBP, which are stored in all classes GCVR. Optimizing the management of patients with atrial fibrillation, including with and through modification within the GCVR risk factors should take into account deviations in orthostatic reactions of VR, SBP and DBP.

  4. Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF‐TIMI 48 Trial

    OpenAIRE

    Eisen, Alon; Ruff, Christian T; Braunwald, Eugene; Hamershock, Rose A.; Lewis, Basil S; Hassager, Christian; Chao, Tze‐Fan; Le Heuzey, Jean Yves; Mercuri, Michele; Rutman, Howard; Antman, Elliott M.; Giugliano, Robert P.

    2017-01-01

    Background: Digoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF). Methods and Results: In the ENGAGE AF‐TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation‐Thrombolysis in Myocardial Infarction 48) trial, clinical outcomes of patients...

  5. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes

    2016-01-01

    BACKGROUND: The aim of this study was to test the hypothesis that alcohol consumption, both observational (self-reported) and estimated by genetic instruments, is associated with a risk of atrial fibrillation and to determine whether people with high cardiovascular risk are more sensitive towards...... register. As a measure of alcohol exposure, both self-reported consumption and genetic variations in alcohol metabolizing genes (ADH1B/ADH1C) were used as instrumental variables. The endpoint was admission to hospital for atrial fibrillation as recorded in a validated hospital register. RESULTS: A total...... of 3493 cases of atrial fibrillation occurred during follow-up. High alcohol consumption was associated with a risk of atrial fibrillation among men, but not among women. Among the men who drank 28-35 and 35+ drinks/week, the hazards ratios were 1.40 (95% confidence interval 1.09-1.80) and 1.62 (95...

  6. Time to implement fitness and reduction of fatness in atrial fibrillation therapy

    NARCIS (Netherlands)

    Van Gelder, Isabelle C.; Hobbelt, Anne H.; Brugemann, Johan; Rienstra, Michiel

    This editorial refers to ‘Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry’ by M. Proietti et al. , doi:10.1093/europace/euw150. Atrial

  7. Atrial fibrillation in patients with sick sinus syndrome: the association with PQ-interval and percentage of ventricular pacing

    DEFF Research Database (Denmark)

    Nielsen, Jens Cosedis; Thomsen, Poul Erik B; Højberg, Søren

    2012-01-01

    AimsIn the recently published DANPACE trial, incidence of atrial fibrillation (AF) was significantly higher with single-lead atrial (AAIR) pacing than with dual-chamber (DDDR) pacing. The present analysis aimed to evaluate the importance of baseline PQ-interval and percentage of ventricular pacing...

  8. Bioptic Study of Left and Right Atrial Interstitium in Cardiac Patients with and without Atrial Fibrillation: Interatrial but Not Rhythm-Based Differences.

    Directory of Open Access Journals (Sweden)

    Natalia Smorodinova

    Full Text Available One of the generally recognized factors contributing to the initiation and maintenance of atrial fibrillation (AF is structural remodeling of the myocardium that affects both atrial cardiomyocytes as well as interstitium. The goal of this study was to characterize morphologically and functionally interstitium of atria in patients with AF or in sinus rhythm (SR who were indicated to heart surgery. Patient population consisted of 46 subjects (19 with long-term persistent AF, and 27 in SR undergoing coronary bypass or valve surgery. Peroperative bioptic samples of the left and the right atria were examined using immunohistochemistry to visualize and quantify collagen I, collagen III, elastin, desmin, smooth muscle actin, endothelium and Vascular Endothelial Growth Factor (VEGF. The content of interstitial elastin, collagen I, and collagen III in atrial tissue was similar in AF and SR groups. However, the right atrium was more than twofold more abundant in elastin as compared with the left atrium and similar difference was found for collagen I and III. The right atrium showed also higher VEGF expression and lower microvascular density as compared to the left atrium. No significant changes in atrial extracellular matrix fiber content, microvascular density and angiogenic signaling, attributable to AF, were found in this cohort of patients with structural heart disease. This finding suggests that interstitial fibrosis and other morphological changes in atrial tissue are rather linked to structural heart disease than to AF per se. Significant regional differences in interstitial structure between right and left atrium is a novel observation that deserves further investigation.

  9. Detection of inter-atrial conduction defects with unfiltered signal-averaged P-wave ECG in patients with lone atrial fibrillation.

    Science.gov (United States)

    Platonov, P G; Carlson, J; Ingemansson, M P; Roijer, A; Hansson, A; Chireikin, L V; Olsson, S B

    2000-01-01

    To demonstrate a possible inter-atrial conduction delay in patients with lone paroxysmal atrial fibrillation (PAF) using 'unfiltered' signal-averaged P-wave ECG (PSAECG) and compare these results with those obtained with conventional filter settings. Twenty one patients with lone PAF and 20 healthy volunteers (control group) were enrolled in the study. An orthogonal lead surface ECG was high-pass filtered at 0.8 Hz, averaged with template matching, and combined into a spatial magnitude ('unfiltered' technique). Results were compared with conventionally filtered (40-300 Hz) PSAECG. The filtered technique revealed no differences in P-wave duration between the two groups (121 +/- 12 vs 128 +/- 15 ms, control and PAF groups respectively, ns). Double-peaked P-wave spatial magnitudes (interpeak distance >30 ms) were revealed in 11 of 21 PAF patients but only in two of 18 controls (PUnfiltered' PSAECG revealed significant differences in orthogonal P-wave morphology in patients with lone PAF, indicating the possibility of an inter-atrial conduction delay, while conventional P-wave duration analysis failed to discriminate between the two groups.

  10. [Evaluation of the quality control of anticoagulation in patients with atrial fibrillation in a Primary Health Care Area of Madrid].

    Science.gov (United States)

    Habashneh Sánchez, S; Abad Díaz, I; Tinajero Valle, C P; Cortés Palmero, A; Lobón Agúndez, M C; Muñoz Fernández, C

    2016-01-01

    To calculate the time in therapeutic range (TTR), as well as the scores on the CHADS2 scale in anticoagulated patients with non-valvular atrial fibrillation, attending the Primary Care Health Centre of Aravaca. Basic health area of Aravaca (Madrid). Retrospective observational study. The Community of Madrid provides a list of patients with non-valvular atrial fibrillation and on anticoagulant therapy in the centre. Excluding those with less than 8 INRs, who began treatment after January 2011, interrupted by inter-current treatment or had cancer or coagulopathy. The study period is from 1 January 2012 to 1 January 2013. The TTR (fraction of INRs in range) was the primary endpoint. The score was also calculated on the CHADS2 scale. A value of 56.28% TTR (59.5-53.1) was obtained from a sample of 963 INRs. Just over half (52%) of patients had a TTRcontrolled patients and introduce corrective measures. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Incidence of atrial fibrillation in patients with either heart failure or acute myocardial infarction and left ventricular dysfunction: a cohort study

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle D; Pedersen, Ole D; Køber, Lars

    2011-01-01

    We examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment with t...... with the class III antiarrhythmic drug dofetilide over 36 months....

  12. Current approaches in atrial fibrillation treatment

    Directory of Open Access Journals (Sweden)

    Cenk Sarı

    2014-09-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed.

  13. A 64-slice multi-detector CT scan could evaluate the change of the left atrial appendage thrombi of the atrial fibrillation patient, which was reduced by warfarin therapy

    OpenAIRE

    Takeuchi, Hidekazu

    2011-01-01

    Curable cause of stroke is the left atrial appendage (LAA) thrombi of atrial fibrillation (AF) patients. Some AF patients have the LAA thrombi. It is very important to cure AF patients by warfarin. Transoesophageal echocardiography (TOE) is the usual clinical tool to detect the LAA thrombi. Recently, a 64-slice multi-detector CT (64-MDCT) scan enables us to display the LAA thrombi more easily than TOE.

  14. Pathogenic Mechanisms of Atrial Fibrillation in Obesity

    Directory of Open Access Journals (Sweden)

    O. M. Drapkina

    2016-01-01

    Full Text Available Atrial fibrillation (AF is one of the most common arrhythmias. It reduces quality of life and its duration due to thromboembolic complications. Obesity contributes to the structural and electrical remodeling of atrial myocardium. This leads to occurrence of ectopic foci in the mouths of the pulmonary veins and the disruption of normal electrical conduction in the atria. Systemic inflammation, myocardial fibrosis, cardiomyocyte overload by Na+ and Ca2+ ions, accumulation in the cells of unoxidized metabolic products, imbalance of the autonomic regulation are considered as the main mechanisms of arrhythmogenic substrate formation. Hypertension, insulin resistance, and obstructive sleep apnea, associated with obesity, increase the risk of development and progression of the arrhythmia. Study of pathogenetic mechanisms of AF in obesity is necessary to develop new strategies for its prevention and the creation of more effective methods of treatment of these patients.

  15. Atrial Fibrillation, Neurocognitive Decline and Gene Expression After Cardiopulmonary Bypass.

    Science.gov (United States)

    Dalal, Rahul S; Sabe, Ashraf A; Elmadhun, Nassrene Y; Ramlawi, Basel; Sellke, Frank W

    2015-01-01

    Atrial fibrillation and neurocognitive decline are common complications after cardiopulmonary bypass. By utilizing genomic microarrays we investigate whether gene expression is associated with postoperative atrial fibrillation and neurocognitive decline. Twenty one cardiac surgery patients were prospectively matched and underwent neurocognitive assessments pre-operatively and four days postoperatively. The whole blood collected in the pre-cardiopulmonary bypass, 6 hours after-cardiopulmonary bypass, and on the 4th postoperative day was hybridized to Affymetrix Gene Chip U133 Plus 2.0 Microarrays. Gene expression in patients who developed postoperative atrial fibrillation and neurocognitive decline (n=6; POAF+NCD) was compared with gene expression in patients with postoperative atrial fibrillation and normal cognitive function (n=5; POAF+NORM) and patients with sinus rhythm and normal cognitive function (n=10; SR+NORM). Regulated genes were identified using JMP Genomics 4.0 with a false discovery rate of 0.05 and fold change of >1.5 or cardiopulmonary bypass, and 34 named genes four days postoperatively (Pcardiopulmonary bypass may have differential genomic responses compared to normal patients and patients with only postoperative atrial fibrillation, suggesting common pathophysiology for these conditions. Further exploration of these genes may provide insight into the etiology and improvements of these morbid outcomes.

  16. A Greek Prospective Observational Study of Cardiovascular Morbidity and Mortality in Patients with Atrial Fibrillation.

    Science.gov (United States)

    Vardas, Panos; Andrikopoulos, George; Baroutsou, Barbara

    2015-01-01

    Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and represents a growing threat to public health. A representation of data among the private sector in Greece and an assessment of the correlation of different treatment strategies (rate or rhythm control) with annual cardiovascular (CV) morbidity and total mortality, are generally lacking. Patients aged >18 years, diagnosed with AF verified by a standard electrocardiogram (ECG), were included in this observational study (n=1545). Information and data, including demographic characteristics, clinical profiles, therapeutic strategies and outcomes, were collected prospectively from each patient at 4 visits: baseline, 6±2, 12±2, and 24±2 months. Data were analyzed using descriptive statistics, quantitative and qualitative variables. The annual non-adjusted CV morbidity was 18.1% [95% CI 16.0-20.3%] and 17.2% [13.9-18.4%] in the first and second years, respectively. At the end of the first year, the non-adjusted CV morbidity was 17.1% [14.0-20.3%] for rhythm-control treatment and 18.9% [15.9-21.8%] for rate-control treatment (p=0.477). At the end of the second year, the non-adjusted CV morbidity was 14.9% [11.6-18.2%] for rhythm-control treatment and 17.2% [14.1-20.2%] for rate-control treatment (p=0.367). Overall non-adjusted mortality was 1.6% [0.9-2.3%] and 1.9% [1.1-2.7%] in the first and second years, respectively. At the end of the first year, the non-adjusted mortality was 0.7% [0.02-1.5%] for rhythm-control treatment and 2.3% [1.9-3.4%] for rate-control treatment (p=0.030). At the end of the second year, the non-adjusted mortality was 0.6% [0-1.4%] for rhythm-control treatment and 2.8% [1.5-4.1%] for rate-control treatment (p=0.009). In this multi-centre, countrywide, 24-month observational prospective study, there were no statistically significant differences in CV morbidity between rhythm and rate control treatments, whereas there were statistically significant differences in total

  17. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra

    2016-01-01

    BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial...

  18. Acutely Onset Amiodarone-Induced Angioedema in a Patient with New Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Hossein Vakili

    2014-01-01

    Full Text Available A 50-year-old man was admitted to our emergency department due to new episode of palpitation. He had history of angioplasty of right coronary artery (RCA with drug eluting stent 2 years ago. His electrocardiogram revealed atrial fibrillation (AF. Intravenous amiodarone 150 mg during 10 minutes and then 1 mg/min infusion were started to achieve rate control and pharmacologic conversion to sinus rhythm. After 60 minutes of starting amiodarone infusion, he developed swelling of the skin around his mouth and eyes, and also mucosa of the mouth, eyes and tongue. To conclude, angioedema should be considered a rare side effect of amiodarone which is used broadly in cardiovascular field.

  19. Comparison of hospital length of stay between hospitalized non-valvular atrial fibrillation patients treated with either apixaban or warfarin.

    Science.gov (United States)

    Farr, Amanda M; Jing, Yonghua; Johnston, Stephen; Trocio, Jeffrey; Singhal, Shalabh; Bruno, Amanda; Graham, John

    2015-01-01

    Hospital length of stay (LOS) is an important cost driver for hospitals and payers alike. Hospitalized non-valvular atrial fibrillation (NVAF) patients treated with apixaban may have shorter LOS than those treated with warfarin because of the absence of need for INR monitoring in apixaban. Thus, this study compared hospital LOS between hospitalized NVAF patients treated with either apixaban or warfarin. This was a retrospective, observational cohort study based on a large US database including diagnosis, procedure, and drug administration information from >600 acute-care hospitals. Patients selected for study were aged ≥18 years and had a hospitalization record with an ICD-9-CM diagnosis code for atrial fibrillation (AF) in any position from 1 January 2013 to 28 February 2014 (index hospitalization). Patients with diagnoses indicative of rheumatic mitral valvular heart disease or a valve replacement procedure during index hospitalization were excluded. Patients were required to have been treated with either apixaban or warfarin, and not treated with rivaroxaban or dabigatran, during index hospitalization. Apixaban patients were propensity score (PS) matched to warfarin patients at a 1:1 ratio, using patient demographic/clinical and hospital characteristics. The study outcome was hospital LOS, calculated as discharge date minus admission date; a sensitivity analysis calculated hospital LOS as discharge date minus first anticoagulant administration date. Sub-analyses were conducted among patients with a primary diagnosis of AF. The study included 832 apixaban patients matched to 832 warfarin patients. Mean [standard deviation (SD)] and median hospital LOS were significantly (p < 0.001) shorter in apixaban patients (4.5 [4.2] and 3 days) than in warfarin patients (5.4 [5.0] and 4). Results were consistent in the sensitivity and sub-analyses. Among NVAF patients, apixaban treatment was associated with shorter hospital LOS when compared with warfarin treatment. These

  20. Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study.

    Science.gov (United States)

    Lakkireddy, Dhanunjaya; Rangisetty, Umamahesh; Prasad, Subramanya; Verma, Atul; Biria, Mazda; Berenbom, Loren; Pimentel, Rhea; Emert, Martin; Rosamond, Thomas; Fahmy, Tamer; Patel, Dimpi; Di Biase, Luigi; Schweikert, Robert; Burkhardt, David; Natale, Andrea

    2008-11-01

    Intracardiac Echo-Guided Radiofrequency Catheter. Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

  1. Echocardiographic evolution of left ventricular and left atrial thrombi in a patient with left ventricular dysfunction due to alcoholic cardiomyopathy, chronic atrial fibrillation and multiple non-fatal systemic embolisms.

    Science.gov (United States)

    Lanzarini, L; Ghio, S

    2001-04-01

    The echocardiographic characteristics and evolution of multiple pedunculated left atrial and left ventricular intracavitary thrombi in a patient with alcoholic cardiomyopathy are reported. The patient had a long history of left ventricular dysfunction and atrial fibrillation but the referring physician had not prescribed anticoagulant prophylaxis. Multiple, non-fatal, systemic embolizations occurred during hospitalization and echocardiography was used to monitor the effect of the anticoagulant therapy on the remodelling and final dissolution of intracavitary thrombi.

  2. Autonomic dysfunction and new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jøns, Christian; Raatikainen, Pekka; Gang, Uffe J

    2010-01-01

    Atrial fibrillation (AF) increases morbidity and mortality in patients with previous myocardial infarction and left ventricular systolic dysfunction. The purpose of this study was to identify patients with a high risk for new-onset AF in this population using invasive and noninvasive electrophysi...

  3. Electrocardiographic and clinical predictors of torsades de pointes induced by almokalant infusion in patients with chronic atrial fibrillation or flutter : A prospective study

    NARCIS (Netherlands)

    Houltz, B; Darpo, B; Edvardsson, N; Blomstrom, P; Brachmann, J; Crijns, Harry J. G. M.; Jensen, Steen M.; Svernhage, E; Vallin, H; Swedberg, K

    The aim of this study was to identify predictors of torsades de pointes (TdP) in patients with atrial fibrillation (AF) or flutter exposed to the Class III antiarrhythmic drug almokalant. TdP can be caused by drugs that prolong myocardial repolarization. One hundred patients received almokalant

  4. Effect of physical exercise training on muscle strength and body composition, and their association with functional capacity and quality of life in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Osbak, Philip Samuel; Mourier, Malene; Henriksen, Jens Henrik

    2012-01-01

    , thus improving quality of life. Design: Randomized clinical trial. Twelve weeks of physical exercise training or control. Patients: Forty-nine patients in permanent atrial fibrillation were randomized to training or control. Methods: Intervention consisted of aerobic training for 1 h 3 times per week...

  5. Prognosis in patients with atrial fibrillation and CHA2DS2-VASc Score = 0 in a community-based cohort study

    DEFF Research Database (Denmark)

    Taillandier, Sophie; Olesen, Jonas B; Clémenty, Nicolas

    2012-01-01

    Patients with atrial fibrillation (AF) and a CHA(2) DS(2) -VASc score = 0 have a very low risk of stroke and current guidelines even recommend no antithrombotic therapy to these patients. We investigated the rate and risk of adverse events and the impact of antithrombotic management in a community...

  6. Net clinical benefit of combination anticoagulant and antiplatelet therapy versus anticoagulation alone in atrial fibrillation patients: Results from the amadeus trial

    NARCIS (Netherlands)

    Lane, Deirdre; Kamphuisen, Pieter; Minini, Pascal; De Peuter, Olaf R.; Buller, Harry R.; Lip, Gregory Y. H.

    2010-01-01

    Background: To compare the effect of combination anticoagulant and antiplatelet (AP) therapy with anticoagulation alone on stroke and bleeding risk in atrial fibrillation (AF) patients and examine predictors of clinically relevant bleeding. Methods: Post-hoc analysis of 4576 AF patients [mean (SD)

  7. Prevention of atrial fibrillation in patients with aortic valve stenosis with candesartan treatment after aortic valve replacement

    DEFF Research Database (Denmark)

    Dahl, J. S.; Videbaek, L.; Poulsen, M. K.

    2013-01-01

    Background: Accumulating data has suggested that treatment with Angiotensin-II receptor antagonists can prevent the new onset of atrial fibrillation (AF). The aim of this study was to evaluate whether treatment with candesartan on top of conventional treatment could prevent new onset AF in patients...... randomised to candesartan 32 mg once daily on top of conventional treatment or conventional therapy immediately after AVR. Patients were examined with ECG 3, 6, 9 and 12 months after surgery, and Holter-ECG analysis after 3 and 12 months. Primary endpoint was episode of AF with a duration exceeding 30 s......, on the ECG or Holter-ECG and/or patients hospitalised due to AF. 14 patients developed new onset AF during follow up. AF-free survival was significantly higher (94% vs 74%, p=0.02) in patients treated with candesartan. Conclusion: In patients with symptomatic severe AS undergoing AVR, treatment...

  8. Warfarin Management and Outcomes in Patients with Nonvalvular Atrial Fibrillation Within an Integrated Health Care System.

    Science.gov (United States)

    An, JaeJin; Niu, Fang; Zheng, Chengyi; Rashid, Nazia; Mendes, Robert A; Dills, Diana; Vo, Lien; Singh, Prianka; Bruno, Amanda; Lang, Daniel T; Le, Paul T; Jazdzewski, Kristin P; Aranda, Gustavus

    2017-06-01

    Warfarin is a common treatment option to manage patients with nonvalvular atrial fibrillation (NVAF) in clinical practice. Understanding current pharmacist-led anticoagulation clinic management patterns and associated outcomes is important for quality improvement; however, currently little evidence associating outcomes with management patterns exists. To (a) describe warfarin management patterns and (b) evaluate associations between warfarin treatment and clinical outcomes for patients with NVAF in an integrated health care system. A retrospective cohort study was conducted among NVAF patients with warfarin therapy between January 1, 2006, and December 31, 2011, using Kaiser Permanente Southern California data, and followed until December 31, 2013. Management patterns related to international normalized ratio (INR) monitoring, anticoagulation clinic pharmacist intervention (consultation), and warfarin dose adjustments were investigated along with yearly attrition rates, time-in-therapeutic ranges (TTRs), and clinical outcomes (stroke or systemic embolism and major bleeding). Descriptive statistics and multivariable Cox proportional hazard models were used to determine associations between TTR and clinical outcomes. A total of 32,074 NVAF patients on warfarin treatment were identified and followed for a median of 3.8 years. About half (49%) of the patients were newly initiating warfarin therapy. INR monitoring and pharmacist interventions were conducted roughly every 3 weeks after 6 months of warfarin treatment. Sixty-three percent of the study population had ≥ 1 warfarin dose adjustments with a mean (SD) of 6.7 (6.3) annual dose adjustments. Warfarin dose adjustments occurred at a median of 1 day (interquartile ranges [IQR] 1-3) after the INR measurement. Yearly attrition rate was from 3.3% to 6.3% during the follow-up, and median (IQR) TTR was 61% (46%-73%). Patients who received frequent INR monitoring (≥ 27 times per year), pharmacist interventions (≥ 24

  9. Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography.

    Science.gov (United States)

    Dentamaro, Ilaria; Vestito, Domenico; Michelotto, Ennio; De Santis, Delia; Ostuni, Vittoria; Cadeddu, Christian; Colonna, Paolo

    2017-04-01

    The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 ± 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE. Before cardioversion, TTE allowed a confident measurement of emptying velocity of LAA (LAAeV) only in 59/93 patients (63%). On the contrary a good quality TEE LAAeV was obtained in all patients with 49/93 (53%) dysfunctional LAA (LAAeV thrombi with certainty in 8/93 patients (8.6%). In other 5 cases with diagnostic doubts for thrombi with 2DTEE (5/93 patients: 5.4%), the addition of the RT3DTEE mode allowed to discriminate with certainty the presence of just pectinate muscles in 4 patients RT3DTEE in patients with AF at risk of embolism is feasible, accurate and showed an additional diagnostic capability in the differential diagnosis of selected cases with suspected LAA thrombi.

  10. [Therapeutic strategies of atrial fibrillation in patients aged 65 and over. Report of 86 cases].

    Science.gov (United States)

    Jaafari, Aïcha; Zakhama, Lilia; Boussabah, Ehlem; Thameur, Moez; Boukhriss, Bessma; Amara, Yosser; Masmoudi, Mourad; Bencheikh, Mamoun; Benyoussef, Soraya

    2004-01-01

    Auricular fibrillation is the most common sustained cardiac arrhythmia, yet the optimal strategy for its management remains unclear. Since the study AFFIRM from which resulted them final were deferred in December 2002, the assumption of responsibility of the fibrillation of the old subject tends to become clarified. 86 patients at least 65 years or more were enrolled in our retrospective study from January 1997 to June 2003. The mean age is 70 years (65 to 82 years) and sex ratio to 0.79. 34% had a history of hypertension and 12% had a coronary artery disease. 2 groups were individualized, according to the year of admission before or after 2002. It comes out from these work 2 points: the restoration of the sinusal rhythm was the first choice. In the event of failure, the option was to maintain fibrillation and this, in the 2 groups. The AVK were founded in the large majority of the cases only after year 2002.

  11. POSTOPERATIVE ATRIAL FIBRILLATION – AN UPDATE

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2015-12-01

    Full Text Available Atrial fibrillation is the most common perioperative cardiac arrhythmia. Sympathetic overactivity, inflammatory state and oxidative stress are important contributors to the genesis of postoperative atrial fibrillation. Advancing age and mitral valve disease along with left atrial size are important parameters in noted in multivariate prediction model. Genetic predisposition has also been noted. Preventive strategies tried include beta blockers, statins, posterior pericardiotomy, carperitide infusion and thoracic epidural analgesia. Treatment options include rate and rhythm control along with anticoagulation if it persists more than 48 hours with high CHADS2 score. Some of the therapeutic modalities which have been found to be NOT useful in preventing post operative atrial fibrillation are dexamethasone, magnesium infusion and concomitant pulmonary vein isolation.

  12. Rhythm- and rate-controlling effects of dronedarone in patients with atrial fibrillation (from the ATHENA trial).

    Science.gov (United States)

    Page, Richard L; Connolly, Stuart J; Crijns, Harry J G M; van Eickels, Martin; Gaudin, Christophe; Torp-Pedersen, Christian; Hohnloser, Stefan H

    2011-04-01

    Dronedarone is a multi-channel-blocking drug for the treatment of patients with atrial fibrillation (AF) or atrial flutter (AFL) with rate- and rhythm-controlling properties. A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg b.i.d. for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in Patients With Atrial Fibrillation/Atrial Flutter (ATHENA) demonstrated that dronedarone reduced the risk for first cardiovascular hospitalization or death from any cause. The aim of this post hoc analysis was to evaluate the rhythm- and rate-controlling properties of dronedarone in the ATHENA trial. Patients were randomized to dronedarone 400 mg twice daily (n = 2,301) or placebo (n = 2,327). Electrocardiographic tracings were classified for AF or AFL or sinus rhythm. Patients with AF or AFL on every postbaseline electrocardiogram were classified as having permanent AF or AFL. All electrical cardioversions were documented. The use of rate-controlling medications was equally distributed in the 2 treatment groups. The median time to first AF or AFL recurrence of patients in sinus rhythm at baseline was 498 days in placebo patients and 737 days in dronedarone patients (hazard ratio 0.749, 95% confidence interval 0.681 to 0.824, p <0.001). In the dronedarone group, 339 patients (15%) had ≥1 electrical cardioversion, compared to 481 (21%) in the placebo group (hazard ratio 0.684, 95% confidence interval 0.596 to 0.786, p <0.001). The likelihood of permanent AF or AFL was lower with dronedarone (178 patients [7.6%]) compared to placebo (295 patients [12.8%]) (p <0.001). At the time of first AF or AFL recurrence, the mean heart rates were 85.3 and 95.5 beats/min in the dronedarone and placebo groups, respectively (p <0.001). In conclusion, dronedarone demonstrated both rhythm- and rate-controlling properties in ATHENA. These effects are likely to contribute to the reduction of important clinical outcomes observed

  13. Dronedarone: an amiodarone analog for the treatment of atrial fibrillation and atrial flutter.

    Science.gov (United States)

    Dale, Krista M; White, C Michael

    2007-04-01

    To review the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of dronedarone for the treatment of atrial fibrillation. A literature search was conducted using the search terms dronedarone, SR 33589, atrial fibrillation, and antiarrhythmic medication in MEDLINE (1966-February 2007), International Pharmaceutical Abstracts (1970-February 2007), and EMBASE (1990-February 2007). References from the identified trials and selected review articles were evaluated. Additional information, including abstracts and posters, was obtained from Sanofi-Aventis. Published studies and meeting abstracts evaluating the effects of dronedarone in humans and animals were reviewed. Dronedarone is a novel antiarrhythmic medication to treat atrial fibrillation. Dronedarone has a multifaceted mechanism of action similar to that of amiodarone. Dronedarone works by blocking potassium, sodium, and calcium channels and exhibits antiadrenergic properties. The drug has been evaluated at doses of 400, 600, and 800 mg twice daily. It prolonged the time to atrial fibrillation recurrence to 60-158 days compared with 5-59 days with placebo and decreased heart rate during atrial fibrillation by 12-25 beats/min in clinical trials. Major adverse events include gastrointestinal side effects and risk of proarrhythmia. Dronedarone may increase the risk of mortality in patients with congestive heart failure. Dronedarone is a new antiarrhythmic agent for the treatment of atrial fibrillation. Further studies are needed to better define dronedarone's safety profile and place in therapy.

  14. Impact of Variations in Kidney Function on Nonvitamin K Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Recent Acute Heart Failure.

    Science.gov (United States)

    Andreu-Cayuelas, José M; Pastor-Pérez, Francisco J; Puche, Carmen M; Mateo-Martínez, Alicia; García-Alberola, Arcadio; Flores-Blanco, Pedro J; Valdés, Mariano; Lip, Gregory Y H; Roldán, Vanessa; Manzano-Fernández, Sergio

    2016-02-01

    Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure. An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up. Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Improvement in estimated glomerular filtration rate in patients with chronic kidney disease undergoing catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Navaravong, Leenhapong; Barakat, Michel; Burgon, Nathan; Mahnkopf, Christian; Koopmann, Matthias; Ranjan, Ravi; Kholmovski, Eugene; Marrouche, Nassir; Akoum, Nazem

    2015-01-01

    Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist. We studied the association of CKD with atrial fibrosis and the effect of AF ablation on kidney function. AF patients who had a pre- and postablation serum creatinine and who completed a late gadolinium enhancement cardiac magnetic resonance imaging (MRI; LGE-MRI) prior to ablation were included. Estimated glomerular filtration rate (eGFR) was calculated and CKD was staged using the National Kidney Foundation guidelines. Patients with eGFR disease. Atrial fibrosis was not significant different between included CKD stages: 15.8 ± 8.8%, 16.6 ± 12.1%, 17.1 ± 10.4%, and 16.5 ± 8.4% for CKD stage 1, 2, 3A, and 3B, respectively (P = 0.476). At a median of 115 days following ablation, eGFR increased significantly in CKD stage 2 (74 ± 9 to 80 ± 23; P = 0.04), 3A (53 ± 5 to 69 ± 24; P chronic kidney disease. © 2014 Wiley Periodicals, Inc.

  16. Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial.

    Science.gov (United States)

    Piccini, Jonathan P; Stevens, Susanna R; Lokhnygina, Yuliya; Patel, Manesh R; Halperin, Jonathan L; Singer, Daniel E; Hankey, Graeme J; Hacke, Werner; Becker, Richard C; Nessel, Christopher C; Mahaffey, Kenneth W; Fox, Keith A A; Califf, Robert M; Breithardt, Günter

    2013-05-14

    This study sought to investigate the outcomes following cardioversion or catheter ablation in patients with atrial fibrillation (AF) treated with warfarin or rivaroxaban. There are limited data on outcomes following cardioversion or catheter ablation in AF patients treated with factor Xa inhibitors. We compared the incidence of electrical cardioversion (ECV), pharmacologic cardioversion (PCV), or AF ablation and subsequent outcomes in patients in a post hoc analysis of the ROCKET AF (Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation) trial. Over a median follow-up of 2.1 years, 143 patients underwent ECV, 142 underwent PCV, and 79 underwent catheter ablation. The overall incidence of ECV, PCV, or AF ablation was 1.45 per 100 patient-years (n = 321; 1.44 [n = 161] in the warfarin arm, 1.46 [n = 160] in the rivaroxaban arm). The crude rates of stroke and death increased in the first 30 days after cardioversion or ablation. After adjustment for baseline differences, the long-term incidence of stroke or systemic embolism (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 0.61 to 3.11), cardiovascular death (HR: 1.57; 95% CI: 0.69 to 3.55), and death from all causes (HR: 1.75; 95% CI: 0.90 to 3.42) were not different before and after cardioversion or AF ablation. Hospitalization increased after cardioversion or AF ablation (HR: 2.01; 95% CI: 1.51 to 2.68), but there was no evidence of a differential effect by randomized treatment (p value for interaction = 0.58). The incidence of stroke or systemic embolism (1.88% vs. 1.86%) and death (1.88% vs. 3.73%) were similar in the rivaroxaban-treated and warfarin-treated groups. Despite an increase in hospitalization, there were no differences in long-term stroke rates or survival following cardioversion or AF ablation. Outcomes were similar in patients treated with rivaroxaban or warfarin

  17. Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options--a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Lip, Gregory Y H; Van Gelder, Isabelle C

    2012-01-01

    the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper...... covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section...

  18. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Ono Koji

    2012-12-01

    Full Text Available Abstract Background The aim of this study was to define the independent determinants of left atrial appendage (LAA thrombus among various echocardiographic parameters measured by Velocity Vector Imaging (VVI in patients with nonvalvular atrial fibrillation (AF receiving warfarin, particularly in patients with a low CHADS2 score. Methods LAA emptying fraction (EF and LAA peak longitudinal strain were measured by VVI using transesophageal echocardiography in 260 consecutive patients with nonvalvular persistent AF receiving warfarin. The patients were divided into two groups according to the presence (n=43 or absence (n=217 of LAA thrombus. Moreover, the patients within each group were further divided into subgroups according to a CHADS2 score ≤1. Results Multivariate logistic regression analysis showed that LAAEF was an independent determinant of LAA thrombus in the subgroup of 140 with a low CHADS2 score. Receiver operating characteristics curve analysis showed that an LAAEF of 21% was the optimal cutoff value for predicting LAA thrombus. Conclusions LAA thrombus formation depended on LAA contractility. AF patients with reduced LAA contractile fraction (LAAEF ≤21% require strong anticoagulant therapy to avoid thromboembolic events regardless of a low CHADS2 score (≤1.

  19. A Systematic Review of Depression and Anxiety in Patients with Atrial Fibrillation: The Mind-Heart Link

    Directory of Open Access Journals (Sweden)

    Dimpi Patel

    2013-01-01

    Full Text Available Atrial fibrillation (AF is the most commonly seen arrhythmia in clinical practice. At present, few studies have been conducted centering on depression and anxiety in AF patients. Our aim in this systematic review is to use the relevant literature to (1 describe the prevalence of depression and anxiety in AF patients, (2 assess the impact that depression and anxiety have on illness perception in patients with AF, (3 provide evidence to support a hypothetical connection between the pathophysiology of AF and depression and anxiety, (4 evaluate the benefit of treatment of AF on depression and anxiety, and (5 give insight on medically managing a patient with AF and concomitant depression and anxiety.

  20. Distinct increase in hematocrit associated with paroxysm of atrial fibrillation.

    Science.gov (United States)

    Okuno, S; Ashida, T; Ebihara, A; Sugiyama, T; Fujii, J

    2000-09-01

    In a previous study we found that hemoconcentration, which was identified by an increase in hematocrit, occured during a paroxysm of atrial fibrillation. In the present study we investigated the changes in hematocrit from sinus rhythm to paroxysm in 10 patients who had multiple paroxysms of atrial fibrillation in order to assess the ranges of the changes in hematocrit among the paroxysms. In these patients hematocrit was measured simultaneously with electrocardiographic recording during 3 or more paroxysms and sinus rhythm just before each paroxysm. The changes in hematocrit varied among the paroxysms. The maximum increase in hematocrit in each patient ranged from 3.5 to 8.0 points with an average of 5.1 points. Such a distinct increase in hematocrit which abruptly develops with a paroxysm of atrial fibrillation may be a potential risk for thrombus formation.