References: Symptomatic improvement after radiofrequency catheter ablation for typical atrial flutter; Heart 2001;86:167-171 Quality-of-Life in Patients With Paroxysmal Atrial Fibrillation After Catheter Ablation: Results of Long-Term Follow-Up; PACE 2003; 26:678-684 Quality of life restored to normal in patients with atrial fibrillation after pulmonary vein ostial Isolation; Am Heart J 2004;148:318-25 Effect of Left Atrial Ablation on the Quality of Life in Patients With Atrial Fibrillation; Circ J 2008; 72: 582-587 Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure; N Engl J Med 2004;351:2373-83. Effects of Radiofrequency Catheter Ablation on Quality of Life in Patients With Atrial Flutter; Am J Cardiol 1999;84:278-283 Radiofrequency Catheter Ablation of Common Atrial Flutter : Significance of Palpitations and Quality-of-Life Evaluation in Patients With Proven Isthmus Block; Circulation 1999;99;534-540 Relationship Between Atrial Fibrillation and Typical Atrial Flutter in ...

TY - JOUR. T1 - Effect of Early Direct Current Cardioversion on the Recurrence of Atrial Fibrillation in Patients With Persistent Atrial Fibrillation. AU - Osmanagic, Armin. AU - Möller, Sören. AU - Osmanagic, Azra. AU - Sheta, Hussam. AU - Høeg Vinther, Kristina. AU - Egstrup, Kenneth. N1 - Copyright © 2015 Elsevier Inc. All rights reserved.. PY - 2015/7. Y1 - 2015/7. N2 - 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 conventional approach of DCC after 3 weeks of anticoagulation with dabigatran-etexilat, reduces the recurrence of AF. A total of 126 consecutive patients with persistent AF were randomly assigned to a TEE followed by early DCC (n = 65) or to a conventional treatment with dabigatran-etexilat for 3 weeks followed by DCC (n = 61). None of the ...

1. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1-76 2. Benjamin EJ, Wolf PA, DAgostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946-52 3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-8 4. Alegret JM, Viñolas X, Arias MA, Martínez-Rubio A, Rebollo P, Ràfols C, Martínez-Sande JL. New oral anticoagulants vs vitamin K antagonists: ...

TY - JOUR. T1 - Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up. AU - Xia, Yu. AU - Stern, David. AU - Friedmann, Patricia. AU - Goldstein, Daniel. N1 - Funding Information: Data collection for this work was supported in whole or in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN268201100025C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) or the National Institutes of Health. This research was also supported in part by the National Institutes of Health/National Center for Advancing Translational Science Einstein-Montefiore Clinical and Translational Science Awards Grant No. UL1TR001073. PY - 2016/7/1. Y1 - 2016/7/1. N2 - Background Atrial fibrillation (AF) is ...

BACKGROUND: In the ENGAGE AF-TIMI 48 trial, the higher-dose edoxaban (HDE) regimen had a similar incidence of ischaemic stroke compared with warfarin, whereas a higher incidence was observed with the lower-dose regimen (LDE). Amiodarone increases edoxaban plasma levels via P-glycoprotein inhibition. The current pre-specified exploratory analysis was performed to determine the effect of amiodarone on the relative efficacy and safety profile of edoxaban.. METHODS AND RESULTS: At randomization, 2492 patients (11.8%) were receiving amiodarone. The primary efficacy endpoint of stroke or systemic embolic event was significantly lower with LDE compared with warfarin in amiodarone treated patients vs. patients not on amiodarone (hazard ratio [HR] 0.60, 95% confidence intervals [CIs] 0.36-0.99 and HR 1.20, 95% CI 1.03-1.40, respectively; P interaction ,0.01). In patients randomized to HDE, no such interaction for efficacy was observed (HR 0.73, 95% CI 0.46-1.17 vs. HR 0.89, 95% CI 0.75-1.05, P ...

TY - JOUR. T1 - Clinical significance of early recurrences of atrial tachycardia after atrial fibrillation ablation. AU - Choi, Jong Il. AU - Pak, Hui Nam. AU - Park, Jae Seok. AU - Kwak, Jae Jin. AU - Nagamoto, Yasutsugu. AU - Lim, Hong Euy. AU - Park, Sang Weon. AU - Hwang, Chun. AU - Kim, Young Hoon. PY - 2010/12. Y1 - 2010/12. N2 - Early Recurrence After AF Ablation. Background: Atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT. Methods: Of 352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for AF, 56 patients (15.9%) with ERAT were identified by retrospective analysis. ERAT was defined as early relapse of AT within a 3-month blanking period after ablation. Results: During 21.7 ± 12.5 months, the rate of late recurrence was higher in ...

TY - JOUR. T1 - Left atrial appendage closure. T2 - Six reasons why I wouldnt choose a percutaneous closure for my appendage. AU - Ferlini, Marco. AU - Rossini, Roberta. PY - 2018/1/15. Y1 - 2018/1/15. N2 - Left atrial appendage has been shown as a primary source of thrombi in patients with non-valvular atrial fibrillation (AF). Non vitamin k oral anticoagulants (NOAC) have been shown to be safe and effective in the prevention of embolic complications. Current guidelines on AF state that percutaneous left atrial appendage closure (LAAC) might be considered in patients with contraindication to long term oral anticoagulant therapy (OAC). An overview of the main trials on NOAC and LAAC is provided.. AB - Left atrial appendage has been shown as a primary source of thrombi in patients with non-valvular atrial fibrillation (AF). Non vitamin k oral anticoagulants (NOAC) have been shown to be safe and effective in the prevention of embolic complications. Current guidelines on AF state that percutaneous ...

BACKGROUND The therapeutic goals of atrial fibrillation (AF) patients are to reduce symptoms and prevent severe complications associated with AF. This study compared the efficacy of flecainide versus pilsicainide in reducing the frequency of AF and improving quality of life (QOL) in symptomatic paroxysmal AF patients without structural heart disease. METHODS The Atrial Fibrillation and Quality Of Life (AF-QOL) study was a prospective, multicenter, randomized, open-label crossover study that compared flecainide and pilsicainide as antiarrhythmic drug therapy. Patients were randomized to receive 3 months of treatment with flecainide twice daily or pilsicainide 3 times daily. Each treatment consisted of a dose-finding phase (weeks 1-4) and an efficacy phase (weeks 5-12). Forty-three patients completed the trial. The main outcome was the number of days with documented AF episodes using a patient-operated electrocardiogram. QOL questionnaires (SF-36 and AF-specific QOL scores) were also completed.

TY - JOUR. T1 - Impact of Digoxin on Mortality in Patients with Atrial Fibrillation Stratified by Heart Failure. T2 - Findings from Gulf Survey of Atrial Fibrillation Events in the Middle East. AU - Al-Zakwani, Ibrahim. AU - Panduranga, P.. AU - Zubaid, M.. AU - Sulaiman, K.. AU - Rashed, W. A.. AU - Alsheikh-Ali, A. A.. AU - Almahmeed, W.. AU - Shehab, A.. AU - Al Qudaimi, A.. AU - Asaad, N.. AU - Amin, H.. PY - 2015. Y1 - 2015. N2 - Objective: The use of digoxin in patients having atrial fibrillation (AF) with or without heart failure (HF) is not without controversy. The aim of this study was to examine the impact of digoxin therapy on mortality stratified by HF. Methods: Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department of 23 hospitals in 6 countries in the Middle East. Patients were recruited between October 2009 and June 2010 and followed up for 1 year after enrollment. ...

The purpose of this study is to determine whether the addition of surgical ablation to planned mitral valve surgery for patients with persistent or longstanding persistent AF (within 6 months prior to randomization) reduces the incidence of postoperative heart arrhythmia compared to mitral valve repair with medication therapy alone. This is a randomized, multi-center trial which will enroll 260 subjects who will be randomized in a 1:1 fashion to: (a) mitral valve surgery plus surgical ablation or (b) mitral valve surgery without ablation (control group). All patients will undergo ligation or excision of the left atrial appendage. Patients assigned to the ablation group will be further randomized (1:1) to one of two lesion sets: (1) pulmonary vein isolation only or (2) biatrial Maze lesions. The target population for this trial consists of adult patients with mitral valve disease requiring surgical intervention and persistent or longstanding persistent atrial fibrillation. All patients who meet ...

AimsDigoxin is recommended for long-term rate control in paroxysmal, persistent, and permanent atrial fibrillation (AF). While some analyses suggest an association of digoxin with a higher mortality in AF, the intrinsic nature of this association has not been examined in propensity-matched cohorts, which is the objective of the current study.Methods and resultsIn Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM), 4060 patients with paroxysmal and persistent AF were randomized to rate (n = 2027) vs. rhythm (n = 2033) control strategies. Of these, 1377 received digoxin as initial therapy and 1329 received no digoxin at baseline. Propensity scores for digoxin use were estimated for each of these 2706 patients and used to assemble a cohort of 878 pairs of patients receiving and not receiving digoxin, who were balanced on 59 baseline characteristics. Matched patients had a mean age of 70 years, 40% were women, and 11% non-white. During the 3.4 years of the mean follow-up, ...

TY - JOUR. T1 - Left atrial isolation for the treatment of atrial fibrillation due to mitral valve disease. Hemodynamic evaluation. AU - Graffigna, A.. AU - Ressia, L.. AU - Pagani, F.. AU - Minzioni, G.. AU - Vigano, M.. PY - 1993. Y1 - 1993. N2 - Ablation of atrial fibrillation secondary to mitral valve disease is frequently impossible after isolated mitral valve surgery. In order to improve sinus rhythm recovery in such patients, patients with rheumatic mitral valve disease and chronic atrial fibrillation underwent surgical electrophysiological isolation of the left atrium at the time of surgery. The left atrium is left free to fibrillate, beat or stand still, while the right atrium recovers its sinus activation and warrants a regular ventricular rate. Apart from this advantage, we tested the hypothesis that the recovery of right atrial booster function could significantly improve cardiac output. From May 1989 to July 1993 184 patients with mitral with or without other valve disease ...

A left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an alternative to blood thinners such as warfarin (Coumadin).. In atrial fibrillation, the hearts upper chambers, or atria, beat irregularly. Pooling of blood flow during atrial fibrillation in an area called the left atrial appendage can increase the risk of blood clot formations that could travel to the brain and cause a stroke.. To perform the procedure, a catheter is inserted over a guide wire through a small incision in the thigh. This catheter travels up a vein and into the right atrium then across the atrial septum and into the left atrium of the heart.. The closure device is deployed securely into the left atrial appendage and the catheter and guide wire are removed.. With the device in place, the left atrial appendage is closed off from blood flow, reducing the risk of blood clot formation and strokes.. ...

A left atrial appendage closure device can be used for atrial fibrillation patients to help prevent strokes and as an alternative to blood thinners such as warfarin (Coumadin).. In atrial fibrillation, the hearts upper chambers, or atria, beat irregularly. Pooling of blood flow during atrial fibrillation in an area called the left atrial appendage can increase the risk of blood clot formations that could travel to the brain and cause a stroke.. To perform the procedure, a catheter is inserted over a guide wire through a small incision in the thigh. This catheter travels up a vein and into the right atrium then across the atrial septum and into the left atrium of the heart.. The closure device is deployed securely into the left atrial appendage and the catheter and guide wire are removed.. With the device in place, the left atrial appendage is closed off from blood flow, reducing the risk of blood clot formation and strokes.. ...

TY - JOUR. T1 - Perceived or actual barriers to warfarin use in atrial fibrillation based on electronic medical records. AU - Rosenman, Marc B.. AU - Simon, Teresa A.. AU - Teal, Evgenia. AU - McGuire, Patricia. AU - Nisi, Daniel. AU - Jackson, Joseph D.. PY - 2012/9/1. Y1 - 2012/9/1. N2 - Compared with usual practice, clinical trials often exclude patients with relative contraindications. A study of real-world warfarin use could help inform trials of new medications that could potentially replace warfarin. The objective of this study was to describe potential barriers to warfarin use among patients with atrial fibrillation. This was a retrospective study of electronic medical records (1998-2007) from an inner-city public hospital and affiliated primary care clinics and included adults aged 18 years or more with atrial fibrillation. Exclusions included mitral or aortic valve replacement, hyperthyroidism, or no clinical encounter within 1 year after first diagnosis. Warfarin exposure was defined ...

A 72-year-old woman with a past history of untreated hypertension presents with palpitations, shortness of breath and ankle swelling for the past 72 h. Examination shows that she has atrial fibrillation with a ventricular rate of 162 bpm, a blood pressure of 146/78 mm Hg and signs of mild left ventricular failure (LVF), both clinically and on the chest x ray. ECG shows atrial fibrillation with a ventricular rate of 160 bpm and voltage criteria for left ventricular hypertrophy. You decide that ventricular rate control is the most appropriate therapy for her. You have been told recently that the chronotropic effects of digoxin are of slow onset and amiodarone runs the risk of cardioversion. You wonder therefore whether diltiazem, a calcium antagonist, may be of use ...

TY - JOUR. T1 - Amiodarone prophylaxis for atrial fibrillation after cardiac surgery. T2 - Meta-analysis of dose response and timing of initiation. AU - Buckley, Mitchell S.. AU - Nolan, Paul E.. AU - Slack, Marion K.. AU - Tisdale, James E.. AU - Hilleman, Daniel E.. AU - Copeland, Jack G.. PY - 2007/3. Y1 - 2007/3. N2 - Study Objective. To investigate a possible dose-response relationship between amiodarone and reduction in incidence of postoperative atrial fibrillation, and to determine whether pre- or postoperative initiation of amiodarone is superior. Design. Meta-analysis of randomized controlled trials. Data Source. MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials for English-language reports published between 1966 and December 2005. Measurements and Main Results. Of 23 identified randomized controlled trials of amiodarone prophylaxis of postoperative atrial fibrillation, 14 were included in the final analysis. These studies enrolled a total of 2864 ...

Introduction: Esophageal injury is a potential complication after catheter ablation of the posterior left atrium (LA). Therefore, we describe a new approach for complete isolation of the posterior LA including all pulmonary veins (PVs) without vertical lesions along the esophageal aspect of the posterior LA, namely Box isolation.. Methods and Results: Ninety-one patients with paroxysmal atrial fibrillation (AF) underwent Box isolation. Continuous lesions at the anterior portions of the ipsilateral PVs were initially created and then linear ablation of LA roof and bottom was performed to isolate the posterior LA. Continuous vertical lesions at the posterior portions of PVs along the esophageal aspect of the posterior LA were not created. Ablation was performed with an 8-mm-tip catheter. The endpoint was the absence of electrical activity and the inability to pace the posterior LA and all PVs in sinus rhythm. Complete isolation of the posterior LA was achieved in 82 patients (90%). Ablation ...

Anticoagulants/therapeutic use; Atrial Appendage/*physiopathology; Atrial Fibrillation/etiology/*prevention & control; Heart Catheterization; Humans; Patient Selection; *Prostheses and Implants/adverse effects; Prosthesis Design; Safety; Treatment Outcome; Warfarin/therapeutic ...

The Global Atrial Fibrillation Market is expected to reach USD 16.17 billion by 2020 growing at a CAGR of 13.2%, according to a new study by Grand View Research, Inc. Growing incidences of atrial fibrillation, strokes and brain damage due to blood clots coupled with a growing global base of geriatric population is expected to be a key driver for this market. Some of the other drivers of this market include the introduction of technological advancements in the fields of radiofrequency and microwave catheter ablation, growing demand for minimally invasive procedures and increasing prevalence of disease causing lifestyle habits such as smoking and excessive alcohol consumption. Pharmacological products for Atrial Fibrillation dominated the overall market in terms of revenue in 2013 at over 55.0%. Relatively low prices associated with these products and the use of anti-coagulants as an add-on therapy to non-pharmacological procedures, are some of the drivers of this segment.. ...

TY - JOUR. T1 - Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation. T2 - a randomised non-inferiority trial. AU - Holmes, David R.. AU - Reddy, Vivek Y.. AU - Turi, Zoltan G.. AU - Doshi, Shephal K.. AU - Sievert, Horst. AU - Buchbinder, Maurice. AU - Mullin, Christopher M.. AU - Sick, Peter. PY - 2009/8/21. Y1 - 2009/8/21. N2 - Background: In patients with non-valvular atrial fibrillation, embolic stroke is thought to be associated with left atrial appendage (LAA) thrombi. We assessed the efficacy and safety of percutaneous closure of the LAA for prevention of stroke compared with warfarin treatment in patients with atrial fibrillation. Methods: Adult patients with non-valvular atrial fibrillation were eligible for inclusion in this multicentre, randomised non-inferiority trial if they had at least one of the following: previous stroke or transient ischaemic attack, congestive heart failure, diabetes, ...

New life-saving treatments for Atrial fibrillation in clinical trial on Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II - ORBIT AF II - Phase II of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF II) is designed to evaluate the utilization of target-specific antithrombotic agents, such as factor Xa (FXa) inhibitors and direct thrombin inhibitors, and associated outcomes.

BACKGROUND: Both segmental ostial and circumferential extraostial pulmonary vein (PV) isolation have been proven effective in the treatment of atrial fibrillation (AF). However, the recurrence of AF and PV conduction after the 2 ablation strategies h

TY - JOUR. T1 - Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair. T2 - A feasibility, safety, and efficacy study. AU - Lakkireddy, Dhanunjaya. AU - Rangisetty, Umamahesh. AU - Prasad, Subramanya. AU - Verma, Atul. AU - Biria, Mazda. AU - Berenbom, Loren. AU - Pimentel, Rhea. AU - Emert, Martin. AU - Rosamond, Thomas. AU - Fahmy, Tamer. AU - Patel, Dimpi. AU - Biase, Luigi Di. AU - Schweikert, Robert. AU - Burkhardt, David. AU - Natale, Andrea. PY - 2008/11/1. Y1 - 2008/11/1. N2 - Intracardiac Echo-Guided Radiofrequency Catheter. Introduction: 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. Method: We prospectively compared post-ASD/patent foramen ovale (PFO) ...

Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting. Atrial remodeling has been observed in AF and has been associated with the development of this arrhythmia. Because 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) have been demonstrated to modify remodeling, we hypothesized a protective role of statins against postoperative AF. We also hypothesized that extracellular matrix turnover and brain natriuretic peptide (BNP) might be related to such atrial remodeling. We studied 234 consecutive patients who underwent coronary artery bypass grafting (173 men; 65 +/- 9 years of age) in whom the occurrence of postoperative AF was monitored. In a subgroup of 66 patients, we measured plasma levels of matrix metalloproteinase-1 (MMP-1), its inhibitor, tissue inhibitor matrix metalloproteinase-1 (TIMP-1; as indexes of extracellular matrix remodeling), and N-terminus pro-BNP (related to left ventricular function) at baseline and at 24 hours after surgery. Of 234 ...

BACKGROUND: The anti-inflammatory or anti-arrhythmic effects of n-3 long-chain polyunsaturated fatty acids (LC-PUFA) may decrease the risk of postoperative atrial fibrillation (POAF), but interventional studies have yielded conflicting results. We examined the association between n-3 LC-PUFA and n-6 LC-PUFA in plasma phospholipids (PL) and POAF in patients undergoing coronary artery bypass grafting (CABG). METHODS: A total of 125 patients undergoing CABG were enrolled in the study. The levels of fatty acids in PL were measured preoperatively and on the third postoperative day. The endpoint was defined as POAF lasting ≥5 min. The incidence of POAF was compared between quartiles of the level of each fatty acid in plasma PL by univariate and multivariable analysis. RESULTS: The incidence of POAF was 49·6%. By univariate analysis, the incidence of POAF increased significantly with each higher quartile of pre- and postoperative docosahexaenoic acid (DHA) and diminished significantly with each ...

Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of isch …

Oral anticoagulant therapy is the mainstay of stroke prevention in patients with atrial fibrillation; it is highly effective at reducing stroke risk, but its use can be limited by increased risk of bleeding. As new oral anticoagulants are available, barriers to optimal use of oral anticoagulation therapy warrant consideration by healthcare professionals and administrators who are seeking to optimize the quality of care for patients with atrial fibrillation.

Background- Segmental ostial catheter ablation (SOCA) to isolate the pulmonary veins (PVs) and left atrial catheter ablation (LACA) to encircle the PVs both may eliminate paroxysmal atrial fibrillation (PAF). The relative efficacy of these 2 techniques has not been directly compared.. Methods and Results- Of 80 consecutive patients with symptomatic PAF (age, 52±10 years), 40 patients underwent PV isolation by SOCA and 40 patients underwent LACA to encircle the PVs. During SOCA, ostial PV potentials recorded with a ring catheter were targeted. LACA was performed by encircling the left- and right-sided PVs 1 to 2 cm from the ostia and was guided by an electroanatomic mapping system; ablation lines also were created in the mitral isthmus and posterior left atrium. The mean procedure and fluoroscopy times were 156±45 and 50±17 minutes for SOCA and 149±33 and 39±12 minutes for LACA, respectively. At 6 months, 67% of patients who underwent SOCA and 88% of patients who underwent LACA were free of ...

The need for this trial arises out of 1) the rapidly increasing number of pts , 60 years of age with AF accompanied by symptoms and morbidity, 2) the failure of anti-arrhythmic drug therapy to maintain sinus rhythm and reduce mortality, 3) the rapidly increasing application of radio-frequency catheter ablation without appropriate evidence-based validation, and 4) the expanding impact of AF on health care costs.. This study will randomize up to 2200 patients to a strategy of catheter ablation versus pharmacologic therapy with rate or rhythm control drugs. Each pt will have 1) characteristics similar to AFFIRM pts (≥65 yo or ,65 with ,1 risk factor for stroke, 2) Documented AF warranting treatment, and 3) Eligibility for both catheter ablation and ≥2 anti-arrhythmic or ≥2 rate control drugs. Pts will be followed every 6 months for an average of approximately 5 years and will undergo repeat trans-telephonic monitor, Holter monitor, and CT/MR studies to assess the impact of treatment.. The ...

Atrial fibrillation is a common heart rhythm abnormality (arrhythmia) in dogs. This arrhythmia affects all dog breeds and frequently coexists with heart failure causing worsening of disease and high mortality. Atrial fibrillation may be managed by administering drugs to slow heart rate or by restoring normal rhythm (cardioversion). Dr. Bright will evaluate dogs with naturally occurring atrial fibrillation and heart failure for their responsiveness to two drugs -- amidodarone, an antiarrhythmic agent, and ranolazine, a drug used in humans with coronary heart disease. She will determine whether ranolazine given with amiodarone prolongs normal rhythm compared to amiodarone alone and whether ranolazine also improves heart function. Results will validate combined ranolazine/amiodarone administration as an improved new treatment for atrial fibrillation in dogs with heart failure, extending their quality of life. Project Summary Atrial fibrillation (AF) is a common heart rhythm abnormality (arrhythmia) that

Introduction: Although current alcohol consumption appears to be a risk factor for incident atrial fibrillation (AF), limitations related to self-reported alcohol use and confounding in observational studies limit the certainty of conclusions regarding causality. Whether cessation of alcohol consumption can protect against incident AF remains unknown.. Methods: We examined all participants in the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort of 15,792 men and women aged 45-65, without prevalent AF. Past alcohol consumption was assessed via self-report during the baseline dietary intake assessment. Cases of incident AF were ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates.. Results: Among 15,262 participants with complete survey data, 2,898 (19.0%) were former drinkers. During an average follow-up of 17.4 years, there were 380 cases of incident AF in former consumers. Both before and after adjustment for potential confounders, a ...

Ferro D and colleagues from Sapienza University of Rome, Rome, Italy have come up with evidence [CIRCEP.111.968248 Published online before print February 23, 2012, doi: 10.1161/?CIRCEP.111.968248] that low serum vitamin E levels are associated with recurrence of atrial fibrillation (AF) after cardioversion. They hypothesise that vitamin E being an antioxidant, low vitamin E levels would correlate with oxidative stress which could have a role in recurrence of atrial fibrillation after cardioversion. The study involved one hundred and forty four patients who had undergone electrical cardioversion with biphasic shocks for non valvar persistent atrial fibrillation. During the three month follow up ninety four patients were in sinus rhythm while fifty had recurrence of atrial fibrillation. Serum vitamin E levels were lower in patients with recurrence of atrial fibrillation (p,0.001). Higher left atrial diameter, urinary isoprostanes, high sensitivity C reactive protein (hsCRP) and sNOX2-dp (soluble ...

Atrial fibrillation is the commonest cardiac arrhythmia. While a number of established drug therapies are often successful in achieving satisfactory control, more recently radiofrequency catheter ablation has emerged as an effective therapy for patients with paroxysmal AF. However, the place of catheter ablation remains unclear with limited data comparing ablation with antiarrhythmic drug therapy as first-line treatment in patients.. In the MANTRA-PAF trial 294 patients (mean age 55) with new onset paroxysmal atrial fibrillation and no history of antiarrhythmic drug use were randomly assigned to an initial strategy of either catheter ablation (146 patients) or therapy with class IC or class III antiarrhythmic agents (148 patients). Follow-up was by 7-day Holter-monitoring at 3, 6, 12, 18, and 24 months. The primary end points were the cumulative and per-visit burden of atrial fibrillation (i.e., percentage of time in atrial fibrillation). During follow-up there was no significant difference ...

Self monitoring is safe and has various studies to prove this. Patients who self monitor have a better life expectancy. Discuss dealing with health professionals when patient knows more about the illness - Patients need to be empowered about there conditions and to give them the confidence to speak with clinicians about what is happening to them. Discuss self monitoring if they wish (not always suitable for APS patients). The NICE Quality Standards for Atrial Fibrillation Statement 6 (developmental) sates Adults with atrial fibrillation on long‑term vitamin K antagonist therapy are supported to self‑manage with a coagulometer. This means that every anticoagulation service in the UK should provide this opportunity to patients. Professor Beverley Hunt Biography: Professor Beverley Hunt is Professor of Thrombosis & Haemostasis at Kings College London and is a Consultant in the Departments of Haematology, Pathology and Rheumatology at Guys & St Thomas NHS Foundation Trust.. She has a ...

Incidence of Direct Oral Anticoagulant use in patients with non-valvular atrial fibrillation and characteristics of users in six European countries (2008-2015): A cross-national drug utilization ...

A study comparing atrial fibrillation patients who do yoga with patients who do not, shows it may improve quality of life, lower heart rate and lower blood pressure.

Denmark MedicalResearch.com: What is the background for this study? What are the main findings?. Response: Atrial fibrillation increases a persons risk of ischemic strokes up to 5-fold. Oral anticoagulation therapy lowers this risk effectively (,60%) and is therefore recommended for patients with atrial fibrillation and at least 1-2 other risk factors for stroke.. Our study show, that oral anticoagulation therapy is still underused in patients with atrial fibrillation - even after a stroke event. In stroke survivors with atrial fibrillation, oral anticoagulation therapy were associated with better outcomes than no oral anticoagulation therapy. MedicalResearch.com: What should readers take away from your report?. Response: Oral anticoagulation therapy is effective (and safe) as secondary stroke prophylaxis in patients with atrial fibrillation.. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Treatment rates with oral anticoagulation ...

TY - JOUR. T1 - Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis. AU - Lin, Ting Tse. AU - Yang, Yao Hsu. AU - Liao, Min Tsun. AU - Tsai, Chia Ti. AU - Hwang, Juey J.. AU - Chiang, Fu Tien. AU - Chen, Pau Chung. AU - Lin, Jiunn Lee. AU - Lin, Lian Yu. PY - 2015/8/4. Y1 - 2015/8/4. N2 - Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of new atrial fibrillation (AF) in a variety of clinical conditions, including the treatment of left ventricular dysfunction or hypertension. Here we assessed whether ACEIs and ARBs could decrease incidence of new-onset AF in patients with end-stage renal disease (ESRD). We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the patients receiving dialysis therapy in Taiwan from ...

BACKGROUND: Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation. METHODS: We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were randomly assigned to receive dronedarone, 400 mg twice a day, or placebo. The primary outcome was the first hospitalization due to cardiovascular events or death. Secondary outcomes were death from any cause, death from cardiovascular causes, and hospitalization due to cardiovascular events. RESULTS: The mean follow-up period was 21+/-5 months, with the study drug discontinued prematurely in 696 of the 2301 patients (30.2%) receiving dronedarone and in 716 of the 2327 patients (30.8%) receiving placebo, mostly because of adverse events. The primary outcome occurred in 734 patients (31.9%) in the dronedarone group and in 917 patients (39.4%) in the placebo group, with a hazard ratio for ...

To the Editor:. Catheter ablation is an important treatment for recurrent, symptomatic atrial fibrillation (AF). The original procedure targeted focal triggers of AF arising from within the pulmonary veins (PVs). This technique generated minimal left atrial (LA) scar but was complicated by the development of PV stenosis (1). Pulmonary vein antral isolation (PVAI) creates circular ablation lines within the left atrium, minimizing the risk for PV stenosis, and has become the preferred procedure for paroxysmal AF ablation. However, when PVAI is combined with adjunctive ablation, as much as 40% of the LA myocardium may be replaced by scar during a single catheter ablation (2), raising a concern that the procedure may adversely affect the ability of the left atrium to act as a contractile chamber (transport function) and/or compliance chamber (reservoir function). Although prior studies have examined the effect of AF ablation (3) and scar (4) on LA contractility, the effect on LA compliance has ...

Good evidence exists that adjusted-dose warfarin reduces the risk for stroke in patients with nonvalvular atrial fibrillation (1). However, because regular monitoring of the INR is required and because of the risk for hemorrhage, a safer alternative is desirable. Aspirin is safer and more convenient but less effective than warfarin (2, 3). This study was restricted to patients who had at least 1 risk factor for stroke in addition to atrial fibrillation. In these patients, the effects of low-intensity, fixed-dose warfarin plus aspirin were disappointing; the risk for stroke increased, and the risk for major hemorrhage was not reduced. Patients who are at high risk for stroke stand to gain more from treatment than patients at low risk for stroke, and the SPAF III study confirms the benefit of adjusted-dose warfarin for these patients. Increasing evidence supports a target range of 2.0 to 3.0 for the INR. The risk for stroke rises steeply if the INR is , 2, and the risk for hemorrhage rises if it ...

TY - GEN. T1 - How Accurately Can We Detect Atrial Fibrillation Using Photoplethysmography Data Measured in Daily Life?. AU - Eerikäinen, Linda M.. AU - Bonomi, Alberto G.. AU - Schipper, Fons. AU - Dekker, Lukas. AU - Vullings, Rik. AU - De Morree, Helma M.. AU - Aarts, Ronald M.. PY - 2019/9. Y1 - 2019/9. N2 - Photoplethysmography (PPG) is an unobtrusive measurement modality recently explored for the detection of atrial fibrillation (AF). When used in wrist-worn applications, PPG-monitoring can be used for long-term monitoring in daily life, which is beneficial when aiming to detect AF. The objective of this study was to investigate whether the performance of an AF detection model trained and tested on short measurements is generalizable to measurements in daily life. PPG, accelerometer, as well as reference ECG data were measured from 32 subjects (13 continuous AF, 19 no AF) in 24-hour monitoring in daily life. An AF detection model combining inter-pulse interval features was trained to ...

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 fibrillation and a risk of stroke to receive, in a blinded fashion, fixed doses of dabigatran--110 mg or 150 mg twice daily--or, in an unblinded fashion, adjusted-dose warfarin. The median duration of the follow-up period was 2.0 years. The primary outcome was stroke or systemic embolism.. RESULTS: Rates of the primary outcome were 1.69% per year in the warfarin group, as compared with 1.53% per year in the group that received 110 mg of dabigatran (relative risk with dabigatran, 0.91; 95% confidence interval [CI], 0.74 to 1.11; P,0.001 for noninferiority) and 1.11% per year in the group that received 150 mg of dabigatran (relative risk, 0.66; 95% CI, 0.53 to 0.82; P,0.001 for superiority). The rate of major ...

BACKGROUND The success rate after cryoballoon ablation (CB-A) performed for paroxysmal atrial fibrillation (PAF) might be underestimated by traditional noninvasive monitoring techniques. The purpose of this study was to evaluate the mid-term outcome o

The recent introduction of direct-current external electric shock for the restoration of a normal sinus mechanism in patients with atrial fibrillation has reopened the question of the desirability of restoring a normal sinus pacemaker. To determine whether restoration of a sinus rhythm is hemodynamically beneficial to some or all patients, we have measured the cardiac output in a group of 47 patients with atrial fibrillation in whom an attempt at conversion was about to be made. The cardiac output determination was repeated if restoration of a normal sinus rhythm was accomplished.. All patients were given digitalis in doses sufficient to ...

The goal of the trial was to evaluate treatment with high-frequency source ablation compared with circumferential pulmonary vein isolation among patients with symptomatic drug-refractory atrial fibrillation (AF).. Contribution to the Literature: The RADAR-AF trial showed that high-frequency source ablation plus circumferential pulmonary vein isolation was not superior to circumferential pulmonary vein isolation alone.. ...

TY - JOUR. T1 - Esmolol versus diltiazem in atrial fibrillation following coronary artery bypass graft surgery. AU - Hilleman, Daniel E.. AU - Reyes, Antonio P.. AU - Mooss, Aryan N.. AU - Packard, Kathleen A.. N1 - Copyright: Copyright 2008 Elsevier B.V., All rights reserved.. PY - 2003. Y1 - 2003. N2 - Purpose: Atrial fibrillation (AF) is the most common arrhythmic complication following coronary artery bypass graft surgery (CABG). The efficacy and safety of esmolol and diltiazem were compared in patients with post-CABG AF. Methods: This study was a retrospective medical record review of consecutive patients with post-CABG AF ≥15 min in duration with a ventricular rate ≥110 b.p.m. who received either i.v. esmolol (n = 59) or i.v. diltiazem (n = 48) with or without concomitant digoxin therapy at a single university-affiliated teaching hospital. Treatment success was defined as either cardioversion to sinus rhythm or a reduction in the ventricular rate to ≤90 b.p.m. at 24h after the start ...

TY - JOUR. T1 - Clinical significance of additional ablation of atrial premature beats after catheter ablation for atrial fibrillation. AU - Kim, In Soo. AU - Yang, Pil Sung. AU - Kim, Tae Hoon. AU - Park, Junbeum. AU - Park, Jin Kyu. AU - Uhm, Jae Sun. AU - Joung, Boyoung. AU - Lee, Moon Hyoung. AU - Pak, Hui Nam. PY - 2016/1. Y1 - 2016/1. N2 - Purpose: The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. Materials and Methods: We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 μg/min), monitored for 10 min after internal cardioversion, and ...

OBJECTIVE: Atrial fibrillation puts patients at significant risk for embolic stroke originating from the left atrial appendage. Few means are available for safe, effective, and durable left atrial appendage occlusion. A new clip device was evaluated with regard to safety and effectiveness for epicardial left atrial appendage occlusion. METHODS: Patients with atrial fibrillation undergoing elective cardiac surgery through a median sternotomy were enrolled for concomitant epicardial clip placement. Early postoperative and 3-month follow-up computed tomography studies were used to assess clip stability and left atrial appendage perfusion. RESULTS: From September 2007 to December 2008, 34 patients underwent successful clip placement. No device-related complications occurred. Operative mortality was 8.8% and not study or device related. Deployment was rapid, and left atrial appendage occlusion was confirmed by intraoperative transesophageal echocardiography in all patients. In addition to excellent ...

TY - JOUR. T1 - Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation. AU - Yorgun, Hikmet. AU - Canpolat, Ugur. AU - Oksul, Metin. AU - Sener, Yusuf Ziya. AU - Ates, Ahmet Hakan. AU - Crijns, Harry J. G. M.. AU - Aytemir, Kudret. PY - 2019/11. Y1 - 2019/11. KW - Atrial fibrillation. KW - Pulmonary vein isolation. KW - Cryoballoon. KW - Left atrial appendage isolation. KW - CATHETER ABLATION. KW - ELECTRICAL ISOLATION. KW - FLOW. U2 - 10.1093/europace/euz232. DO - 10.1093/europace/euz232. M3 - Article. C2 - 31504432. VL - 21. SP - 1653. EP - 1662. JO - EP Europace. JF - EP Europace. SN - 1099-5129. IS - 11. ER - ...

AIMS: To evaluate the effects of pulmonary vein isolation (PVI) in terms of feasibility, safety and success rate on a midterm follow-up period in septuagenarians undergoing ablation with the Arctic Front Cryoballoon for atrial fibrillation (AF). METHODS AND RESULTS: We prospectively enrolled 21 patients aged 70 years or older (14 male; age 73 +/- 2.5 years) elected to circumferential PVI with the 28mm cryoballoon for symptomatic drug resistant paroxysmal AF. A total number of 82 pulmonary veins (PV) were evidenced. Successful isolation could be obtained in all 82 (100%) PV ostia at the end of procedure. No major complication occurred during procedure. At a mean follow-up of 11.5 +/- 4.7 months following ablation, 62% of patients did not present recurrence of atrial arrhythmias. CONCLUSION: Cryoballoon ablation may be feasible and safe in older patients. Moreover a large proportion of the latter did not present AF recurrence during follow-up ...

Introduction: Pulmonary veins isolation (PVI) is useful method in patients (pts) with mitral valve disease (MVD) and chronic atrial fibrillation (AF) during prosthetic valve implantation. The aim of the study: To evaluate e.ectiveness of PVI in the treatment of AF in pt with MVD during valve implantation. Material and methods: 45 pts (mean age 55 yrs) with AF were operated on for MVD.RF ablation around the pulmonary veins, a lesion between them and to the mitral annulus were performed. There were 44 prostheses implanted, 1 case of mitral valve annuloplasty, associated with tricuspid valve repair (5 pts), aorto-coronary bypass procedure (2 pts), ASD II closure (1 pt). Results: SR was achieved in 2 (44,5%) pts, 21 (46,5%)pts were in AF, 4 (9%) pts needed pacing. No correlation between SR restoration and preoperative echocardiographic parameters, age, gender, NYHA functional class were found. In long-term follow-up 1 pt have reversed AF to SR spontaneously. There were 6 cases of paroxysmal AF,1 pt ...

Introduction: Warfarin reduces stroke risk in atrial fibrillation (AF), but increases bleed risk. Frequent testing with dose adjustment is needed to maintain INR levels in the therapeutic range of 2.0-3.0. Novel anticoagulants (NOACs) now challenge warfarin as stroke-preventive therapy for AF. They are available at fixed doses but costlier. Warfarin anticoagulation at a time in therapeutic range (TTR) ≥70% is similarly effective and safe as NOACs. It is unclear whether AF patients with TTR ≥70% will remain stably anticoagulated and avoid the need to switch to a NOAC. We assessed stability of warfarin anticoagulation in AF patients with an initial TTR ≥70% primarily managed by anticoagulation clinics.. Hypothesis: AF patients who achieve TTR ≥70% in the first 6 months of warfarin therapy will maintain high TTR subsequently.. Methods: Within the community-based ATRIA cohort of AF patients, we identified 2521 new warfarin users who continued warfarin therapy over 15 months. We excluded ...

Methods We prospectively studied 44 consecutive patients after successful electrical cardioversion of persistent AF. All patients received standard treatment and were randomised in one to one fashion to either oral vitamin C administration or no additional therapy. We followed-up the patients for 7 days performing successive measurements of white blood cell (WBC) count, C-reactive protein (CRP), fibrinogen, and ferritin levels.. Results One week after successful cardioversion, AF recurred in 4.5% of patients in the vitamin C group and in 36.3% of patients in the control group (p = 0.024). Compared to baseline values, inflammatory indices decreased after cardioversion in patients receiving vitamin C but did not change significantly in the control group. A significant variance was found in the serial measurements of WBC counts (F = 5.86, p = 0.001) and of fibrinogen levels (F = 4.10, p = 0.0084) in the two groups. In the vitamin C group CRP levels were lower on the seventh day (p , 0.05). CRP and ...

BACKGROUND: Radiofrequency ablation (RFA) of paroxysmal atrial fibrillation (PAF) has focused on pulmonary vein isolation (PVI). However, despite initial positive results, significant recurrences have occurred, partly because of pulmonary vein (PV) reconnection or non-PV ectopic foci, including the superior vena cava (SVC).. OBJECTIVES: This prospective, randomized study sought to investigate the efficacy of additional SVCI combined with PVI in symptomatic PAF patients referred for ablation.. METHODS: From November 2011 to May 2013, RFA was performed remotely using a CARTO(®) 3 System in patients randomized to undergo PVI for symptomatic drug-refractory PAF, with (PVI+SVCI group) or without (PVI alone group) SVCI. PVI and SVCI were confirmed by spiral catheter recording during ablation. Procedural data, complications and freedom from atrial tachycardia (AT) and atrial fibrillation (AF) were assessed.. RESULTS: Over an 18-month period, 100 consecutive patients (56±9years; 17 women) with ...

Purpose: This study aimed to establish the role of risk factors in the etiology of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG). ...

At Boston AF, two poster presentations showed that a multidisciplinary procedure that uses both epicardial and endocardial ablation (convergent procedure) is associated with high single procedure efficacy in a patient population dominated by persistent atrial fibrillation and is a viable treatment option for restoring sinus rhythm in patients with persistent atrial fibrillation and enlarged atria.. The aim of the convergent procedure is to be a treatment alternative to patients with atrial fibrillation who have failed previous ablation procedures or who have enlarged atria (,4.5cm), and it uses the skills of both the cardiovascular surgeon and the electrophysiologist. The procedure starts with a cardiovascular surgeon creating bi-atrial lesion patterns epicardially without the need for chest incisions, which is then followed by an electrophysiologist completing the lesion pattern endocardially with catheter ablation. The convergent procedure, which was developed by physicians, has been made ...

Spectral analysis of the first 40 seconds of ventricular fibrillation confirmed the presence of a large periodic component in fibrillation, with a dominant frequency of 9.9 +/- 0.7 Hz and a narrow bandwidth. To determine whether less energy was required for defibrillation at any particular phase of the ventricular fibrillation cycle, the authors studied the effect of synchronization of the countershock to the peaks and troughs of the ventricular fibrillation waveform in 12 dogs anesthetized with sodium pentobarbitone (35 mg/kg iv). There was no significant difference in threshold-delivered energy or threshold-delivered current between shocks synchronized to the peaks of ventricular fibrillation, shocks synchronized to the troughs of ventricular fibrillation, and unsynchronized shocks.

antiarrhythmic medications - MedHelps antiarrhythmic medications Center for Information, Symptoms, Resources, Treatments and Tools for antiarrhythmic medications. Find antiarrhythmic medications information, treatments for antiarrhythmic medications and antiarrhythmic medications symptoms.

Posted on 03/03/2014 8:27:11 PM PST by 2ndDivisionVet. Using a 3D printer, scientists have made an elastic membrane that closely mimics the outer layer of the hearts wall. The new membrane, which was described Tuesday (Feb. 25) in the journal Nature Communications, contains tiny sensors that can track the hearts temperature, pH and level of strain. The device could one day be used to treat patients with rhythm disorders in the lower chambers of the heart, as well as the rhythm disorder atrial fibrillation, the researchers said. Heart rhythm irregularities are a common problem, with one of the most well-known forms, atrial fibrillation, affecting 3 million to 5 million people in the U.S. yearly. Left untreated, rhythm irregularities can cause blood clots, which can lead to stroke. People with atrial fibrillation are often treated with blood thinners or other treatments that may ablate the hearts pacemaker cells and replace them with electrodes. But these techniques are fairly simplistic and ...

We present two cases of proarrhythmia after propafenone treatment. In the first case slowing of the flutter cycle length from 205 ms to 290 ms resulted in a change from well tolerated two to one atrioventricular conduction to one to one conduction with hypotension and presyncope. In the second case organization of atrial fibrillation to atypical atrial flutter and use-dependent left bundle branch block resulted in fast broad QRS tachycardia that mimicked ventricular tachycardia ...

To the editor: Gjesdal et al1 show the result of an exploratory analysis pooling data from the SPORTIF III and V trials. The authors conclude that digitalis may increase mortality.. We have previously shown that anticoagulation therapy is inversely associated, while digoxin (digitalis) and antiarrhythmic drugs are directly associated, with increased mortality after adjustment for other covariates in patients with atrial fibrillation (AF) treated with a rate control compared with patients treated with a rhythm control approach.2 … ...

In assessing the value of FFR, the studys investigators defined management strategies for patients based on angiography results before performing FFR, and then made a final treatment strategy decision after performing FFR. Results showed that management strategy reclassification after performing routine FFR was high and that FFR is safe to use in ACS patients, indicating a management strategy guided by FFR safely leads to changes in physician decision making.. Researchers also assessed the impact of a LAAO in patients with atrial fibrillation and intracerebral hemorrhage versus patients who received standard medical therapy.. The LAAO in atrial fibrillation and intracerebral hemorrhage study found that patients with AF and a prior intracerebral hemorrhage who were treated with a St Jude Medical LAAO device had a lower risk of ischaemic stroke, major bleeding and all-cause mortality compared to patients treated with standard care, suggesting that LAAO offers a major clinical benefit.. Patients ...

We searched our electronic database for all patients aged 18 years or above who developed first ICH in the presence of anticoagulation with warfarin for non-valvular AF (ICH-W group) from the three hospitals, and matched them with a comparison group (ICH-C group) without taking warfarin at a 1:1 ratio for age (±1 year), gender, and admission year. The comparison group comprised patients from the medical unit of PMH (principal study centre) who had a first episode of ICH without anticoagulation, regardless of any AF. Patients with isolated subdural, subarachnoid, or intraventricular haemorrhage were excluded. We retrieved and compared the data regarding neurological impairment and investigation findings, estimated the ICH volume on CT through the ABC/2 method, and calculated the ICH score.3 4 Hospital mortality and 6-month modified Rankin Scale score (mRS, 0-6) were selected as primary and secondary outcomes, respectively. We used independent sample t test and Mann-Whitney U test for univariate ...

Heidbuchel, H.; Anne, W.; Willems, R.; Adams, J.; Van, D.W.rf, F.; Ector, H., 2003: Endurance sports is related to atrial fibrillation development after atrial flutter ablation

A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation ...

To date, there have only been limited data on the prevalence of LA thrombus detection among patients with AF on NOAC therapy. In a subgroup analysis of patients in the RELY (Randomized Evaluation of Long Term Anticoagulant Therapy) study, the rates of LA thrombus detection among patients undergoing TEE before cardioversion were 1.2% to 1.8% for patients on dabigatran (14). In the ARISTOLE (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) study, TEE data were available in 86 patients on apixaban and none of these patients had LA thrombus (15). In an analysis of patients undergoing cardioversions or catheter ablation of AF in 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) study, no TEE data were collected to assess rates of LA thrombus detection among patients on rivaroxaban (16).. In our study, the rate of LA thrombus detection among patients on ...

An implantable system for the defibrillation of the atria of a patients heart comprises (a) a first catheter configured for insertion into the right atrium of the heart; a first atrial defibrillation electrode carried by the first catheter and positioned to stimulate Bachmanns bundle, or positioned at the atrial septum of the heart (i.e., an atrial septum electrode); (b) a second atrial defibrillation electrode which together with the first atrial defibrillation electrode provides a pair of atrial defibrillation electrodes that are configured for orientation in or about the patients heart to effect atrial defibrillation, and (c) a pulse generator operatively associated with the pair of atrial defibrillation electrodes for delivering a first atrial defibrillation pulse to the heart of the patient. The second electrode may be configured for positioning through the coronary sinus ostium and in the coronary sinus or a vein on the surface of the left ventricle, such as the great vein. An additional

Background: Warfarin stays a commonly used anticoagulant in the setting of EndStage Renal Disease (ESRD) and Atrial Fibrillation (AF). Research has in..

A pill-in-the-pocket rhythm-control treatment strategy is acceptable as initial therapy for patients who are quite symptomatic with new-onset paroxysmal AF and no structural heart disease.1 This strategy involves a larger, 1-time dose of a class I antiarrhythmic (propafenone or flecainide). A fast-acting atrioventricular nodal blocking agent such as metoprolol should be used in conjunction to prevent concealed conduction that can progress to ventricular tachycardia or fibrillation. First-time administration requires observation and is usually performed by a cardiologist. Pill-in-the-pocket dosing for flecainide and propafenone can be found in Table 5.1,4,17-19. Dronedarone has received increased attention as a novel agent for the treatment of arrhythmias in the hope of finding a safer alternative to amiodarone therapy. According to data from the ATHENA20 (A Placebo-controlled, Double Blind, Parallel-arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of Cardiovascular ...

Various antiarrhythmic agents can be used to return the heart to normal sinus rhythm. Pharmacological cardioversion is an especially good option in patients with fibrillation of recent onset. Drugs that are effective at maintaining normal rhythm after electric cardioversion can also be used for pharmacological cardioversion. Drugs like amiodarone, diltiazem, verapamil and metoprolol are frequently given before cardioversion to decrease the heart rate, stabilize the patient and increase the chance that cardioversion is successful. There are various classes of agents that are most effective for pharmacological cardioversion. Class I agents are sodium (Na) channel blockers (which slow conduction by blocking the Na+ channel) and are divided into 3 subclasses a, b and c. Class Ia slows phase 0 depolarization in the ventricles and increases the absolute refractory period. Procainamide, quinidine and disopyramide are Class Ia agents. Class 1b drugs lengthen phase 3 repolarization. They include ...

Thyrotoxicosis is associated with cardiac dysfunction; more commonly, left ventricular dysfunction. However, in recent years, there have been more cases reported on right ventricular dysfunction, often associated with pulmonary hypertension in patients with thyrotoxicosis. Three cases of thyrotoxicosis associated with right ventricular dysfunction were presented. A total of 25 other cases of thyrotoxicosis associated with right ventricular dysfunction published from 1994 to 2017 were reviewed along with the present 3 cases. The mean age was 45 years. Most (82%) of the cases were newly diagnosed thyrotoxicosis. There was a preponderance of female gender (71%) and Graves disease (86%) as the underlying aetiology. Common presenting features included dyspnoea, fatigue and ankle oedema. Atrial fibrillation was reported in 50% of the cases. The echocardiography for almost all cases revealed dilated right atrial and or ventricular chambers with elevated pulmonary artery pressure. The abnormal ...

Vascular occlusion of a retinal artery or vein is a common cause of retinal vascular pathology with potential life-changing complications.1 ,2 Retinal vein occlusion (RVO) may differentiate itself from retinal artery occlusion (RAO) in terms of its aetiology and pathology, but both contribute to sight loss or even blindness.. The pathogenesis of RAO is generally accepted to be directly related to atherosclerotic thromboembolism (80%) and cardiac embolism, rarely vasculitis, or thrombophilic states. Importantly, the pathogenesis of RAO and strokes or arterial thromboembolism has many similarities. Indeed, retinal emboli are commonly associated with hypertension, atrial fibrillation, coronary heart disease, increased plasma lipoprotein, and smoking,3 thus we are dealing with a systemic condition, not something simply isolated to the eye ...

John Bullinga, MD and Kurt Schillinger, MD, take opposing views on rotor mapping ablation. Dr. Bullinga, as advocate, argues that the future of atrial fibrillation ablation includes the ablation of rotors (rotational circuits or focal beats). In defending this assertion, he emphasizes recent basic and clinical studies to argue for the existence of rotors in the electrophysiological substrate for AF and for the theoretical efficacy of rotor ablation versus pulmonary vein isolation (PVI) for the elimination for freedom from AF.. In rebuttal, Dr. Schillinger argues that stable electrical rotors do not exist in human AF, that efforts to define their physiological importance in AF are premature and that the efficacy of rotor ablation versus standard pulmonary vein isolation has yet to be demonstrated in randomized, prospective studies.. Both physicians offer counter rebuttals.. ...

Patients randomized to vernakalant received a 10-minute infusion of 3 mg/kg vernakalant in one infusion line, followed by a 15-minute observation period and an additional 10-minute infusion of 2 mg/kg vernakalant if still in AF. To maintain blinding, a 60-minute infusion of placebo (5% dextrose in water) was administered in a second infusion line, followed by a maintenance infusion of placebo for an additional 60 minutes. Patients randomized to amiodarone received a 60-minute infusion of 5 mg/kg amiodarone in one infusion line, followed by a maintenance infusion of 50 mg amiodarone over an additional 60 minutes (equivalent to approximately 15 mg/kg over 24 hours). To maintain blinding, these patients received a 10-minute infusion of placebo (normal saline) in a second infusion line, followed by a 15-minute observation period and a second 10-minute infusion of placebo if still in AF ...

The aim of the present study was to determine whether left atrial size--a likely indicator of atrial stretching--correlates with the plasma concentration of atrial natriuretic peptide and whether this relation is different in patients in sinus rhythm and in those with atrial fibrillation. Arterial plasma concentrations of immunoreactive atrial natriuretic peptide (ir-ANP), adrenaline, noradrenaline, aldosterone, and vasopressin were measured in 13 patients in sinus rhythm without apparent heart failure and in 13 patients in atrial fibrillation. The two groups were matched for left atrial diameter and the ratio of the left atrial diameter to the diameter of the aortic root (assessed by echocardiography). There were no significant differences in age, heart rate, blood pressure, or left ventricular end diastolic diameter between the two groups. Left atrial diameters varied from 33 to 60 mm. The mean (SD) plasma concentration of ir-ANP was significantly higher (35 (21) pmol/l) in the patients with ...

Results:. Patients accumulated more than 66Â 000 person-years of follow-up. The adjusted net clinical benefit of warfarin for the cohort overall was 0.68% per year (95% CI, 0.34% to 0.87%). Adjusted net clinical benefit was greatest for patients with a history of ischemic stroke (2.48% per year [CI, 0.75% to 4.22%]) and for those 85 years or older (2.34% per year [CI, 1.29% to 3.30%]). The net clinical benefit of warfarin increased from essentially zero in CHADS2 stroke risk categories 0 and 1 to 2.22% per year (CI, 0.58% to 3.75%) in CHADS2 categories 4 to 6. The patterns of results were preserved when weighting factors for intracranial hemorrhage of 1.0 and 2.0 were used. ...