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Latest & greatest articles for atrial fibrillation
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Stroke prevention in atrial fibrillation. Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding (...) , and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants. The default strategy should be to offer anticoagulant thromboprophylaxis to all patients with atrial fibrillation unless defined as truly low risk by simple validated risk scores, such as CHA2DS2-VASc. Assessment of bleeding risk using the HAS-BLED score should focus attention on reversible bleeding risk factors. Finally, patients need
Rate control in atrial fibrillation. Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate (...) cautiously. Atrioventricular node ablation with pacemaker insertion for rate control should be used as an approach of last resort but is also an option early in the management of patients with atrial fibrillation treated with cardiac resynchronisation therapy. However, catheter ablation of atrial fibrillation should be considered before atrioventricular node ablation. Although rate control is a top priority and one of the first management issues for all patients with atrial fibrillation, many issues
Rhythm control in atrial fibrillation. Many patients with atrial fibrillation have substantial symptoms despite ventricular rate control and require restoration of sinus rhythm to improve their quality of life. Acute restoration (ie, cardioversion) and maintenance of sinus rhythm in patients with atrial fibrillation are referred to as rhythm control. The decision to pursue rhythm control is based on symptoms, the type of atrial fibrillation (paroxysmal, persistent, or long-standing persistent (...) ), patient comorbidities, general health status, and anticoagulation status. Many patients have recurrent atrial fibrillation and require further intervention to maintain long term sinus rhythm. Antiarrhythmic drug therapy is generally recommended as a first-line therapy and drug selection is on the basis of the presence or absence of structural heart disease or heart failure, electrocardiographical variables, renal function, and other comorbidities. In patients who continue to have recurrent
Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. BACKGROUND: Atrial fibrillation is an important cause of morbidity and mortality worldwide, but scant data are available for long-term outcomes in individuals outside North America or Europe, especially in primary care settings. METHODS: We did a cohort study using a prospective registry of patients in 47 countries who presented to a hospital emergency department (...) with atrial fibrillation or atrial flutter as a primary or secondary diagnosis. 15 400 individuals were enrolled to determine the occurrence of death and strokes (the primary outcomes) in this cohort over eight geographical regions (North America, western Europe, and Australia; South America; eastern Europe; the Middle East and Mediterranean crescent; sub-Saharan Africa; India; China; and southeast Asia) 1 year after attending the emergency department. Patients from North America, western Europe, and Australia were
Low performance of bleeding risk models in the very elderly with atrial fibrillation using vitamin K antagonists 27172860 2016 09 25 2016 09 25 1538-7836 14 9 2016 Sep Journal of thrombosis and haemostasis : JTH J. Thromb. Haemost. Low performance of bleeding risk models in the very elderly with atrial fibrillation using vitamin K antagonists. 1715-24 10.1111/jth.13361 Essentials Under-treatment of oral anticoagulation in the elderly with atrial fibrillation is common. As bleeding prediction (...) is challenging, we compared HAS-BLED, ATRIA and HEMORR2 HAGES. All three were associated with major bleeding in the elderly, but with poor predictive abilities. Future studies with focus on elderly-specific risk factors for bleeding are warranted. Background Anticipated bleeding complications contribute to underuse of oral anticoagulants, especially in elderly patients with atrial fibrillation (AF). Bleeding risk models could provide guidance; however, these were developed in the general AFpopulation
Association of Fibroblast Growth Factor 23 With Atrial Fibrillation in Chronic Kidney Disease, From the Chronic Renal Insufficiency Cohort Study 27434583 2018 10 01 2018 11 20 2380-6591 1 5 2016 08 01 JAMA cardiology JAMA Cardiol Association of Fibroblast Growth Factor 23 With Atrial Fibrillation in Chronic Kidney Disease, From the Chronic Renal Insufficiency Cohort Study. 548-56 10.1001/jamacardio.2016.1445 Levels of fibroblast growth factor 23 (FGF23) are elevated in chronic kidney disease (...) (CKD) and strongly associated with left ventricular hypertrophy, heart failure, and death. Whether FGF23 is an independent risk factor for atrial fibrillation in CKD is unknown. To investigate the association of FGF23 with atrial fibrillation in CKD. Prospective cohort study of 3876 individuals with mild to severe CKD who enrolled in the Chronic Renal Insufficiency Cohort Study between June 19, 2003, and September 3, 2008, and were followed up through March 31, 2013. Baseline plasma FGF23 levels
Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation 27617094 2016 09 12 2018 11 13 2050-3369 5 2 2016 Aug Arrhythmia & electrophysiology review Arrhythm Electrophysiol Rev Reduction of Fluoroscopy Time and Radiation Dosage During Catheter Ablation for Atrial Fibrillation. 144-9 10.15420/AER.2016.16.2 Radiofrequency catheter ablation has become the treatment of choice for atrial fibrillation (AF) that does not respond to antiarrhythmic drug therapy (...) and should learn how to decrease radiation exposure by both changing the setting of the system and using complementary imaging technologies. In this review, we aim to discuss the basics of X-ray exposure and suggest practical instructions for how to reduce radiation dosage during AFablation procedures. Yamagata Kenichiro K Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic. Aldhoon Bashar B Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
Apixaban 5 mg Twice Daily and Clinical Outcomes in Patients With Atrial Fibrillation and Advanced Age, Low Body Weight, or High Creatinine: A Secondary Analysis of a Randomized Clinical Trial. 27463942 2016 09 22 2017 02 03 2380-6591 1 6 2016 Sep 01 JAMA cardiology JAMA Cardiol Apixaban 5 mg Twice Daily and Clinical Outcomes in Patients With Atrial Fibrillation and Advanced Age, Low Body Weight, or High Creatinine: A Secondary Analysis of a Randomized Clinical Trial. 673-81 10.1001/jamacardio (...) .2016.1829 In the Apixaban for Reduction of Stroke and Other Thromboembolic Complications in Atrial Fibrillation (ARISTOTLE) trial, the standard dose of apixaban was 5 mg twice daily; patients with at least 2 dose-reduction criteria-80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher-received a reduced dose of apixaban of 2.5 mg twice daily. Little is known about patients with 1 dose-reduction criterion who received the 5 mg twice daily dose of apixaban. To determine
Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. 27438322 2016 07 21 2017 02 03 2380-6591 1 4 2016 Jul 01 JAMA cardiology JAMA Cardiol Efficacy and Safety of Apixaban Compared With Warfarin in Patients With Atrial Fibrillation in Relation to Renal Function Over Time: Insights From the ARISTOTLE Randomized Clinical Trial. 451-60 10.1001/jamacardio.2016.1170 (...) Renal impairment confers an increased risk of stroke, bleeding, and death in patients with atrial fibrillation. Little is known about the efficacy and safety of apixaban in relation to renal function changes over time. To evaluate changes of renal function over time and their interactions with outcomes during a median of 1.8 years of follow-up in patients with atrial fibrillation randomized to apixaban vs warfarin treatment. The prospective, randomized, double-blind Apixaban for Reduction in Stroke
Developing a Complex Educational-Behavioural Intervention: The TREAT Intervention for Patients with Atrial Fibrillation. 27417598 2016 07 15 2016 07 15 2017 02 20 4 1 2016 Jan 14 Healthcare (Basel, Switzerland) Healthcare (Basel) Developing a Complex Educational-Behavioural Intervention: The TREAT Intervention for Patients with Atrial Fibrillation. 10.3390/healthcare4010010 E10 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 AFpatient 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
Topera 3D mapping system (RhythmView Workstation and FIRMap) to guide ablation procedures for atrial fibrillation Topera 3D mapping system (RhythmView Workstation and FIRMap) to guide ablation procedures for atrial fibrillation Topera 3D mapping system (RhythmView Workstation and FIRMap) to guide ablation procedures for atrial fibrillation HAYES, Inc. Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has (...) been made for the HTA database. Citation HAYES, Inc.. Topera 3D mapping system (RhythmView Workstation and FIRMap) to guide ablation procedures for atrial fibrillation. Lansdale: HAYES, Inc.. Healthcare Technology Brief Publication. 2016 Authors' conclusions Description of Technology: The Topera 3D Rotor Mapping Solution, comprising the RhythmView Workstation and the FIRMap catheter, allows physicians to perform intraprocedural mapping of individualized rotors and other electrical sources
Risk of malignant cancer among women with new-onset atrial fibrillation 27438314 2018 10 09 2018 11 13 2380-6591 1 4 2016 07 01 JAMA cardiology JAMA Cardiol Risk of Malignant Cancer Among Women With New-Onset Atrial Fibrillation. 389-96 10.1001/jamacardio.2016.0280 A substantial proportion of patients with atrial fibrillation (AF) die of noncardiovascular causes, and recent studies suggest a link between AFand cancer. To evaluate the associations between AFand cancer in a large, long-term (...) prospective cohort study. In this cohort study, a total of 34 691 women 45 years or older and free of AF, cardiovascular disease, and cancer at baseline were prospectively followed up between 1993 and 2013, for incident AFand malignant cancer within the Women's Health Study, a randomized clinical trial of aspirin and vitamin E for the prevention of cardiovascular disease and cancer. Cox proportional hazards models using time-updated covariates were constructed to assess the association of new-onset AF
Association of atrial fibrillation and cancer 27438312 2018 08 09 2018 11 13 2380-6591 1 4 2016 07 01 JAMA cardiology JAMA Cardiol Association of Atrial Fibrillation and Cancer. 384-6 10.1001/jamacardio.2016.0582 Rahman Faisal F Department of Medicine, Boston University Medical Center, Boston, Massachusetts. Ko Darae D Department of Medicine, Boston University Medical Center, Boston, Massachusetts. Benjamin Emelia J EJ Section of Cardiovascular Medicine, Preventive Medicine, and Epidemiology (...) Haemost. 2013 Aug;110(2):213-22 23595785 Am Heart J. 1951 Feb;41(2):311-5 14818942 J Thromb Haemost. 2015 Jan;13(1):10-6 25330989 Dis Chest. 1957 Oct;32(4):435-40 13473657 JAMA Cardiol. 2016 Jul 1;1(4):389-96 27438314 Atrial Fibrillation Humans Neoplasms 2016 7 21 6 0 2016 7 22 6 0 2018 8 10 6 0 ppublish 27438312 2525425 10.1001/jamacardio.2016.0582 PMC4957662 NIHMS778166
Genetic Investigation into the Paradoxical Differential Risk of Atrial Fibrillation Among Blacks and Whites 27438321 2018 10 09 2018 11 13 2380-6591 1 4 2016 07 01 JAMA cardiology JAMA Cardiol Genetic Investigation Into the Differential Risk of Atrial Fibrillation Among Black and White Individuals. 442-50 10.1001/jamacardio.2016.1185 White persons have a higher risk of atrial fibrillation (AF) compared with black individuals despite a lower prevalence of risk factors. This difference may be due (...) , at least in part, to genetic factors. To determine whether 9 single-nucleotide polymorphisms (SNPs) associated with AFaccount for this paradoxical differential racial risk for AFand to use admixture mapping to search genome-wide for loci that may account for this phenomenon. Genome-wide admixture analysis and candidate SNP study involving 3 population-based cohort studies that were initiated between 1987 and 1997, including the Cardiovascular Health Study (CHS) (n = 4173), the Atherosclerosis Risk
Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study 27438320 2018 10 09 2018 11 13 2380-6591 1 4 2016 07 01 JAMA cardiology JAMA Cardiol Racial Differences in Atrial Fibrillation-Related Cardiovascular Disease and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study. 433-41 10.1001/jamacardio.2016.1025 The adverse outcomes associated with atrial fibrillation (AF) have been studied (...) in predominantly white cohorts. Racial differences in outcomes associated with AFmerit continued investigation. To evaluate the race-specific associations of AFwith stroke, heart failure, coronary heart disease (CHD), and all-cause mortality in a community-based cohort. The Atherosclerosis Risk in Communities (ARIC) Study is a prospective, observational cohort. From 1987 through 1989, the ARIC Study enrolled 15 792 men and women and conducted 4 follow-up examinations (2011-2013) with active surveillance
Comparative effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted nationwide cohort study. OBJECTIVE: To study the effectiveness and safety of the non-vitamin K antagonist oral anticoagulants (novel oral anticoagulants, NOACs) dabigatran, rivaroxaban, and apixaban compared with warfarin in anticoagulant naïve patients with atrial fibrillation. DESIGN: Observational nationwide cohort study. SETTING: Three (...) Danish nationwide databases, August 2011 to October 2015. PARTICIPANTS: 61 678 patients with non-valvular atrial fibrillation who were naïve to oral anticoagulants and had no previous indication for valvular atrial fibrillation or venous thromboembolism. The study population was distributed according to treatment type: warfarin (n=35 436, 57%), dabigatran 150 mg (n=12 701, 21%), rivaroxaban 20 mg (n=7192, 12%), and apixaban 5 mg (n=6349, 10%). MAIN OUTCOME MEASURES: Effectiveness outcomes defined
Systematic screening for the detection of atrial fibrillation. BACKGROUND: Atrial fibrillation (AF), the most common arrhythmia in clinical practice, is a leading cause of morbidity and mortality. Screening for AFin asymptomatic patients has been proposed as a way of reducing the burden of the disease by detecting people who would benefit from prophylactic anticoagulation therapy before the onset of symptoms. However, for screening to be an effective intervention, it must improve the detection (...) of AFand provide benefit for those detected earlier as a result of screening. OBJECTIVES: This review aims to answer the following questions.Does systematic screening increase the detection of AFcompared with routine practice? Which combination of screening population, strategy and test is most effective for detecting AFcompared with routine practice? What safety issues and adverse events may be associated with individual screening programmes? How acceptable is the intervention to the target
Usefulness of CHADS and CHADS-VASc Scores in the Prediction of New-Onset Atrial Fibrillation: A Population-Based Study 27012854 2016 07 25 2017 05 08 2017 05 08 1555-7162 129 8 2016 Aug The American journal of medicine Am. J. Med. Usefulness of CHADS2 and CHA2DS2-VASc Scores in the Prediction of New-Onset Atrial Fibrillation: A Population-Based Study. 843-9 10.1016/j.amjmed.2016.02.029 S0002-9343(16)30286-8 CHADS2 and CHA2DS2-VASc are validated scores used to predict stroke in patients (...) with atrial fibrillation. Many of the individual risk factors included in these scores are also risk factors for atrial fibrillation. We aimed to examine the performance of CHADS2 and CHA2DS2-VASc scores in predicting new-onset atrial fibrillation in subjects without preexisting diagnosis of atrial fibrillation. Using the computerized database of the largest health maintenance organization in Israel, we identified all adults aged 50 years or older without atrial fibrillation prior to January 1, 2012. CHADS2