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Latest & greatest articles for atrial fibrillation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on atrial fibrillation or other clinical topics then use Trip today.
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Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with AtrialFibrillation: the Valkyrie Study Vitamin K antagonists (VKAs), although commonly used to reduce thromboembolic risk in atrialfibrillation, have been incriminated as probable cause of accelerated vascular calcification (VC) in patients on hemodialysis. Functional vitamin K deficiency may further contribute to their susceptibility for VC. We (...) investigated the effect of vitamin K status on VC progression in 132 patients on hemodialysis with atrialfibrillation treated with VKAs or qualifying for anticoagulation.Patients were randomized to VKAs with target INR 2-3, rivaroxaban 10 mg daily, or rivaroxaban 10 mg daily plus vitamin K2 2000 µg thrice weekly during 18 months. Systemic dp-ucMGP levels were quantified to assess vascular vitamin K status. Cardiac and thoracic aorta calcium scores and pulse wave velocity were measured to evaluate VC
Electrical versus pharmacological cardioversion for emergency department patients with acute atrialfibrillation (RAFF2): a partial factorial randomised trial. Acute atrialfibrillation is the most common arrythmia treated in the emergency department. Our primary aim was to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug-shock), and electrical cardioversion alone (shock-only). Our secondary aim was to compare the effectiveness (...) of two pad positions for electrical cardioversion.We did a partial factorial trial of two protocols for patients with acute atrialfibrillation at 11 academic hospital emergency departments in Canada. We enrolled adult patients with acute atrialfibrillation. Protocol 1 was a randomised, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with intravenous procainamide (15 mg/kg over 30 min) followed by electrical cardioversion if necessary (up to three shocks, each
Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on AtrialFibrillation Recurrence Among Patients With Paroxysmal AtrialFibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial. Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation.To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy.The Evaluate Renal (...) Denervation in Addition to Catheter Ablation to Eliminate AtrialFibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrialfibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrialfibrillation, and plans for ablation were enrolled from April 2013 to March 2018
Alcohol Abstinence in Drinkers with AtrialFibrillation. Excessive alcohol consumption is associated with incident atrialfibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrialfibrillation is unclear.We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol (...) ) per week and who had paroxysmal or persistent atrialfibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrialfibrillation (after a 2-week "blanking period") and total atrialfibrillation burden (proportion of time in atrialfibrillation) during 6 months of follow-up.Of 140 patients who underwent randomization (85% men; mean [±SD] age
[Nurse-led educational intervention in patients with atrialfibrillation discharged from the emergency department reduces complications and shortterm admissions]. To assess whether a nurse-led patient educational intervention for patients with atrialfibrillation (AF) discharged from the emergency department (ED) can improve the patients' understanding of arrhythmia and its treatment and reduce the number of complications and arrhythmia-related admissions.Prospective study of an intervention
Should This Patient Be Screened for AtrialFibrillation?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Atrialfibrillation (AFib) is the most common type of cardiac arrhythmia, affecting 2.7 million to 6.1 million persons in the United States. Although some persons with AFib have no symptoms, others do. For those without symptoms, AFib may be detected by 12-lead electrocardiogram (ECG), single-lead monitors (such as ambulatory blood pressure monitors and pulse oximeters (...) ), or consumer devices (such as wearable monitors and smartphones). Pulse palpation and heart auscultation also may detect AFib. In a systematic review, screening with ECG identified more new cases of AFib than no screening. Atrialfibrillation is an important cause of stroke, and without anticoagulant treatment, patients with AFib have approximately a 5-fold increased risk for stroke. The U.S. Preventive Services Task Force reviewed the benefits and harms of ECG screening for AFib in adults aged 65 years
Antithrombotic Therapy in Patients With AtrialFibrillation and Acute Coronary Syndrome Treated Medically or With Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial The safety and efficacy of antithrombotic regimens may differ between patients with atrialfibrillation who have acute coronary syndromes (ACS), treated medically or with percutaneous coronary intervention (PCI), and those undergoing elective PCI.Using a 2×2 (...) factorial design, we compared apixaban with vitamin K antagonists and aspirin with placebo in patients with atrialfibrillation who had ACS or were undergoing PCI and were receiving a P2Y12 inhibitor. We explored bleeding, death and hospitalization, as well as death and ischemic events, by antithrombotic strategy in 3 prespecified subgroups: patients with ACS treated medically, patients with ACS treated with PCI, and those undergoing elective PCI.Of 4614 patients enrolled, 1097 (23.9%) had ACS treated
Association of Anticoagulant Therapy With Risk of Fracture Among Patients With AtrialFibrillation Warfarin is prescribed to patients with atrialfibrillation (AF) for the prevention of cardioembolic complications. Whether warfarin adversely affects bone health is controversial. The availability of alternate direct oral anticoagulant (DOAC) options now make it possible to evaluate the comparative safety of warfarin in association with fracture risk.To test the hypothesis that, among patients
Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident AtrialFibrillation in a Healthy Population (From a Nationwide Danish Cohort Study) A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrialfibrillation (AF), with good discrimination and internal calibration. To define high-risk patients
Cryoballoon or Radiofrequency Ablation for AtrialFibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial Advanced generation ablation technologies have been developed to achieve more effective pulmonary vein isolation (PVI) and minimize arrhythmia recurrence after atrialfibrillation (AF) ablation.We randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force-guided radiofrequency ablation (CF-RF; n=115), 4-minute cryoballoon ablation (Cryo-4; n=115 (...) ), or 2-minute cryoballoon ablation (Cryo-2; n=116). Follow-up was 12 months. The primary outcome was time to first documented recurrence of symptomatic or asymptomatic atrial tachyarrhythmia (AF, atrial flutter, or atrial tachycardia) between days 91 and 365 after ablation or a repeat ablation procedure at any time. Secondary end points included freedom from symptomatic arrhythmia and AF burden. All patients received an implantable loop recorder.One-year freedom from atrial tachyarrhythmia defined
Large-Scale Assessment of a Smartwatch to Identify AtrialFibrillation. Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrialfibrillation during typical use is unknown.Participants without atrialfibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatch-based irregular pulse notification algorithm identified possible atrialfibrillation (...) , a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days. Surveys were administered 90 days after notification of the irregular pulse and at the end of the study. The main objectives were to estimate the proportion of notified participants with atrialfibrillation shown on an ECG patch and the positive predictive value of irregular pulse intervals with a targeted confidence interval width of 0.10.We recruited 419,297 participants
Nurse-led vs. usual-care for atrialfibrillation Nurse-led integrated care is expected to improve outcome of patients with atrialfibrillation compared with usual-care provided by a medical specialist.We randomized 1375 patients with atrialfibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint
Maximum-fixed energy shocks for cardioverting atrialfibrillation Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation.In a single-centre, single-blinded, randomized trial, we allocated elective atrialfibrillation patients to cardioversion using maximum-fixed (360 (...) -360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm 1 min after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ± standard deviation age: 68 ± 9 years, male: 72%, atrialfibrillation duration >1 year: 30%). Sinus rhythm 1 min after cardioversion
Antithrombotic Therapy for AtrialFibrillation with Stable Coronary Disease. There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrialfibrillation and stable coronary artery disease.In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrialfibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had (...) for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01 for superiority).As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrialfibrillation and stable coronary artery disease. (Funded by the Japan Cardiovascular Research Foundation; AFIRE
An artificial intelligence-enabled ECG algorithm for the identification of patients with atrialfibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Atrialfibrillation is frequently asymptomatic and thus underdetected but is associated with stroke, heart failure, and death. Existing screening methods require prolonged monitoring and are limited by cost and low yield. We aimed to develop a rapid, inexpensive, point-of-care means of identifying patients with atrial (...) fibrillation using machine learning.We developed an artificial intelligence (AI)-enabled electrocardiograph (ECG) using a convolutional neural network to detect the electrocardiographic signature of atrialfibrillation present during normal sinus rhythm using standard 10-second, 12-lead ECGs. We included all patients aged 18 years or older with at least one digital, normal sinus rhythm, standard 10-second, 12-lead ECG acquired in the supine position at the Mayo Clinic ECG laboratory between Dec 31, 1993
Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrialfibrillation. Atrialfibrillation is the most frequent sustained arrhythmia. Atrialfibrillation often recurs after restoration of normal sinus rhythm. Antiarrhythmic drugs have been widely used to prevent recurrence. This is an update of a review previously published in 2006, 2012 and 2015.To determine the effects of long-term treatment with antiarrhythmic drugs on death, stroke, drug adverse effects and recurrence (...) of atrialfibrillation in people who had recovered sinus rhythm after having atrial fibrillation.We updated the searches of CENTRAL, MEDLINE and Embase in January 2019, and ClinicalTrials.gov and WHO ICTRP in February 2019. We checked the reference lists of retrieved articles, recent reviews and meta-analyses.Two authors independently selected randomised controlled trials (RCTs) comparing any antiarrhythmic drug with a control (no treatment, placebo, drugs for rate control) or with another
Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrialfibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. We aimed to assess the safety of edoxaban in combination with P2Y12 inhibition in patients with atrialfibrillation who had percutaneous coronary intervention (PCI).ENTRUST-AF PCI was a randomised, multicentre, open-label, non-inferiority phase 3b trial with masked outcome evaluation, done (...) at 186 sites in 18 countries. Patients had atrialfibrillation requiring oral anticoagulation, were aged at least 18 years, and had a successful PCI for stable coronary artery disease or acute coronary syndrome. Participants were randomly assigned (1:1) from 4 h to 5 days after PCI using concealed, stratified, and blocked web-based central randomisation to either edoxaban (60 mg once daily) plus a P2Y12 inhibitor for 12 months or a vitamin K antagonist (VKA) in combination with a P2Y12 inhibitor
Rate or Rhythm Control in Older AtrialFibrillation Patients: Risk of Fall-Related Injuries and Syncope Management of atrialfibrillation (AF) with rate and/or rhythm control could lead to fall-related injuries and syncope, especially in the older AF population. We aimed to determine the association of rate and/or rhythm control with fall-related injuries and syncope in a real-world older AF cohort.A retrospective cohort study.Danish nationwide administrative registries from 2000 to 2015