Latest & greatest articles for atrial fibrillation

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Top results for atrial fibrillation

801. Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. (PubMed)

Management of atrial fibrillation: review of the evidence for the role of pharmacologic therapy, electrical cardioversion, and echocardiography. PURPOSE: This review summarizes the available evidence regarding the efficacy of medications used for ventricular rate control, stroke prevention, acute conversion, and maintenance of sinus rhythm, as well as the efficacy of electrical cardioversion and the use of echocardiography in patients with atrial fibrillation. DATA SOURCES: The Cochrane (...) Collaboration's database of controlled clinical trials and MEDLINE. STUDY SELECTION: Primarily randomized, controlled trials of medications. DATA EXTRACTION: Paired reviewers obtained data on efficacy and safety. Strength of evidence was assessed. DATA SYNTHESIS: Recent clinical trial results showed that most patients with atrial fibrillation have similar outcomes with strategies for controlling ventricular rate compared with strategies for restoring sinus rhythm. For efficacy of primary stroke prevention

2003 Annals of Internal Medicine

802. Management of newly detected atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. (PubMed)

Management of newly detected atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. The Joint Panel of the American Academy of Family Physicians and the American College of Physicians, in collaboration with the Johns Hopkins Evidence-based Practice Center, systematically reviewed the available evidence on the management of newly detected atrial fibrillation and developed recommendations for adult patients (...) with first-detected atrial fibrillation. The recommendations do not apply to patients with postoperative or post-myocardial infarction atrial fibrillation, patients with class IV heart failure, patients already taking antiarrhythmic drugs, or patients with valvular disease. The target physician audience is internists and family physicians dedicated to primary care. The recommendations are as follows: RECOMMENDATION 1: Rate control with chronic anticoagulation is the recommended strategy for the majority

2003 Annals of Internal Medicine

803. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. (PubMed)

Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. BACKGROUND: The incidence of stroke in patients with atrial fibrillation is greatly reduced by oral anticoagulation, with the full effect seen at international normalized ratio (INR) values of 2.0 or greater. The effect of the intensity of oral anticoagulation on the severity of atrial fibrillation-related stroke is not known but is central to the choice of the target INR. METHODS: We studied (...) incident ischemic strokes in a cohort of 13,559 patients with nonvalvular atrial fibrillation. Strokes were identified through hospitalization data bases and validated on the basis of medical records, which also provided information on the use of warfarin or aspirin, the INR at admission, and coexisting illnesses. The severity of stroke was graded according to a modified Rankin scale. Thirty-day mortality was ascertained from hospitalization and mortality files. RESULTS: Of 596 ischemic strokes, 32

2003 NEJM

804. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. (PubMed)

A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. CONTEXT: Prior risk stratification schemes for atrial fibrillation (AF) have been based on randomized trial cohorts or Medicare administrative databases, have included patients with established AF, and have focused on stroke as the principal outcome. OBJECTIVE: To derive risk scores for stroke alone and stroke or death in community-based individuals (...) with new-onset AF. DESIGN, SETTING, AND PARTICIPANTS: Prospective, community-based, observational cohort in Framingham, Mass. We identified 868 participants with new-onset AF, 705 of whom were not treated with warfarin at baseline. Risk scores for stroke (ischemic or hemorrhagic) and stroke or death were developed with censoring when warfarin initiation occurred during follow-up. Event rates were examined in low-risk individuals, as defined by the risk score and 4 previously published risk schemes

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2003 JAMA

805. Lessons from the Stroke Prevention in Atrial Fibrillation trials. (PubMed)

Lessons from the Stroke Prevention in Atrial Fibrillation trials. Atrial fibrillation predisposes to left atrial thrombus formation and carries a sixfold increased risk for stroke. Antithrombotic therapies are the mainstay for stroke prevention. The National Institute of Neurological Disorders and Stroke-sponsored Stroke Prevention in Atrial Fibrillation (SPAF) studies assessed the value of warfarin, aspirin, and their combination for preventing stroke in six multicenter trials involving 3950 (...) participants. This review presents the major results and implications, which offer unique perspectives on antithrombotic therapies for stroke prevention in atrial fibrillation. Warfarin and aspirin reduce stroke. Anticoagulation substantially benefits high-risk patients with atrial fibrillation, while many younger patients with atrial fibrillation have a low stroke rate when given aspirin. Pathogenetic and transesophageal echocardiographic correlations shed light on mechanisms by which antithrombotic

2003 Annals of Internal Medicine

806. Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. (PubMed)

Pulmonary vein stenosis after catheter ablation of atrial fibrillation: emergence of a new clinical syndrome. BACKGROUND: Pulmonary vein isolation is a new, effective curative procedure for selected patients with atrial fibrillation. Pulmonary vein stenosis is a potential complication and may lead to symptoms that are often underrecognized. OBJECTIVE: To describe the clinical course and symptoms associated with pulmonary vein stenosis developing after ablation in the pulmonary veins. DESIGN (...) : Retrospective study. SETTING: Tertiary care referral center. PATIENTS: 335 patients referred for catheter ablation of drug-refractory atrial fibrillation. INTERVENTION: Pulmonary vein electrical isolation using radiofrequency catheter ablation. MEASUREMENTS: Three months after ablation, patients underwent routine screening for pulmonary vein stenosis with spiral computed tomography. Screening was considered earlier if symptoms suggestive of stenosis developed and was repeated at 6 and 12 months if any

2003 Annals of Internal Medicine

807. Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. (PubMed)

Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. 14643116 2003 12 03 2004 02 04 2015 06 16 1474-547X 362 9397 2003 Nov 22 Lancet (London, England) Lancet Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular atrial fibrillation (SPORTIF III): randomised controlled trial. 1691-8 Warfarin (...) prevents ischaemic stroke in patients with non-valvular atrial fibrillation, but dose adjustment, coagulation monitoring, and bleeding risk limit its use. The oral direct thrombin inhibitor ximelagatran represents a potential alternative. We aimed to establish whether ximelagatran is non-inferior to warfarin, within a margin of 2% per year, for prevention of stroke and systemic embolism. We randomised 3410 patients with atrial fibrillation and one or more stroke risk factors to open-label warfarin

2003 Lancet

808. Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation

Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation Institute for Clinical Systems Improvement 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 Institute for Clinical Systems Improvement. Rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation. Bloomington MN: Institute for Clinical Systems Improvement (ICSI) 2003 Authors' objectives This review aims to assess the available evidence on rhythm therapy versus rate control for long-term management of recurrent atrial fibrillation (AF). Authors' conclusions With regard to rhythm therapy versus rate control for long-term management of recurrent

2003 Health Technology Assessment (HTA) Database.

809. Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis

Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis Chevalier P, Durand-Dubief A, Burri H, Cucherat M, Kirkorian G, Touboul P CRD summary This well reported review compared amiodarone with placebo (...) or class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF). Even though the onset of conversion was delayed, the efficacy of amiodarone was similar at 24 hours compared with class Ic drugs. The conclusions reached by the authors seem valid and the limited generalisability of the findings was acknowledged. Authors' objectives To conduct a meta-analysis comparing amiodarone with placebo or class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF). Searching

2003 DARE.

810. Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis

Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis Temporary atrial epicardial pacing as prophylaxis against atrial fibrillation after heart surgery: a meta-analysis Daoud E G, Snow R, Hummel J D, Kalbfleisch S J, Weiss R, Augostini R CRD summary This review assessed the short-term use of pacemakers to prevent (...) atrial fibrillation after heart surgery. The authors concluded that evidence supports the use of pacemakers. The review had a limited search, review methods were not always reported and there was some confusion about numerical values in the paper. These factors make it difficult to assess the reliability of the conclusions. Authors' objectives To assess the effect of pacing therapies for the prevention of new-onset atrial fibrillation following cardiac surgery. Searching MEDLINE, bibliographies of identified

2003 DARE.

811. Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation

Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation De Paola A A, Figueiredo E, Sesso R, Veloso H H, Nascimento L O Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary (...) of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study compared the use of chemical versus electrical cardioversion as an initial treatment to convert atrial fibrillation (AF) to sinus rhythm in patients with persistent AF of less than 6 months. The authors not only compared the initial strategies, but they also evaluated whether a strategy that started with either method followed

2003 NHS Economic Evaluation Database.

812. Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection

Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection Low-dose oral amiodarone prophylaxis reduces atrial fibrillation after pulmonary resection Lanza L A, Visbal A I, DeValeria P A, Zinsmeister A R, Diehl N N, Trastek V F Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief (...) summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of low-dose oral amiodarone (LDOA) as prophylactic treatment for atrial fibrillation (AF) after pulmonary resection. LDOA comprised 200 mg by mouth every 8 hours. Treatment was started after recovery from general anaesthesia and was discontinued at dismissal. Type of intervention Secondary prevention. Economic study type

2003 NHS Economic Evaluation Database.

813. Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources

Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources Goldberg A, Menen M, Mickelsen S, MacIndoe C, Binder M, Nawman R, West G, Kusumoto F M Record Status (...) . Study population The study population comprised patients referred for radiofrequency catheter ablation for drug refractory atrial fibrillation. Setting The setting was secondary care. The economic study was carried out in Albuquerque, USA. Dates to which data relate The effectiveness data were collected for patients referred to the medical centre between June 1996 and June 1997. The cost information was collected for the same time period. The price year was 2001. Source of effectiveness data

2003 NHS Economic Evaluation Database.

814. Atrial fibrillation: strategies to control, combat, and cure. (PubMed)

Atrial fibrillation: strategies to control, combat, and cure. Atrial fibrillation is the commonest clinical arrhythmia, is increasing in incidence and prevalence, and is associated with substantial morbidity and mortality. The arrhythmia may be paroxysmal (self-limiting), persistent (amenable to cardioversion), or permanent. Especially in its paroxysmal form, atrial fibrillation may be initiated by rapidly firing foci, generally located in the proximal pulmonary veins. Sustained (...) atrial fibrillation is maintained by an atrial tissue substrate capable of accommodating many meandering wavelets. With continuing arrhythmia, the electrophysiological properties of the atria change and further facilitate continuing fibrillation. Treatment is aimed at prevention of thromboembolic complications, restoration and maintenance of sinus rhythm, and control of ventricular rate during atrial fibrillation. With greater understanding of the arrhythmia mechanisms, it is becoming possible to offer targeted

2002 Lancet

815. Electrical cardioversion for atrial fibrillation and flutter. (PubMed)

Electrical cardioversion for atrial fibrillation and flutter. BACKGROUND: Atrial fibrillation increases the risk of stroke, increases the risk of cognitive impairment, and adversely affects cardiovascular haemodynamics. Electrical cardioversion for atrial fibrillation has been in use since the 1960s; the rationale is that restoration of sinus rhythm improves cardiovascular haemodynamics, reduces the risk of stroke, and obviates the need for long-term anticoagulation. OBJECTIVES: To assess (...) the effects of electrical cardioversion of atrial fibrillation or atrial flutter on the annual risk of thromboembolic events, strokes and mortality (primary outcomes measures), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcome measures) in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and any aetiology. SEARCH STRATEGY: One reviewer searched the Cochrane

2002 Cochrane

816. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. (PubMed)

Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. 12435257 2002 11 18 2002 11 26 2016 10 17 0098-7484 288 19 2002 Nov 20 JAMA JAMA Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. 2441-8 Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke and other vascular events. To compare the risk of vascular and bleeding events in patients with nonvalvular AF treated (...) with vitamin K -inhibiting oral anticoagulants or acetylsalicylic acid (aspirin). Pooled analysis of patient-level data from 6 published, randomized clinical trials. A total of 4052 patients with AF randomly assigned to receive therapeutic doses of oral anticoagulant or aspirin with or without low-dose oral anticoagulants. Ischemic and hemorrhagic stroke, other cardiovascular events, all-cause death, and major bleeding events. Person-year incidence rates were calculated to provide crude comparisons

2002 JAMA

817. Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. (PubMed)

Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. 12414201 2002 11 04 2002 12 04 2015 06 16 0140-6736 360 9342 2002 Oct 26 Lancet (London, England) Lancet Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial. 1275-9 External cardioversion is a readily available treatment for persistent atrial fibrillation. Although anatomical (...) and electrophysiological considerations suggest that an anterior-posterior electrode position should create a more homogeneous shock-field gradient throughout the atria than an anterior-lateral position, both electrode positions are equally recommended for external cardioversion in current guidelines. We undertook a randomised trial comparing the two positions with the endpoint of successful cardioversion. 108 consecutive patients (mean age 60 years [SD 16]) with persistent atrial fibrillation (median duration 5

2002 Lancet

818. A comparison of rate control and rhythm control in patients with atrial fibrillation. (PubMed)

A comparison of rate control and rhythm control in patients with atrial fibrillation. 12466506 2002 12 05 2002 12 11 2013 11 21 1533-4406 347 23 2002 Dec 05 The New England journal of medicine N. Engl. J. Med. A comparison of rate control and rhythm control in patients with atrial fibrillation. 1825-33 There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate (...) -controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended. We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality. A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary

2002 NEJM

819. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. (PubMed)

A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. 12466507 2002 12 05 2002 12 11 2006 11 15 1533-4406 347 23 2002 Dec 05 The New England journal of medicine N. Engl. J. Med. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. 1834-40 Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation. However, recurrences of atrial fibrillation and side (...) effects of antiarrhythmic drugs offset the benefits of sinus rhythm. We hypothesized that ventricular rate control is not inferior to the maintenance of sinus rhythm for the treatment of atrial fibrillation. We randomly assigned 522 patients who had persistent atrial fibrillation after a previous electrical cardioversion to receive treatment aimed at rate control or rhythm control. Patients in the rate-control group received oral anticoagulant drugs and rate-slowing medication. Patients in the rhythm

2002 NEJM

820. Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials

Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials Hilleman D E, Spinler S A Authors' objectives To evaluate the efficacy and safety of intravenous amiodarone for conversion (...) of recent-onset atrial fibrillation (AF). Searching MEDLINE was searched from January 1975 to March 2001 for studies published in the English language. The search terms were 'atrial fibrillation', 'amiodarone' and 'cardioversion'. Pertinent review articles and the reference lists in the identified studies were examined for additional studies. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs) were eligible. Specific interventions included

2002 DARE.