Last Build Date: Tue, 22 Mar 2016 08:27:40 +0100
Tue, 22 Mar 2016 05:43:04 +0100ConclusionsThe presence of a wide and/or large S-wave in lead I was a powerful predictor of life-threatening ventricular arrhythmias in patients with BrS and no history of cardiac arrest at presentation. However, the prognostic value of a significant S-wave in lead I should be confirmed by larger studies and by an independent confirmation cohort of healthy subjects. (Source: Journal of the American College of Cardiology)
Mon, 21 Mar 2016 00:00:00 +0100Conclusions In this large cohort study of individuals of European ancestry, gene scores for lipid fractions were not associated with incident AF. (Source: PLoS One)
Mon, 21 Mar 2016 00:00:00 +0100(DAVNNT), also known as ‘double fire’, has recently received more attention since it was demonstrated to mimic more common arrhythmias such as atrial premature beats, atrial fibrillation, and ventricular tachycardia. This is important, since mistaken differential diagnoses and the resulting therapeutic decisions have severe consequences for affected patients. DAVNNT is characterized by conduction characteristics of the atrioventricular (AV) node that leads to a double antegrade conduction of one sinoatrial nodal activity via the slow and fast AV nodal pathways. As a result, the most significant hint from an electrocardiogram (ECG) is a P wave followed by two narrow QRS complexes. Although DAVNNT is rather a rare arrhythmia, it now appears to be more common than previously thou...
Mon, 21 Mar 2016 00:00:00 +0100Conclusion BMS 914932 has not been shown to reduce AF burden in patients with PAF and pacemakers using beat-to-beat pacemaker monitoring throughout the study. BMS 914392 was well tolerated and did not affect QTc or reduce heart rate. Trial registration Clinicaltrials.gov: NCT01356914. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion This work demonstrates the ability of a pilot system to classify alerts and improves personalized remote monitoring of patients. In particular, our method allows integration of patient medical history with device alert notifications, which is useful both from medical and resource-management perspectives. The system was able to automatically classify the importance of 1783 AF alerts in 60 patients, which resulted in an 84% reduction in notification workload, while preserving patient safety. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusions HA pacing compared with RVA or RVS pacing seems to be associated with a lower risk of persistent/permanent AF occurrence. The risk of persistent/permanent AF was similar in the RVA vs. RVS groups. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion In PsAF, the addition of CFAE ablation or LALA, in comparison with PVI alone, offers no significant improvement in arrhythmia-free survival. Furthermore, they are associated with increases in both procedural and fluoroscopy times. The optimal ablation strategy for PsAF is currently unclear and needs further refinement. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion First-line ablation for PAF is safe and effective with either RF or CB. The procedure was faster with the CB, but the radiation exposure was higher. Although there was a trend for more recurrences and complications in the RF group, a more favourable risk profile in patients undergoing CB ablation might have biased the results. ClinicalTrials.gov identifier NCT01360008. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusions Left atrial wall thickness can be measured robustly and efficiently across the whole left atrium using a solution of the Laplace equation over a finite element mesh of the left atrium. Further studies are indicated to determine whether the integration of LAWT maps into pre-existing 3D anatomical mapping systems may provide important anatomical information for guiding radiofrequency ablation. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Low P-wave amplitude (<0.1 mV) in lead I is related to LA remodelling and displaced inter-atrial conduction pattern to low septum, and independently predicts clinical recurrence after RFCA in patients with PAF. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion To the best of our knowledge, this is the largest study in the literature investigating the predictors of LAVIR following AF ablation. According to this data, younger patients without hypertension or moderate MR are most likely to experience LAVIR following ablation. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion The aetiology of cardiomyopathy should be taken into consideration for the therapy of ICD patients. The protective role of CRT devices should be pointed out in ischaemic cardiomyopathy (ICM) and a more rigorous antiarrhythmic treatment should be considered for ICM patients with secondary prevention or for dilated cardiomyopathy patients with AF. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Nearly two-thirds of CRT-D patients had AHR episodes within 2.5 years after implantation. Almost 90% of AHRs were indeed AA. Misdetections were caused by far-field sensing or noise. A two-step diagnostic algorithm (>9% of time spent in AHRs and episode duration >36 s) allowed for proper detection of AA with a high hit-rate and specificity. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusion Auricular thrombosis is not an infrequent finding in AFL before CV. Our study suggests the use of TEE screening in AFL, as well as in AF, when patients arrive to clinical attention after more than 48 h from arrhythmia onset. (Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100The purpose of this patient survey was to analyse the knowledge about blood thinning medications relative to gender, age, education, and region of residence in patients with atrial fibrillation (AF). A total of 1147 patients with AF [mean age 66 ± 13 years, 529 (45%) women] from eight European countries responded to this survey. Most patients understood that the indication for anticoagulation therapy was to ‘thin the blood’, but 8.1% responded that the purpose of the medication was to treat the arrhythmia. Patients with college or university grades reported less frequent deviations from their target INR range compared with those without schooling (2.8% vs. 5.1%, P < 0.05). The awareness of anticoagulation-related risk of bleedings was lowest in patients without school...
Mon, 21 Mar 2016 00:00:00 +0100(Source: Europace)
Mon, 21 Mar 2016 00:00:00 +0100Conclusions The present study suggests that C-VKA is superior to I-VKA for AF patients undergoing RFCA. Rivaroxaban is the highest probability to be the optimal alternative to C-VKA among the three non-VKA oral anticoagulants in AF ablation. (Source: Journal of Interventional Cardiac Electrophysiology)
Mon, 21 Mar 2016 00:00:00 +0100The objective of this prospective, cluster randomized controlled trial (IMPACT-AF; ClinicalTrials.gov #NCT02082548) is to determine whether a comprehensive customized intervention will increase the rate and persistence of use of OAC in patients with AF. IMPACT-AF will be conducted in approximately 50 centers in 5 low- to middle-income countries. Before randomization, sites within countries will be paired to match in size, practice type and baseline rate of OAC use. Site pairs will be randomized to intervention versus control. In total, 40 to 70 patients with AF and at least 2 CHA2DS2-VASc risk factors will be enrolled at each site using a consecutive enrollment strategy, with the goal of capturing actual practice patterns. We aim for patients with a new diagnosis of AF to comprise at least...
Mon, 21 Mar 2016 00:00:00 +0100ABSTRACT Several studies investigated the role of physical activity in atrial fibrillation (AF), but the results remain controversial. We aimed to estimate the association between physical activity and incident AF, as well as to determine whether a sex difference existed. We systematically retrieved relevant studies from Cochrane Library, PubMed, and ScienceDirect through December 1, 2015. Data were abstracted from eligible studies and effect estimates pooled using a random‐effects model. Thirteen prospective studies fulfilled inclusion criteria. For primary analysis, neither total physical activity exposure (relative risk [RR]: 0.98, 95% confidence interval [CI]: 0.90‐1.06, P = 0.62) nor intensive physical activity (RR: 1.07, 95% CI: 0.93‐1.25, P = 0.41) was associated with a signif...
Mon, 21 Mar 2016 00:00:00 +0100(Source: Clinical Pharmacokinetics)
Mon, 21 Mar 2016 00:00:00 +0100(Source: Clinical Pharmacokinetics)
Mon, 21 Mar 2016 00:00:00 +0100CHADS2 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. (Source: The American Journal of Medicine)
Sun, 20 Mar 2016 10:11:01 +0100Authors: Adukauskienė D, Čiginskienė A, Adukauskaitė A, Pentiokinienė D, Šlapikas R, Čeponienė I Abstract Coping with cardiovascular diseases (CVD), which are of the main causes of death worldwide, has influenced investigation of high sensitivity CRP (hsCRP) and its role in pathogenesis, prognosis and prevention of CVD. hsCRP can be synthesized in vascular endothelium, atherosclerotic plaques, and theory of inflammatory origin of atherosclerosis is being more widely debated, raising questions, whether higher hsCRP plasma concentration might be the cause or the consequence. Summing up controversial data from multiple studies, guidelines recommend hsCRP testing for both, primary (stratifying CVD risk groups, selecting patients for statin therapy) and secondary CVD prevention ...
Sat, 19 Mar 2016 00:00:00 +0100This article reviews current literature on the risk of stroke with CIED-detected AHRE and raises questions that need further clarification. (Source: Cardiology Clinics)
Sat, 19 Mar 2016 00:00:00 +0100The burden of stroke is increasing due to aging population and unhealthy lifestyle habits. The considerable rise in atrial fibrillation (AF) is due to greater diffusion of risk factors and screening programs. The link between AF and ischemic stroke is strong. The subtype most commonly associated with AF is cardioembolic stroke, which is particularly severe and shows the highest rates of mortality and permanent disability. A trend toward a higher prevalence of cardioembolic stroke in high-income countries is probably due to the greater diffusion of AF and the control of atherosclerotic of risk factors. (Source: Cardiology Clinics)
Sat, 19 Mar 2016 00:00:00 +0100Obesity is associated with an increased likelihood for the development of AF and with worsened AF symptom severity. However, other factors that are correlated with obesity may confound or mediate the relationship of obesity with AF symptom severity. The purpose of this study was to determine if depression and physical inactivity may confound the association of obesity and AF symptom severity. Health status and demographic data were captured by questionnaire for 332 outpatients with documented AF. (Source: The American Journal of Cardiology)
Sat, 19 Mar 2016 00:00:00 +0100Tissue refractoriness to conduction is a crucial electrophysiological factor in determining susceptibility to fibrillation. The relationship between atrial refractoriness and future onset of atrial fibrillation (AF) has not been well studied. (Source: Heart Rhythm)
Sat, 19 Mar 2016 00:00:00 +0100Concomitant use of vitamin K antagonist (VKA) and aspirin (ASA) is becoming increasingly prevalent among atrial fibrillation (AF) patients. We quantified the net clinical benefit of adding ASA to a VKA using nationwide prospective AF registry data. (Source: International Journal of Cardiology)
Sat, 19 Mar 2016 00:00:00 +0100Publication date: Available online 19 March 2016 Source:Canadian Journal of Cardiology Author(s): Marit Wiersma, Robert H. Henning, Bianca J.J.M. Brundel Age comprises the single most important risk factor for cardiac disease development. The incidence and prevalence of cardiac diseases, which represent the main cause of death worldwide, will rise even more due to the aging population. A hallmark of aging is that it is accompanied by a gradual derailment of proteostasis, e.g. the homeostasis of protein synthesis, folding, assembly, trafficking, function and degradation. Loss of proteostasis is highly relevant to cardiomyocytes, as they are post-mitotic cells and therefore not constantly replenished by proliferation. The derailment of proteostasis during aging is thus an important fact...
Sat, 19 Mar 2016 00:00:00 +0100Publication date: Available online 19 March 2016 Source:Cardiac Electrophysiology Clinics Author(s): Rafik Tadros, Stanley Nattel, Jason G. AndradeTeaser Dronedarone is the newest antiarrhythmic drug approved for the maintenance of sinus rhythm in patients with nonpermanent atrial fibrillation (AF). It is a multi-channel blocker with diverse electrophysiologic properties. Dronedarone decreases the incidence of AF recurrence and the ventricular rate during recurrence. Dronedarone decreases rates of cardiovascular hospitalizations in patients with paroxysmal and persistent AF. Dronedarone increases mortality in patients with permanent AF and those with moderate-severe heart failure, and should thus be avoided in these populations. Dronedarone is less effective than amiodarone but also h...
Sat, 19 Mar 2016 00:00:00 +0100Publication date: Available online 18 March 2016 Source:Cardiac Electrophysiology Clinics Author(s): Vincent Algalarrondo, Stanley NattelTeaser Heart disease produces substantial remodeling of K+ channels that in general promotes arrhythmia occurrence. In the case of ventricular arrhythmias, K+ channel remodeling contributes to the arrhythmic risk and increases vulnerability to torsades de pointes with K+ channel inhibiting drugs. Atrial K+ channel remodeling caused by atrial fibrillation promotes arrhythmia stability and presents opportunities for the development of new drugs targeting atrial inward rectifier K+ currents. A better understanding of K+ channel remodeling will help clinicians to appreciate arrhythmia mechanisms and determinants in a variety of clinical situations and to ...
Sat, 19 Mar 2016 00:00:00 +0100(Source: American Journal of Hematology)
Sat, 19 Mar 2016 00:00:00 +0100The purpose of this study was to determine whether new-onset transient postoperative atrial fibrillation (TPAF) affects mortality rates after abdominal aortic aneurysm (AAA) repair and to identify predictors for the development of TPAF. (Source: Journal of Vascular Surgery)
Fri, 18 Mar 2016 23:15:02 +0100Authors: Hishikari K, Kuwahara T, Kimura S, Hikita H, Takahashi A, Isobe M Abstract Primary cardiac lymphoma (PCL) only rarely occurs and it is defined as a lymphoma in which the bulk of the tumor is located within the heart and pericardium. A 53-year-old woman was referred due to dyspnea, and an electrocardiogram exhibited atrial fibrillation (AF). Echocardiography revealed no abnormal findings. Scintigraphy and a lymph node biopsy led to a diagnosis of PCL. After the start of chemotherapy, AF was converted to atrial tachycardia prior to sinus rhythm with a first-degree atrioventricular block, which was finally restored to a normal sinus rhythm. PCL is only rarely encountered, but it should be included in the differential diagnosis as a possible cause of AF, and such AF could be r...
Fri, 18 Mar 2016 17:57:37 +0100(MedPage Today) -- Case Findings: A woman in her nineties presents with sudden changes to her feet, including blisters that were becoming larger and occasionally leaking blood-tinged fluid. The feet were cold to the touch, with no palpable pulses. The patient had a history of atrial fibrillation, and complained of excruciating pain in both feet. What is your diagnosis? (Source: MedPage Today Geriatrics)
Fri, 18 Mar 2016 12:10:02 +0100CONCLUSIONS: The discrete event simulation of the VALUE PVI data demonstrates the potential positive economic value of AF ablation procedures using the cryoballoon. These benefits include more days where overtime is avoided, fewer cumulative overtime hours, and more days with time left for additional usage of EP lab resources. PMID: 26984931 [PubMed - as supplied by publisher] (Source: The Journal of Invasive Cardiology)
Fri, 18 Mar 2016 09:19:14 +0100One of the more vexing problems for cardiac surgeons is how best to approach the patient with ischemic mitral regurgitation (IMR). Through the decades, we have been witness to many different surgical concepts, approaches, and especially opinions. We may encounter IMR in patients with advanced heart disease who seem to have no option other than cardiac transplant or ventricular assist device support; we may see IMR in symptom-free patients with an occluded coronary and no other indication for surgery; we may find IMR in patients with angina in the coronary care unit with 3-vessel disease and no previous infarction; or, perhaps most commonly in the surgical population in patients with IMR, we may find IMR associated with a reduced ejection fraction, significant coronary artery disease, atria...
Fri, 18 Mar 2016 08:59:02 +0100Authors: Sovari AA Abstract Current therapies for arrhythmia using ion channel blockade, catheter ablation, or an implantable cardioverter defibrillator have limitations, and it is important to search for new antiarrhythmic therapeutic targets. Both atrial fibrillation and heart failure, a condition with increased arrhythmic risk, are associated with excess amount of reactive oxygen species (ROS). There are several possible ways for ROS to induce arrhythmia. ROS can cause focal activity and reentry. ROS alter multiple cardiac ionic currents. ROS promote cardiac fibrosis and impair gap junction function, resulting in reduced myocyte coupling and facilitation of reentry. In order to design effective antioxidant drugs for treatment of arrhythmia, it is essential to explore the molecul...
Fri, 18 Mar 2016 08:59:02 +0100Authors: Dallaglio PD, Betts TR, Ginks M, Bashir Y, Anguera I, Rajappan K Abstract The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine ...
Fri, 18 Mar 2016 00:00:00 +0100In conclusion, we need more data and more studies to prove the LAAC principle specifically in the new era of direct oral anticoagulation therapy. (Source: Cor et Vasa)
Fri, 18 Mar 2016 00:00:00 +0100Authors: Rodrigues PG, Leite-Moreira AF, Falcão-Pires I Abstract Heart failure (HF) is a systemic disease that can be divided into HF with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). HFpEF accounts for over 50% of all HF patients and is typically associated to high prevalence of several comorbidities, including hypertension, diabetes mellitus, pulmonary hypertension, obesity and atrial fibrillation. Myocardial remodeling occurs both in HFrEF and HFpEF and it involves changes in cardiac structure, myocardial composition, myocyte deformation, and multiple biochemical and molecular alterations that impact heart function and its reserve capacity. Understanding the features of myocardial remodeling has become a major objective for limiting or reversi...
Thu, 17 Mar 2016 22:22:14 +0100The developers of Cardiogram, a consumer heart rate-tracking app, have launched a study aiming to use deep learning to detect atrial fibrillation, the most common form of irregular heartbeat. (Source: WSJ.com: Health)
Thu, 17 Mar 2016 11:46:57 +0100Atrial fibrillation (AF) is the most common pathologic clinical arrhythmia lasting more than 30 seconds, and its incidence and prevalence continue to increase. (Source: Radcliffe Cardiology)
Thu, 17 Mar 2016 10:38:39 +0100It is presumed that the pathogenesis of stroke in atrial fibrillation (AF) patients is due to embolization of thrombus from the left atrium. Within the left atrium, the left atrial appendage is the predominant site of thrombus formation. (Source: Radcliffe Cardiology)
Thu, 17 Mar 2016 04:34:34 +0100Brief Report Daniela Righi, Massimo S. Silvetti, Fabrizio Drago, Cardiology in the Young, Volume 26 Issue 03, pp 589-592Abstract (Source: Cardiology in the Young)
Thu, 17 Mar 2016 00:00:00 +0100Atrial fibrillation (AF) is a well-established risk factor for thromboembolic (TE) complications. Moreover, AF is frequently found in patients with advanced heart failure including those undergoing left ventricular assist device (LVAD) implantation. However, reports on whether preoperative AF increases the risk of TE events following LVADs are scarce and limited to one or two-center studies. We sought to evaluate the association of preoperative AF with TE events and patient survival using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). (Source: The Journal of Heart and Lung Transplantation)
Thu, 17 Mar 2016 00:00:00 +0100CONCLUSIONS: LAA occlusion was feasible in non-valvular AF patients with high risk of stroke and hemorrhage. The ACP and Watchman devices were similar in terms of procedural and clinical outcomes. PMID: 26984716 [PubMed - as supplied by publisher] (Source: Circulation Journal)
Thu, 17 Mar 2016 00:00:00 +0100Conclusions ADMA and related arginine derivatives were not associated with incident AF in the community after accounting for other clinical risk factors and confounders. Its role in the pathogenesis of AF needs further refinement. Graphical abstract (Source: American Heart Journal)
Thu, 17 Mar 2016 00:00:00 +0100Conclusions In this large study of post-menopausal women, traditional cardiovascular risk factors conferred a similar degree of individual risk of AF among four race-ethnic groups. However, major AF risk factors conferred a higher attributable risk in African- Americans and Hispanics compared to NHWs and Asians. (Source: American Heart Journal)
Thu, 17 Mar 2016 00:00:00 +0100We examined the prevalence, incidence, and prognostic significance of aIAB in 14,625 (mean age=54±5.8 years; 26% black; 55% female) participants from the Atherosclerosis Risk in Communities (ARIC) study. aIAB was detected from digital electrocardiograms recorded during 4 study visits (1987-1989, 1990-1992, 1993-1995, and 1996-1998). (Source: The American Journal of Cardiology)
Thu, 17 Mar 2016 00:00:00 +0100The objective of this real-life study was to compare medication adherence to newly-initiated rivaroxaban or dabigatran therapy among NVAF patients in the United States (US). (Source: International Journal of Cardiology)
Thu, 17 Mar 2016 00:00:00 +0100ConclusionsApart from modified GRACE score, overall correlations between risk scores and calcium burden, as well as revascularization rates during index stay, were low. By contrast, the determination of CS may be used as an additional surrogate marker in risk stratification in AF patients with intermediate pretest likelihood for CAD admitted to a CPU. (Source: Clinical Cardiology)
Thu, 17 Mar 2016 00:00:00 +0100A 71-year-old woman who was undergoing anticoagulant treatment because of atrial fibrillation for a long time was admitted with neck pain and paraparesis of 2 days duration. Magnetic resonance imaging of the cervical and thoracic spine revealed a cervicothoracic ventral epidural hematoma, causing anterior cord compression. The lesion demonstrated mixed signal intensity on T2-weighted images and marked low signal intensity “blooming” on T2-weighted gradient-echo images (Fig. 1). It was iso/hyperintense to cord on T1-weighted images and did not show enhancement on postcontrast images (Fig. (Source: The Spine Journal)
Thu, 17 Mar 2016 00:00:00 +0100Conclusion. This population-based study indicates that gout is independently associated with a higher risk of AF at diagnosis and the risk is also higher after the diagnosis. (Source: Rheumatology)
Wed, 16 Mar 2016 16:59:19 +0100Alan Mozes, HealthDay News Less than half of atrial fibrillation patients at highest risk for stroke are prescribed recommended blood thinners by their cardiologists, new research finds. (Source: Health News - UPI.com)
Wed, 16 Mar 2016 16:00:00 +0100Less than half at highest risk take recommended blood-thinning medication, study finds Source: HealthDay Related MedlinePlus Pages: Atrial Fibrillation, Blood Thinners, Stroke (Source: MedlinePlus Health News)
Wed, 16 Mar 2016 12:03:31 +0100WEDNESDAY, March 16, 2016 -- Doctors know that a heart rhythm disorder called atrial fibrillation increases the odds for stroke. But less than half of "a-fib" patients at highest risk for stroke are prescribed recommended blood thinners by their... (Source: Drugs.com - Daily MedNews)
Wed, 16 Mar 2016 00:00:00 +0100To the Editor: (Source: Journal of Cardiothoracic and Vascular Anesthesia)
Wed, 16 Mar 2016 00:00:00 +0100Atrial fibrillation (AF) is the commonest cardiac rhythm disorder. Evaluation of patients with AF requires an electrocardiogram, but imaging techniques should be considered for defining management and driving treatment. The present document is an expert consensus from the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association. The clinical value of echocardiography, cardiac magnetic resonance (CMR), computed tomography (CT), and nuclear imaging in AF patients are challenged. Left atrial (LA) volume and strain in echocardiography as well as assessment of LA fibrosis in CMR are discussed. The value of CT, especially in planning interventions, is highlighted. Fourteen consensus statements have been reached. These may serve as a guide for both imagers ...
Wed, 16 Mar 2016 00:00:00 +0100Transesophageal echocardiography (TEE) is recommended in patients undergoing atrial fibrillation (AF) ablation, but use of this strategy is variable. (Source: Heart Rhythm)
Wed, 16 Mar 2016 00:00:00 +0100Left atrial (LA) enlargement evaluated by echocardiography is a very strong predictor of cardiovascular (CV) outcomes such as atrial fibrillation (AF), stroke, congestive heart failure, and CV death in multiple clinical settings [1,2]. As a consequence, researchers have focused their attention on the best method to assess LA size. Left atrium is a thin-walled cardiac chamber directly exposed to left ventricular (LV) pressure during diastole, which represents its afterload. In particular, in hypertrophic cardiomyopathy (HCM), almost all patients have some degree of LV diastolic dysfunction. (Source: International Journal of Cardiology)
Wed, 16 Mar 2016 00:00:00 +0100This article summarizes recommendations for the clinical use of antiarrhythmic drugs for the treatment and prevention of atrial and ventricular arrhythmias based on current guideline and consensus documents. The choice of antiarrhythmic drug is based on the efficacy and safety profile and influenced by the presence or absence of structural heart disease. Because of its adverse side-effect profile, amiodarone is recommended for the management of atrial fibrillation only when other agents have failed or are contraindicated. For treatment of symptomatic ventricular arrhythmias in the setting of structural heart disease, amiodarone is generally the preferred agent. (Source: Cardiac Electrophysiology Clinics)
Wed, 16 Mar 2016 00:00:00 +0100Conclusions Box isolation of non-PAF is effective and safe even in elderly patients. A prophylactic CTI ablation combined with Box isolation might be feasible to improve the long-term outcome. (Source: Journal of Arrhythmia)
Wed, 16 Mar 2016 00:00:00 +0100Publication date: Available online 15 March 2016 Source:Journal of Arrhythmia Author(s): Yosuke Miwa, Toshinori Minamishima, Toshiaki Sato, Konomi Sakata, Hideaki Yoshino, Kyoko Soejima The majority of embolisms associated with atrial fibrillation (AF) are from the left atrial appendage (LAA). To treat the existing thrombus, warfarin and novel anticoagulants have been used. However, there has been no clinical information regarding the difference of the effects of congealing the fibrinogenolysis system among these oral anticoagulants. Here, we report a case of persistent AF, in whom apixaban, factor Xa inhibitor resolved an LAA clot refractory to warfarin and direct thrombin inhibition. Factor Xa inhibitor, apixaban, could resolve the left appendage thrombosis refractory to warfarin...
Wed, 16 Mar 2016 00:00:00 +0100When compared with warfarin, edoxaban significantly reduced cardiovascular mortality in the ENGAGE AF-TIMI 48 trial. We studied the possible reasons leading to this reduction. (Source: The American Journal of Medicine)
Wed, 16 Mar 2016 00:00:00 +0100Conclusions There seems to be no effect of CPAP on ECG measures of arrhythmia risk in patients with minimally symptomatic OSA. Trial registration number ISRCTN34164388; Post-results. (Source: BMJ Open)
Wed, 16 Mar 2016 00:00:00 +0100Abstract Despite considerable basic research into the mechanisms of atrial fibrillation (AF), not much progress has been made in the prognosis of patients with AF. With the exception of anticoagulant therapy, current treatments for AF still do not improve major cardiovascular outcomes. This may be due partly to the diverse aetiology of AF with increasingly more factors found to contribute to the arrhythmia. In addition, a strong increase has been seen in the technological complexity of the methods used to quantify the main pathophysiological alterations underlying the initiation and progression of AF. Because of the lack of standardization of the technological approaches currently used, the perception of basic mechanisms of AF varies widely in the scientific community. Areas of debate incl...
Wed, 16 Mar 2016 00:00:00 +0100Abstract Understanding of the pathophysiological mechanism(s) underlying atrial fibrillation (AF) is the foundation on which current ablation strategies are built. In the vast majority of patients with paroxysmal AF, the ablation procedure should target the pulmonary veins. In patients with nonparoxysmal AF, however, pulmonary vein isolation alone seems to be insufficient to prevent the arrhythmia. Several recent clinical trials have investigated the concept that rotors (re‐entry based on a meandering central core from which spiral waves emanate) might be the mechanism responsible for sustaining AF. Ablation of these localized AF sources is an important step towards substrate‐driven procedures in persistent AF. Hybrid AF ablation procedures, based on the integration of endocardial tran...
Wed, 16 Mar 2016 00:00:00 +0100Abstract Atrial fibrillation (AF) is not benign. Cardiovascular diseases and risk factors differ importantly amongst patients. Careful phenotyping with the aim to start tailored therapy may improve outcome and quality of life. Furthermore, structural remodelling plays an important role in initiation and progression of AF. Therapies that interfere in the remodelling processes are promising because they may modify the atrial substrate. However, success is still limited probably due to variations in the underlying substrate in individual patients. The most favourable effects of lifestyle changes on success of rhythm control have been demonstrated in obese patients with AF. Differences in genotype may also play an important role. Common gene variants have been associated with recurrence of AF ...
Wed, 16 Mar 2016 00:00:00 +0100For patients with atrial fibrillation (AF) who are refractory to anti-arrhythmic drugs (AADs), minimally invasive video-assisted thoracoscopic surgical ablation (SA) and catheter ablation (CA) are potential alternative treatment options. The recent FAST randomized study suggested that thoracoscopic SA was superior to CA in achieving freedom of AF in patients who have failed at least one prior AAD. To assess the relative merits and risks of SA versus CA, a systematic review and meta-analysis was conducted. Electronic searches were performed using six databases from their inception to December 2014. Relevant studies comparing thoracoscopic SA and CA were identified; data were extracted and analysed according to predefined clinical endpoints. Relative risk (RR) and weighted mean difference we...
Wed, 16 Mar 2016 00:00:00 +0100(Source: European Journal of Cardio-Thoracic Surgery)
Wed, 16 Mar 2016 00:00:00 +0100Authors: De Caterina R, Goto S Abstract Patients after an acute coronary syndrome (ACS) are at increased risk of recurrent thrombotic events, justifying the search for additional antithrombotic treatments. The pathophysiology of ACS involves arterial thrombus formation, in turn occurring because of a combination of platelet activation and fibrin formation, with thrombin playing a key role in both. Antiplatelet therapy, targeting the thromboxane pathway and the ADP P2Y12 receptor has been widely accepted for secondary prevention after an ACS. Now, data from recent clinical trials in such patients also encourage the pursuit of inhibiting thrombin formation or thrombin-mediated platelet activation in addition to antiplatelet therapy. This "triple pathway inhibition", including inhibit...
Tue, 15 Mar 2016 21:07:37 +0100"To handle the emotional consequences that comes with atrial fibrillation, patients need practical tools," say experts, noting that yoga complementary to standard treatment can be effective. Heartwire from Medscape (Source: Medscape Medical News Headlines)
Tue, 15 Mar 2016 16:19:04 +0100The association of atrial fibrillation (AF) with an increased risk of cognitive impairment or dementia is independent of clinical stroke (1) and may be mediated by subclinical cerebral infarcts (SCIs) (2). However, little is known about whether AF burden (i.e., the percentage of time a person is in AF) is related to cognitive function. Moreover, if such a relationship exists, whether it is mediated by clinical stroke or SCIs is unknown. We hypothesized that a higher AF burden would be independently associated with lower cognitive function after adjustment for clinical stroke but that this association would be attenuated after adjustment for SCIs. We tested our hypothesis in a sample of participants from the U.S. community-based ARIC (Atherosclerosis Risk in Communities) study. (Source: Jou...
Tue, 15 Mar 2016 15:34:16 +0100Conclusions Results of this study suggest that testing is associated with a range of clinical covariates. However, an association was similarly identified with preoperative consultation, and significant variation between institutions exists across the jurisdiction. (Source: Anesthesiology)
Tue, 15 Mar 2016 13:37:02 +0100Authors: Zhang Y, Chen A, Song L, Li M, Chen Y, He B Abstract Natriuretic peptides like B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro BNP) are reported to be increased in atrial fibrillation (AF) patients. However, the prognostic roles of BNP and NT-pro BNP in post-ablation AF recurrence remain inconclusive. We performed this meta-analysis to investigate the potential role of baseline natriuretic peptides in predicting AF recurrence after catheter ablation.Electronic databases were searched for studies that evaluated the potential relationship between AF recurrence and baseline BNP or NT-pro BNP levels. The pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to quantify differences in BNP or NT-pro BNP levels between patients...
Tue, 15 Mar 2016 13:37:02 +0100Authors: Watanabe A, Suzuki S, Kano H, Matsuno S, Takai H, Kato Y, Otsuka T, Uejima T, Oikawa Y, Nagashima K, Kirigaya H, Kunihara T, Sagara K, Yamashita N, Sawada H, Aizawa T, Yajima J, Yamashita T Abstract Atrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV ...
Tue, 15 Mar 2016 13:37:02 +0100We describe 2 of the 3 specific cases because they illustrate these potentially risky situations: a case in which the intrinsic heart rate increased and another in which atrial fibrillation occurred. Safe MRI in patients with an MR conditional device necessitates detailed MRI mode programming. The MRI pacing mode should be carefully and individually selected. PMID: 26973263 [PubMed - as supplied by publisher] (Source: International Heart Journal)
Tue, 15 Mar 2016 00:00:00 +0100Conclusion In patients with paroxysmal AF and moderate or severe MR, primary MR may increase the risk of AF recurrence after the initial and final CA. (Source: Journal of Interventional Cardiac Electrophysiology)
Tue, 15 Mar 2016 00:00:00 +0100Publication date: February 2016 Source:Archives of Cardiovascular Diseases Supplements, Volume 8, Issue 2 Author(s): A. Cohen, C. Leclercq Résumé La fibrillation atriale (FA) est le trouble du rythme le plus fréquent touchant l'adulte âgé et est associée à une augmentation du risque de décès, d'accident ischémique cérébral (AIC), d'insuffisance cardiaque ainsi qu'à une réduction de la qualité de la vie. La charge de cette pathologie sur le patient, les soignants, et donc le retentissement sociétal, est importante. La FA est une maladie chronique augmentant de façon significative le coût de la prise en charge qui peut être lié aux modalités initiales de prise en charge, au traitement des complications, ainsi qu'à la baisse d'activité professionnelle. Cependant, le...
Tue, 15 Mar 2016 00:00:00 +0100Conclusion Les nouveaux traitements présentent des ratios coût/efficacité acceptables en Europe et au Canada, au regard des standards habituels. Au-delà des différences intrinsèques entre les différents systèmes de santé, la diversité des résultats témoigne cependant d'une nécessaire standardisation des études à des fins de comparabilité. Background The cost-effectiveness analysis of therapeutic innovations has become a reference for decision makers in developed countries. When new treatments are available as alternatives to existing well established and cheap treatments, payers anticipate a major budget impact and will assess the extra benefit for society for extra Euros spent. Aims This study aimed at presenting the different published results of cost-effectiveness anal...
Tue, 15 Mar 2016 00:00:00 +0100ConclusionIn oldest old community‐dwelling participants, AF is an independent risk factor for global mortality after a three‐year follow‐up period. (Source: Australasian Journal on Ageing)
Tue, 15 Mar 2016 00:00:00 +0100T1 mapping enables assessment of myocardial characteristics. As the most common type of arrhythmia, atrial fibrillation (AF) is often accompanied by a variety of cardiac pathologies, whereby the irregular and ... (Source: Journal of Cardiovascular Magnetic Resonance)
Tue, 15 Mar 2016 00:00:00 +0100Conclusion Vitamin K deficiency may be a modifiable cardiovascular risk factor in the haemodialysis population. Conversely, vitamin K antagonists may aggravate VC burden in haemodialysis patients. Several ongoing trials may provide an answer to these questions in the near future. (Source: CKJ: Clinical Kidney Journal)
Tue, 15 Mar 2016 00:00:00 +0100Response to Letter Regarding Article, "Upregulation of K2P3.1 K+ Current Causes Action Potential Shortening in Patients With Chronic Atrial Fibrillation". Circulation. 2016 Mar 15;133(11):e440-1 Authors: Schmidt C, Wiedmann F, Voigt N, Zhou XB, Heijman J, Lang S, Albert V, Kallenberger S, Ruhparwar A, Szabó G, Kallenbach K, Karck M, Borggrefe M, Biliczki P, Ehrlich JR, Baczkó I, Lugenbiel P, Schweizer PA, Donner BC, Katus HA, Dobrev D, Thomas D PMID: 26976923 [PubMed - in process] (Source: Circulation)
Tue, 15 Mar 2016 00:00:00 +0100Letter by Olschewski et al Regarding Article, "Upregulation of K2P3.1 K+ Current Causes Action Potential Shortening in Patients With Chronic Atrial Fibrillation". Circulation. 2016 Mar 15;133(11):e439 Authors: Olschewski A, Chandran N, Olschewski H PMID: 26976922 [PubMed - in process] (Source: Circulation)
Tue, 15 Mar 2016 00:00:00 +0100Conclusions— In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation. However, dabigatran is associated with a lower risk for intracranial bleeding relative to warfarin, but—particularly among the elderly—a greater risk for gastrointestinal bleeding. Bleeding outcomes from observational studies are consistent with those from the pivotal Randomized Evaluation of Long-Term Anticoagulation Therapy trial. (Source: Circulation: Cardiovascular Quality and Outcomes)
Tue, 15 Mar 2016 00:00:00 +0100Anticoagulation clinics were initially developed to provide safe and effective care for warfarin-treated patients with atrial fibrillation, venous thromboembolism, and mechanical valve replacement. Traditionally, these patients required ongoing laboratory monitoring and warfarin dose adjustment by expert providers. With the introduction of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban), many have questioned the need for anticoagulation clinic. However, we think that the growing number of oral anticoagulant choices creates an urgent need for expanding the traditional role of the anticoagulation clinic. We outline 3 key purposes that a reimagined anticoagulation clinic would serve: (1) to assist patients and clinicians with selecting the most appropriate drug an...
Tue, 15 Mar 2016 00:00:00 +0100We present the case of a 54-year-old male patient with Loeffler endocarditis. It is a rare disorder characterized by fibrous thickening of the endocardium leading to apical obliteration and restrictive cardiomyopathy resulting in heart failure, thromboembolic events or atrial fibrillation. To the best of our knowledge, this is the first case reporting the electrical silence of the right ventricular (RV) apex caused by fibrothrombotic thickening of this area. Under these circumstances RV apical implantation of an implantable cardioverter defibrillator (ICD) or pacemaker electrode may lead to unsuccessful stimulation of these devices. PMID: 26980214 [PubMed - as supplied by publisher] (Source: Wiener Klinische Wochenschrift)
Tue, 15 Mar 2016 00:00:00 +0100Authors: Kirchhof P, Goette A, Näbauer M, Schotten U Abstract "The whole is greater than the sum of its parts" (Aristotle).Atrial fibrillation (AF) is the most common sustained arrhythmia and affects 1-2 % of the population in developed countries, especially the elderly. We expect that the prevalence of AF will double in the next few decades. The last decades have seen important improvements in the management of atrial fibrillation, but many questions remain regarding the optimal diagnosis and management of the condition. The German Atrial Fibrillation NETwork (AFNET) was one of three cardiovascular competence networks in medicine funded by the German Ministry of Education and Research between 2003-2014. AFNET has contributed to the understanding of atrial fibrillation, and AFNE...
Tue, 15 Mar 2016 00:00:00 +0100This article is protected by copyright. All rights reserved. PMID: 26990354 [PubMed - as supplied by publisher] (Source: The Journal of Physiology)
Tue, 15 Mar 2016 00:00:00 +0100CONCLUSION: In oldest old community-dwelling participants, AF is an independent risk factor for global mortality after a three-year follow-up period. PMID: 26991145 [PubMed - as supplied by publisher] (Source: Australasian Journal on Ageing)
Tue, 15 Mar 2016 00:00:00 +0100CONCLUSIONS: The improvement of LV systolic function was the only independent predictor of reversible TR. Appropriate medical therapy including management for heart failure should be considered before performing surgery in patients with severe functional TR and AF, especially in patients with LV dysfunction. PMID: 26993263 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
Mon, 14 Mar 2016 20:44:17 +0100Biotronik said today it launched its BioMonitor 2 subcutaneous insertable cardiac monitor in the U.K. and Ireland. The BioMonitor 2 device is designed for remote monitoring of patients with atrial fibrillation, syncope, bradycardia and tachychardia, Biotronik said. The device uses Biotronik’s ProMRI technology and is approved for full-body MRI scans at 1.5 and 3 tesla strength. “AF is often so sporadic and unpredictable that it is sometimes impossible to diagnose at the time the patient has symptoms. It is similar with syncope. The patient can hardly choose to faint when they are hooked up to an ECG just so we can find out what’s causing it. But, because BioMonitor 2 is always on and always recording, we can see exactly what’s going on with their cardiac rhythm in these pre...
Mon, 14 Mar 2016 14:48:09 +0100LOS ANGELES – Medtronic’s Reveal LINQ implantable loop recorders misidentified 84% of rhythm anomalies as atrial fibrillation in 52 stroke patients at Emory University in Atlanta, according to a... (Source: Internal Medicine News)
Mon, 14 Mar 2016 10:00:00 +0100A 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. (Source: Health News from Medical News Today)
Mon, 14 Mar 2016 00:00:00 +0100(Source: European Heart Journal)
Mon, 14 Mar 2016 00:00:00 +0100Abstract Atrial fibrillation (AF) is common in dialysis patients. However, clinical characteristics and outcomes of dialysis patients with AF are poorly understood. The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available for 3713 patients with a median follow-up of 2.8 years. We compared clinical characteristics and outcomes between the dialysis group (n = 92; 2.5 %) and others. The dialysis group had more various co-morbidities, with a mean CHADS2 score of 2.5, and the rate of warfarin prescription was 38 %. The annual incidence rates of stroke or systemic embolism (SE), major bleeding, and all-cause death in the dialysis group were 4.0, 5.1, and 20.9 per 100 person-years, respectively. There was no significant...
Mon, 14 Mar 2016 00:00:00 +0100Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with increased risk of heart failure and stroke . Accumulating studies have revealed that a series of striking alterations in atrial electrical, structural, and autonomic properties is critical to most acquired forms of AF [2–3]. However, the impact of cardiac energy metabolism upon the initiation or persistence of AF is incompletely understood. Metabolomic and proteomic analyses have indicated a close relationship between metabolic dysfunction and AF development . (Source: International Journal of Cardiology)
Mon, 14 Mar 2016 00:00:00 +0100Abstract In the USA, 69 % of adults are either overweight or obese and 35 % are obese. Obesity is associated with an increased incidence of various cardiovascular disorders. Obesity is a risk marker for cardiovascular disease, in that it is associated with a much higher prevalence of comorbidities such as diabetes, hypertension, and metabolic syndrome, which then increase the risk for cardiovascular disease. However, in addition, obesity may also be an independent risk factor for the development of cardiovascular disease. Furthermore, although obesity has been shown to be an independent risk factor for several cardiovascular diseases, it is often associated with improved survival once the diagnosis of the cardiovascular disease has been made, leading to the term “obesity para...