Latest & greatest articles for atrial fibrillation

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Top results for atrial fibrillation

21. An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. (Abstract)

An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction. Atrial fibrillation 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 atrial fibrillation 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

2019 Lancet

22. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. (Abstract)

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Atrial fibrillation is the most frequent sustained arrhythmia. Atrial fibrillation 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 atrial fibrillation 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

2019 Cochrane

23. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. (Abstract)

Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (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 atrial fibrillation 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 atrial fibrillation 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

2019 Lancet

24. Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope Full Text available with Trip Pro

Rate or Rhythm Control in Older Atrial Fibrillation Patients: Risk of Fall-Related Injuries and Syncope Management of atrial fibrillation (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

2019 EvidenceUpdates

25. Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation

Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation SHTG Advice | 1 SHTG Advice 06-19 August 2019 In response to an enquiry from the National Advisory Committee for Heart Disease Left atrial appendage occlusion (LAAO) in patients with atrial fibrillation who have contraindications to oral anticoagulation Advice for NHSScotland Left atrial appendage occlusion (LAAO) may be offered to patients with non-valvular atrial (...) procedure volume per centre should be maximised to support optimal patient outcomes and ensure clinical experience is achieved and retained. NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice. SHTG Advice | 2 What were we asked to look at? The National Advisory Committee for Heart Disease asked us to look at a percutaneous intervention, left atrial appendage occlusion (LAAO), in patients with atrial fibrillation and contraindications to oral anticoagulation. Why

2019 SHTG Advice Statements

26. Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves (Abstract)

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves Current guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis

2019 EvidenceUpdates

27. Atrial fibrillation: apixaban (Eliquis) as an alternative to warfarin (Coumadin and other brands) in some situations

Atrial fibrillation: apixaban (Eliquis) as an alternative to warfarin (Coumadin and other brands) in some situations Prescrire IN ENGLISH - Spotlight ''Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations'', 1 June 2019 {1} {1} {1} | | > > > Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations Spotlight Every month, the subjects in Prescrire’s Spotlight. 100 most (...) recent :  |   |   |   |   |   |   |   |   |  Spotlight Atrial fibrillation: apixaban (Eliquis°) as an alternative to warfarin (Coumadin° and other brands) in some situations When atrial fibrillation warrants the use of an anticoagulant, the anti-vitamin K warfarin (Coumadin° and other brands) is still the best long-term evaluated oral anticoagulant. The anti-Xa apixaban (Eliquis°) is an alternative in some situations. In patients

2019 Prescrire

28. Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus Full Text available with Trip Pro

Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus We aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA2DS2-VASc score.Derivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression

2019 EvidenceUpdates

29. Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation: A Randomized Clinical Trial Full Text available with Trip Pro

Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing Atrial Fibrillation Catheter Ablation: A Randomized Clinical Trial Uninterrupted dabigatran therapy reduces stroke risk in patients with nonvalvular atrial fibrillation (NVAF) undergoing ablation and is associated with a lower bleeding risk than uninterrupted warfarin therapy. Minimally interrupted direct oral anticoagulant therapy is widely used, but data from controlled studies (...) the incidence of embolism during the perioperative period and atrial thrombus just before the ablation. The main secondary end point was the incidence of major bleeding events until 3 months after ablation.Of the 442 patients who underwent ablation, 74.9% were men and the median age was 66 years (interquartile range, 59-71 years). Before ablation, 1 cerebral infarction and 1 thrombus in the left atrium occurred in the warfarin group, but no events occurred in the interrupted dabigatran group. After ablation

2019 EvidenceUpdates

30. Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study (Abstract)

Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study  Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008-2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs

2019 EvidenceUpdates

31. Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial Full Text available with Trip Pro

Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation: the ELIMINATE-AF trial Edoxaban is a direct factor Xa inhibitor approved for stroke prevention in atrial fibrillation (AF). Uninterrupted edoxaban therapy in patients undergoing AF ablation has not been tested.The ELIMINATE-AF trial, a multinational, multicentre, randomized, open-label, parallel-group study, was conducted to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients

2019 EvidenceUpdates

32. Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care

Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care L Lead-I ECG de ead-I ECG devices for detecting vices for detecting symptomatic atrial fibrillation using symptomatic atrial fibrillation using single time point testing in primary care single time point testing in primary care Diagnostics guidance Published: 8 May 2019 www.nice.org.uk/guidance/dg35 © NICE 2019. All rights reserved. Subject to Notice of rights (https (...) health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care (DG35) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 40Contents Contents 1 Recommendations 4 2 Clinical need and practice 5 The problem addressed 5 The condition 5

2019 National Institute for Health and Clinical Excellence - Diagnostics Guidance

33. A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects Full Text available with Trip Pro

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects

2019 EvidenceUpdates

34. Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With Atrial Fibrillation: The CAPTAF Randomized Clinical Trial. Quality of life is not a standard primary outcome in ablation trials, even though symptoms drive the indication.To assess quality of life with catheter ablation vs antiarrhythmic medication at 12 months in patients with atrial fibrillation.Randomized clinical trial at 4 university hospitals in Sweden and 1 in Finland of 155 patients aged 30-70 (...) years with more than 6 months of atrial fibrillation and treatment failure with 1 antiarrhythmic drug or β-blocker, with 4-year follow-up. Study dates were July 2008-September 2017. Major exclusions were ejection fraction <35%, left atrial diameter >60 mm, ventricular pacing dependency, and previous ablation.Pulmonary vein isolation ablation (n = 79) or previously untested antiarrhythmic drugs (n = 76).Primary outcome was the General Health subscale score (Medical Outcomes Study 36-Item Short-Form

2019 JAMA Controlled trial quality: predicted high

35. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. Full Text available with Trip Pro

Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. Patients with recent-onset atrial fibrillation commonly undergo immediate restoration of sinus rhythm by pharmacologic or electrical cardioversion. However, whether immediate restoration of sinus rhythm is necessary is not known, since atrial fibrillation often terminates spontaneously.In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned patients with hemodynamically stable, recent-onset (<36 (...) hours), symptomatic atrial fibrillation in the emergency department to be treated with a wait-and-see approach (delayed-cardioversion group) or early cardioversion. The wait-and-see approach involved initial treatment with rate-control medication only and delayed cardioversion if the atrial fibrillation did not resolve within 48 hours. The primary end point was the presence of sinus rhythm at 4 weeks. Noninferiority would be shown if the lower limit of the 95% confidence interval for the between

2019 NEJM Controlled trial quality: predicted high

36. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. Full Text available with Trip Pro

Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. Appropriate antithrombotic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone percutaneous coronary intervention (PCI) are unclear.In an international trial with a two-by-two factorial design, we randomly assigned patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a P2Y12 inhibitor to receive (...) , 0.83; 95% CI, 0.74 to 0.93; P = 0.002) and a similar incidence of ischemic events. Patients in the aspirin group had an incidence of death or hospitalization and of ischemic events that was similar to that in the placebo group.In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y12 inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences

2019 NEJM Controlled trial quality: predicted high

37. Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrial fibrillation (AF), but its incremental effect on long-term quality of life (QOL) is uncertain.To determine whether catheter ablation is more beneficial than conventional drug therapy for improving QOL in patients with AF.An open-label randomized (...) by investigators for the drug therapy group (n = 1096).Prespecified co-primary QOL end points at 12 months, including the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary score (range, 0-100; 0 indicates complete disability and 100 indicates no disability; patient-level clinically important difference, ≥5 points) and the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score (range, 0-40; 0 indicates no symptoms and 40 indicates the most severe symptoms; patient-level clinically important

2019 JAMA Controlled trial quality: predicted high

38. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrial fibrillation (AF), but its effects on long-term mortality and stroke risk are uncertain.To determine whether catheter ablation is more effective than conventional medical therapy for improving outcomes in AF.The Catheter Ablation vs (...) Antiarrhythmic Drug Therapy for Atrial Fibrillation trial is an investigator-initiated, open-label, multicenter, randomized trial involving 126 centers in 10 countries. A total of 2204 symptomatic patients with AF aged 65 years and older or younger than 65 years with 1 or more risk factors for stroke were enrolled from November 2009 to April 2016, with follow-up through December 31, 2017.The catheter ablation group (n = 1108) underwent pulmonary vein isolation, with additional ablative procedures

2019 JAMA Controlled trial quality: predicted high

39. Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? Full Text available with Trip Pro

Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? - CanadiEM Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI? In , by Vinai Bhagirath March 5, 2019 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert Main Messages P2Y12 inhibition is important (...) for the first 1-6 months after PCI insertion, and may have ongoing benefits up to 12 months or longer. Addition of anticoagulant to antiplatelet therapy increases the risk of bleeding, but reduces the risk of stroke. Use of an anticoagulant plus P2Y12 inhibitor is preferable to anticoagulant plus dual antiplatelet therapy, because of reduced bleeding risk. Case Description You are seeing a 72-year-old woman with a history of atrial fibrillation (AF), and additional stroke risk factors of hypertension

2019 CandiEM

40. Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrial fibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial Full Text available with Trip Pro

Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrial fibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial After percutaneous coronary intervention (PCI) in patients with atrial fibrillation, safety and efficacy with dabigatran dual therapy were evaluated in pre-specified subgroups of patients undergoing PCI due to acute coronary syndrome (ACS) or elective PCI, and those receiving

2019 EvidenceUpdates