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Latest & greatest articles for atrial fibrillation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on atrial fibrillation or other clinical topics then use Trip today.
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Safety and Efficacy of Minimally Interrupted Dabigatran vs Uninterrupted Warfarin Therapy in Adults Undergoing AtrialFibrillation Catheter Ablation: A Randomized Clinical Trial Uninterrupted dabigatran therapy reduces stroke risk in patients with nonvalvular atrialfibrillation (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
Incident AtrialFibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study Atrialfibrillation (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
Uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrialfibrillation: the ELIMINATE-AF trial Edoxaban is a direct factor Xa inhibitor approved for stroke prevention in atrialfibrillation (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
A Simple Clinical Risk Score (C2HEST) for Predicting Incident AtrialFibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects The incidence of atrialfibrillation (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
Effect of Catheter Ablation vs Antiarrhythmic Medication on Quality of Life in Patients With AtrialFibrillation: 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 atrialfibrillation 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
Early or Delayed Cardioversion in Recent-Onset AtrialFibrillation. Patients with recent-onset atrialfibrillation 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 atrialfibrillation often terminates spontaneously.In a multicenter, randomized, open-label, noninferiority trial, we randomly assigned patients with hemodynamically stable, recent-onset (<36 (...) hours), symptomatic atrialfibrillation 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 atrialfibrillation 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
Antithrombotic Therapy after Acute Coronary Syndrome or PCI in AtrialFibrillation. Appropriate antithrombotic regimens for patients with atrialfibrillation 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 atrialfibrillation 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 atrialfibrillation 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
Effect of Catheter Ablation vs Medical Therapy on Quality of Life Among Patients With AtrialFibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is more effective than drug therapy in restoring sinus rhythm in patients with atrialfibrillation (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 AtrialFibrillation 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
Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With AtrialFibrillation: The CABANA Randomized Clinical Trial. Catheter ablation is effective in restoring sinus rhythm in atrialfibrillation (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 AtrialFibrillation 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
Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation post-PCI? Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation post-PCI? - CanadiEM Blood & Clots Series: What is the optimal antithrombotic strategy for atrialfibrillation 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 atrialfibrillation (AF), and additional stroke risk factors of hypertension
Dabigatran dual therapy with ticagrelor or clopidogrel after percutaneous coronary intervention in atrialfibrillation patients with or without acute coronary syndrome: a subgroup analysis from the RE-DUAL PCI trial After percutaneous coronary intervention (PCI) in patients with atrialfibrillation, 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
Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular AtrialFibrillation Patients with nonvalvular atrialfibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage (...) , gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet use and concomitant vitamin K antagonist (VKA)-antiplatelet use in patients with nonvalvular atrial fibrillation.Using computerized health care databases from Québec, we conducted a cohort study among patients newly diagnosed with nonvalvular atrialfibrillation between January 2011 and March 2014. Cox proportional hazards models yielded hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for disease risk
Major Bleeding Rates in AtrialFibrillation Patients on Single, Dual, or Triple Antithrombotic Therapy Patients with atrialfibrillation generally require anticoagulant therapy and, at times, therapy with additional platelet aggregation inhibitors. Data are scarce on bleeding rates in high-risk groups receiving combination therapy, such as the elderly or patients with a high CHA2DS2-VASc score.We conducted a nationwide cohort study of Danish patients with atrialfibrillation ≥50 years of age (...) patients with atrialfibrillation. Median age was 75 years (interquartile range, 67-83) and 47% were women. Over a total follow-up period of 1 373 131 patient-years (PYs), 31 459 major bleeds occurred (IR 2.3/100 PYs; 95% CI, 2.3-2.3/100 PYs). In comparison with vitamin K antagonist monotherapy, adjusted hazard ratios of major bleeding were 1.13 (95% CI, 1.06-1.19) for dual antiplatelet therapy, 1.82 (95% CI, 1.76-1.89) for therapy with a vitamin K antagonist and an antiplatelet drug, 1.28 (95% CI
Performance of the ABC Scores for Assessing the Risk of Stroke or Systemic Embolism and Bleeding in Patients With AtrialFibrillation in ENGAGE AF-TIMI 48 The ABC (age, biomarker, clinical history)-stroke and ABC-bleeding risk scores incorporate clinical variables and cardiovascular biomarkers to estimate risk of stroke or systemic embolic events and bleeding, respectively, in patients with atrialfibrillation. These scores have been proposed for routine clinical use, but their performance (...) in external cohorts remains uncertain.ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in AtrialFibrillation-Thrombolysis in Myocardial Infarction 48) was a multinational randomized trial of the oral factor Xa inhibitor edoxaban in patients with atrialfibrillation and a CHADS2 score ≥2. We performed a nested prospective biomarker study in 8705 patients, analyzing baseline high-sensitivity troponin T (hsTnT), NT-proBNP (N-terminal B-type natriuretic peptide), and growth
CHA2DS2-VASc Score and Stroke Prediction in AtrialFibrillation in Whites, Blacks, and Hispanics Background and Purpose- Despite modest predictive ability for ischemic stroke (IS), the CHA2DS2-VASc score is widely used for stroke prediction in atrialfibrillation. Among patients with atrialfibrillation, we aimed to (1) compare the IS or transient ischemic attack (TIA) incidence by CHA2DS2-VASc in blacks and Hispanics versus whites; (2) compare predictive ability of CHA2DS2-VASc score (...) for IS or TIA in blacks and Hispanics versus whites; and (3) determine improvement in predictive ability of CHA2DS2-VASc score from addition of race/ethnicity. Methods- Using data from Optum Clinformatics, a large administrative claims database, we analyzed patients with atrialfibrillation enrolled in commercial and Medicare Advantage health plans from 2009 to 2015. We computed IS or TIA incidence rates, improvement in C statistic, continuous and categorical net reclassification improvement, and relative
Refining Prediction of AtrialFibrillation-Related Stroke Using the P2-CHA2DS2-VASc Score In people with atrialfibrillation (AF), periods of sinus rhythm present an opportunity to detect prothrombotic atrial remodeling through measurement of P-wave indices (PWIs)-prolonged P-wave duration, abnormal P-wave axis, advanced interatrial block, and abnormal P-wave terminal force in lead V1. We hypothesized that the addition of PWIs to the CHA2DS2-VASc score would improve its ability to predict AF (...) -1.44) and 0.82 (0.36-1.39), respectively.Abnormal P-wave axis-an ECG correlate of left atrial abnormality- improves ischemic stroke prediction in AF. Compared with CHA2DS2-VASc, the P2-CHA2DS2-VASc is a better prediction tool for AF-related ischemic stroke.
Decreased risk of renal impairment in atrialfibrillation patients receiving non-vitamin K antagonist oral anticoagulants: A pooled analysis of randomized controlled trials and real-world studies Patients with warfarin have a potential risk of warfarin-related nephropathy, which could result in the discontinuation of anticoagulation therapy. The question of whether non-vitamin K antagonist oral anticoagulants (NOACs) use is associated with increased risk of renal impairment in atrial (...) fibrillation (AF) patients remains unanswered.Studies were systematically searched through Medline, Embase, Cochrane Library databases, and ClinicalTrials.gov Website. Randomized controlled trials (RCTs) reporting renal impairment events and observational nationwide database studies presenting adjusted hazard ratio (HR) in AF patients with NOACs were identified. The Primacy outcome was renal impairment, defined as a composite of any renal disorder. The secondary outcomes were narrow definition of renal
AtrialFibrillation (Focused Update) Accepted Manuscript 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With AtrialFibrillation Craig T. January, MD, PhD, FACC, Chair, Writing Group, L. Samuel Wann, MD, MACC, FAHA, Vice Chair, Writing Group, Hugh Calkins, MD, FACC, FAHA, FHRS, Writing Group Member, Lin Y. Chen, MD, MS, FACC, FAHA, FHRS, Writing Group Member, Joaquin E. Cigarroa, MD, FACC, Writing Group Member, Joseph C. Cleveland, Jr., MD, FACC (...) the content, and all legal disclaimers that apply to the journal pertain.MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on AtrialFibrillation Page 1 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With AtrialFibrillation A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society Developed in Collaboration With the Society of Thoracic