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Latest & greatest articles for atrial fibrillation
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Oral amiodarone for prevention of atrialfibrillation after open heart surgery, the AtrialFibrillation Suppression Trial (AFIST): a randomised placebo-controlled trial. Beta-blockers and amiodarone reduce the frequency of atrialfibrillation after open-heart surgery but the effectiveness of oral amiodarone in older patients already receiving beta-blockers is unknown. We have assessed the efficacy of oral amiodarone in preventing atrialfibrillation in patients aged 60 years or older undergoing (...) fibrillation (22.5% vs 38.0%; p=0.01; absolute difference 15.5% [95% CI 3.4-27.6%]), and there were significant differences in favour of the active drug for symptomatic atrialfibrillation (4.2% vs 18.0%, p=0.001), cerebrovascular accident (1.7% vs 7.0%, p=0.04), and postoperative ventricular tachycardia (1.7% vs 7.0%, p=0.04). Beta-blocker use (87.5% amiodarone vs 91.0% placebo), nausea (26.7% vs 16.0%), 30-day mortality (3.3% vs 4.0%), symptomatic bradycardia (7.5% vs 7.0%), and hypotension (14.2% vs
2001LancetControlled trial quality: predicted high
Management of new onset atrialfibrillation Management of new onset atrialfibrillation Management of new onset atrialfibrillation McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, Robinson KA, Powe NR Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation McNamara RL, Bass EB, Miller MR, Segal JB, Goodman SN, Kim NL, Robinson KA (...) , Powe NR. Management of new onset atrialfibrillation. Rockville: Agency for Healthcare Research and Quality (AHRQ). Evidence Report/Technology Assessment No. 12. 2001 Authors' objectives Atrialfibrillation (AF) is the most common arrhythmia physicians face in clinical practice, with an incidence of up to 2.3% per year and a prevalence of almost 9% in those aged 80-89 years. In addition to having various symptoms, patients with AF have increased risk for stroke and death. This report synthesizes
Use of transesophageal echocardiography to guide cardioversion in patients with atrialfibrillation. The conventional treatment strategy for patients with atrialfibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy.In a multicenter (...) , randomized, prospective clinical trial, we enrolled 1222 patients with atrialfibrillation of more than two days' duration and assigned them to either treatment guided by the findings on transesophageal echocardiography or conventional treatment. The composite primary end point was cerebrovascular accident, transient ischemic attack, and peripheral embolism within eight weeks. Secondary end points were functional status, successful restoration and maintenance of sinus rhythm, hemorrhage, and death.There
Management of new onset atrialfibrillation Management of new onset atrialfibrillation Management of new onset atrialfibrillation McNamara R L, Bass E B, Miller M R, Segal J B, Goodman S N, Kim N L, Robinson K A, Powe N R Authors' objectives To synthesise the evidence that exists to guide clinicians in the management of patients with new onset atrialfibrillation (AF). The key questions to be addressed were identified as follows. Which patients should receive cardioversion and which should (...) were resolved by consensus. Data extraction The data were extracted by one reviewer and checked by a second. The following data were abstracted: participant inclusion and exclusion criteria; baseline participant characteristics; baseline left atrial size; the duration of left atrialfibrillation or flutter; the percentage of participants with atrial flutter; co-morbid illnesses; therapeutic protocols; goal time of follow-up; main outcomes; and secondary outcomes, including adverse events
Pharmacologic conversion of atrialfibrillation: a systematic review of available evidence Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrialfibrillation Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrialfibrillation Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrialfibrillation Taylor F C, Cohen H, Ebrahim S Authors' objectives To examine the benefits and risks of long-term anticoagulation (warfarin (...) ) compared with antiplatelet treatment (aspirin, indobufen) in patients with non-rheumatic atrialfibrillation. Searching The CENTRAL Register on the Cochrane Library, EMBASE, MEDLINE, CINAHL and SIGLE were searched from 1966 to 1999 using the terms 'atherosclerosis', 'atrialfibrillation', 'myocardial infarction' or 'coronary disease' and 'anticoagulation' and a RCT filter (see Other Publications of Related Interest no.1). In addition, the authors checked references in relevant papers and approached key
Anticoagulants for preventing stroke in patients with nonrheumatic atrialfibrillation and a history of stroke or transient ischemic attacks. People with nonrheumatic atrialfibrillation who have had a transient ischemic attack or a minor ischemic stroke are at risk of recurrent stroke.The objective of this review was to assess the effect of anticoagulants for secondary prevention, after a stroke or transient ischaemic attack, in patients with nonrheumatic atrial fibrillation.The reviewer (...) searched the Cochrane Stroke Group trials register and contacted trialists.Randomised trials comparing oral anticoagulants (target International Normalised Ratio range 2.5 to 4.0) with control or placebo in people with nonrheumatic atrialfibrillation and a previous transient ischaemic attack or minor ischaemic stroke.One reviewer assessed trial quality and extracted data.Two trials involving 485 people were included. Anticoagulants reduced the risk of recurrent stroke by two-thirds (odds ratio 0.36
Antiplatelet therapy for preventing stroke in patients with nonrheumatic atrialfibrillation and a history of stroke or transient ischemic attacks. People with nonrheumatic atrialfibrillation who have had a transient ischemic attack or minor ischemic stroke are at risk of recurrent stroke.The objective of this review was to assess the effect of antiplatelet therapy for secondary prevention in people with nonrheumatic atrialfibrillation and a previous transient ischaemic attack or ischaemic (...) stroke.The reviewer searched the Cochrane Stroke Group trials register and contacted trialists.Randomised trials comparing an antiplatelet agent with placebo or open control in people with nonrheumatic atrialfibrillation and a previous transient ischaemic attack or minor ischaemic stroke.One reviewer extracted the data.One trial was included, in which 300 milligrams of aspirin per day was compared with placebo. This review includes 404 aspirin-treated patients and 378 placebo patients in total. The mean
Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrialfibrillation and a history of stroke or transient ischemic attacks. People with nonrheumatic atrialfibrillation who have had a transient ischemic attack or minor ischemic stroke are at risk of recurrent stroke.The objective of this review was to compare the effect of anticoagulants with antiplatelet therapy, for secondary prevention, in people with nonrheumatic atrialfibrillation and previous (...) cerebral ischaemia.The reviewer searched the Cochrane Stroke Group trials register and contacted trialists.Randomised trials comparing oral anticoagulants with aspirin in patients with non-rheumatic atrialfibrillation and a previous transient ischaemic attack or minor ischaemic stroke.One reviewer extracted the data.One trial was included, involving 455 patients. They received either anticoagulants (International Normalised Ratio 2.5 to 4.0), or 300 milligrams of aspirin per day. People joined
Antiplatelet therapy for preventing stroke in patients with non-valvular atrialfibrillation and no previous history of stroke or transient ischemic attacks. Atrialfibrillation (AF) carries an increased risk of stroke; antiplatelet agents are proven effective for stroke prevention in other settings.The objective of this review was to determine the efficacy and safety of antiplatelet therapy for prevention of stroke in patients with chronic non-valvular AF.We searched the Cochrane Stroke Group (...) . All analysis were, as far as possible, "intention-to-treat". Since the published results of two trials included 3-8% of participants with prior stroke or TIA, unpublished results excluding these participants were obtained from the AtrialFibrillation Investigators.Among 1680 participants without prior stroke/TIA, randomized to aspirin (N = 838) or placebo in two trials, aspirin was associated with nonsignificantly lower risks of ischemic stroke (OR = 0.71, CI 95% 0. 46 - 1.10), all stroke
Oral anticoagulants for preventing stroke in patients with non-valvular atrialfibrillation and no previous history of stroke or transient ischemic attacks. Non-valvular atrialfibrillation (AF) is associated with an increased risk of stroke.The objective of this review was to characterize the efficacy and safety of oral anticoagulation (OAC) with vitamin K antagonists for the primary prevention of stroke in patients with chronic AF.We searched the Cochrane Stroke Group Specialised Register (...) of Trials (June 1999), MEDLINE database, and the database of the Antithrombotic Trialists Collaboration, as well as reference lists of relevant articles.All randomized controlled trials comparing the value of OAC versus control in patients with non-valvular chronic atrialfibrillation and no history of transient ischemic attack (TIA) or stroke.Trials for inclusion were independently selected by two reviewers who also extracted each outcome and double-checked the data. The Peto method was used
Rhythm or rate control in atrialfibrillation--Pharmacological Intervention in AtrialFibrillation (PIAF): a randomised trial. Atrialfibrillation is the most commonly encountered sustained cardiac arrhythmia. Restoration and maintenance of sinus rhythm is believed by many physicians to be superior to rate control only. However, there are no prospective data that compare both therapeutic strategies.The Pharmacological Intervention in AtrialFibrillation (PIAF) trial was a randomised trial (...) in 252 patients with atrialfibrillation of between 7 days and 360 days duration, which compared rate (group A, 125 patients) with rhythm control (group B, 127 patients). In group A, diltiazem was used as first-line therapy and amiodarone was used in group B. The primary study endpoint was improvement in symptoms related to atrial fibrillation.Over the entire observation period of 1 year, a similar proportion of patients reported improvement in symptoms in both groups (76 responders at 12 months
Amiodarone to prevent recurrence of atrialfibrillation. Canadian Trial of AtrialFibrillation Investigators. The restoration and maintenance of sinus rhythm is a desirable goal in patients with atrialfibrillation, because the prevention of recurrences can improve cardiac function and relieve symptoms. Uncontrolled studies have suggested that amiodarone in low doses may be more effective and safer than other agents in preventing recurrence, but this agent has not been tested in a large (...) , randomized trial.We undertook a prospective, multicenter trial to test the hypothesis that low doses of amiodarone would be more efficacious in preventing recurrent atrialfibrillation than therapy with sotalol or propafenone. We randomly assigned patients who had had at least one episode of atrialfibrillation within the previous six months to amiodarone or to sotalol or propafenone, given in an open-label fashion. The patients in the group assigned to sotalol or propafenone underwent a second
Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrialfibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Patients with acute ischaemic stroke and atrialfibrillation have an increased risk of early stroke recurrence, and anticoagulant treatment with heparins has been widely advocated, despite missing data on the balance of risk and benefit.Heparin in Acute Embolic Stroke Trial (HAEST (...) ) was a multicentre, randomised, double-blind, and double-dummy trial on the effect of low-molecular-weight heparin (LMWH, dalteparin 100 IU/kg subcutaneously twice a day) or aspirin (160 mg every day) for the treatment of 449 patients with acute ischaemic stroke and atrialfibrillation. The primary aim was to test whether treatment with LMWH, started within 30 h of stroke onset, is superior to aspirin for the prevention of recurrent stroke during the first 14 days.The frequency of recurrent ischaemic stroke
2000LancetControlled trial quality: predicted high
Clinical outcomes after ablation and pacing therapy for atrialfibrillation: a meta-analysis Clinical outcomes after ablation and pacing therapy for atrialfibrillation: a meta-analysis Clinical outcomes after ablation and pacing therapy for atrialfibrillation: a meta-analysis Wood M A, Brown-Mahoney C, Kay G N, Ellenbogen K A Authors' objectives To quantify the effects of ablation and pacing therapy on measures of clinical outcome and survival, in people with medically refractory atrial (...) tachyarrhythmia, or explicit separation of radiofrequency ablation data from direct-current catheter ablation. Studies using only direct current ablation, or examining only atrioventricular (AV) nodal modification for ventricular rate slowing rather than complete AV junction ablation, were excluded. Participants included in the review Patients with medically refractory atrial tachyarrhythmia, including those with chronic or paroxysmal atrialfibrillation, atrial flutter or atrial tachycardia. The eligible
Esmolol versus diltiazem in the treatment of postoperative atrialfibrillation/atrial flutter after open heart surgery Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Clinical and cost comparison of ibutilide and direct-current cardioversion for atrialfibrillation and flutter Clinical and cost comparison of ibutilide and direct-current cardioversion for atrialfibrillation and flutter Clinical and cost comparison of ibutilide and direct-current cardioversion for atrialfibrillation and flutter Murdock D K, Schumock G T, Kaliebe J, Olson K, Guenette A J 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 compares using first-line ibutilide for cardioversion with direct-current cardioversion (DCC) for recent onset of atrialfibrillation (AF) or atrial flutter (AFl) in patients undergoing anticoagulation for 3 to 4 weeks before elective cardioversion. Type of intervention Treatment
Facilitating transthoracic cardioversion of atrialfibrillation with ibutilide pretreatment. Atrialfibrillation cannot always be converted to sinus rhythm by transthoracic electrical cardioversion. We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for atrial defibrillation and assessed the value of this agent in facilitating cardioversion in patients with atrialfibrillation that is resistant to conventional transthoracic cardioversion.One hundred (...) patients who had had atrialfibrillation for a mean (+/-SD) of 117+/-201 days were randomly assigned to undergo transthoracic cardioversion with or without pretreatment with 1 mg of ibutilide. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. If transthoracic cardioversion was unsuccessful in a patient who had not received ibutilide pretreatment, ibutilide was administered and transthoracic cardioversion attempted again.Conversion
A patient decision aid regarding antithrombotic therapy for stroke prevention in atrialfibrillation: a randomized controlled trial. Decision aids are tools designed to help patients participate in the clinical decision-making process.To determine whether use of an audiobooklet (AB) decision aid explaining the results of a clinical trial affected the decision-making process of study participants.Randomized controlled trial conducted from May 1997 to April 1998.Fourteen centers that participated (...) in the Stroke Prevention in AtrialFibrillation (SPAF) III trial.A total of 287 patients from the SPAF III aspirin cohort study, in which patients with atrialfibrillation and a relatively low risk of stroke received 325 mg/d of aspirin and were followed up for a mean of 2 years.At the end of SPAF III, participants were randomized to be informed of the study results with usual care plus use of an AB (AB group) vs usual care alone (control group). The AB included pertinent information to help patients decide
Primary prevention of arterial thromboembolism in non-rheumatic atrialfibrillation in primary care: randomised controlled trial comparing two intensities of coumarin with aspirin. To investigate the effectiveness of aspirin and coumarin in preventing thromboembolism in patients with non-rheumatic atrialfibrillation in general practice.Randomised controlled trial.729 patients aged >/=60 years with atrialfibrillation, recruited in general practice, who had no established indication (...) pressure and age were independent prognostic factors.In a general practice population (without established indications for coumarin) neither low nor standard intensity anticoagulation is better than aspirin in preventing primary outcome events. Aspirin may therefore be the first choice in patients with atrialfibrillation in general practice.