Safe Cardioversion for Patients with Acute-Onset Atrial Fibrillation and Flutter: Practical Concerns and Considerations
Publication date: Available online 13 June 2019Source: Canadian Journal of CardiologyAuthor(s): Ian G. Stiell, M. Sean McMurtry, Andrew McRae, Ratika Parkash, Frank Scheuermeyer, Clare L. Atzema, Allan SkanesAbstractThis commentary discusses concerns raised by Canadian emergency physicians regarding Recommendations 2 and 6 from the recent CCS 2018 Update for atrial fibrillation. These recommendations narrow the window for safe cardioversion and suggest four weeks of anticoagulation for all patients undergoing urgent cardioversion regardless of their CHADS-65 status. We discuss the implications of GRADE weak recommendations based upon low-quality evidence.
Conclusion: Left atrial reduction and radiofrequency ablation concomitant with robotically assisted mi nimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.
Interview with Adrian F. Hernandez, MD, MHS, author of Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke: Findings From the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study
This cohort assesses the clinical effectiveness of direct oral anticoagulants vs warfarin for stroke prevention in patients with atrial fibrillation.
ConclusionsThis study demonstrated the utility of CHA2DS2-VASc score in predicting TEC-associated readmission rate following CV and the temporal relationship of TEC to CV. Patients> 65 years old without other comorbidities may benefit from 30-day OAC following successful CV irrespective of the duration of AF episodes.
ConclusionsAssessment of transmural mitral isthmus block can be challenging. Placement of an endocardial mapping catheter around the mitral annulus can provide a precise assessment of conduction across the mitral isthmus.This article is protected by copyright. All rights reserved.
ConclusionsIn patients with AF undergoing PCI at lower ischemic risk and higher bleeding risk, 1 month of TT seems safe and efficacious. Further studies are warranted in patients at high ischemic risk.
Alcohol withdrawal syndrome (AWS) has been associated with significant medical complications and length of stay. Cardiovascular effects from AWS include a physiologic tachycardia and hypertensive response. While atrial fibrillation (AF) is one of the most common arrhythmias, the impact of a known history of AF on AWS is unclear. The purpose of our study is to assess the impact of history of AF on clinical outcomes, cost and length of stay on AWS. The Nationwide Inpatient Sample was used to identify patients aged 18 years or older who underwent AWS with or without AF using the International Classification of Disease 9 Clini...
AbstractIntroductionSubclinical atrial fibrillation (AF), in the form of cardiac implantable device ‐detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter‐defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for s ubclinical AF detection in patients, with a prospective multicenter, cohort‐controlled trialMethods and Results150 patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort...
AbstractBackgroundThe utility of pressure waveform analyses to assess pulmonary vein(PV) occlusions has been reported in cryoballoon PV isolation(CB ‐PVI) using first‐generation CBs. This prospective randomized study compared the procedural and clinical outcomes of pressure‐guided and conventional CB‐PVI.Methods and ResultsSixty paroxysmal atrial fibrillation patients underwent CB ‐PVI with 28‐mm second‐generation CBs. PV occlusions were assessed either by real‐time pressure waveforms without contrast utilization(pressure‐guided group) or contrast injections(conventional group) and randomly assigned. Befo...
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