The functional medicine approach to atrial fibrillation: can a cure for atrial fibrillation be found in the gut?
Purpose of review
The importance of addressing the proximal causes of atrial fibrillation is recognized, yet frustration with the currently applied preventive measures is high. This review describes the functional medicine model (FMM), which identifies the proximal causes of atrial fibrillation at the level of gene-environment interaction.
Recent findings
The pathological processes leading to atrial fibrillation sustaining disorder have been elucidated in translational studies and are described as ‘nodal points.’ Examples are inflammation, oxidative stress, autoimmune mechanisms, and visceral adiposity. Thes...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Percutaneous left atrial appendage occlusion
In conclusion, percutaneous LAAO appears to be a promising option for NVAF patients who are not candidates for long-term OAC in the current era. Further evidence guiding optimal patient selection and periprocedural antithrombotic regimen will help identify the patients who would benefit the most from this procedure. (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Artificial intelligence in cardiovascular medicine
Purpose of review
Artificial intelligence is a broad set of sophisticated computer-based statistical tools that have become widely available. Cardiovascular medicine with its large data repositories, need for operational efficiency and growing focus on precision care is set to be transformed by artificial intelligence. Applications range from new pathophysiologic discoveries to decision support for individual patient care to optimization of system-wide logistical processes.
Recent findings
Machine learning is the dominant form of artificial intelligence wherein complex statistical algorithms ‘learn’ by deduc...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Cryoballoon ablation for extrapulmonary vein targets
Purpose of review
Cryoballoon catheter can create large and contiguous lesions with stable contact during ablation. It has proven to be well tolerated and effective in pulmonary vein isolation. But atrial arrhythmias, including atrial fibrillation, atrial tachycardia, and atrial flutter (AFL), also relate to many extrapulmonary vein targets. It is necessary to understand the current evidence for the use of cryoballoon ablation for targets outside of pulmonary veins.
Recent findings
Studies have shown that the cryoballoon ablation can be used in extrapulmonary vein area, including left atrium roof, left atrial ap...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Focal cryoablation of atrioventricular node reentrant tachycardia: a review and comparison of data
Purpose of review
Atrioventricular node reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Radiofrequency ablation has been the most prevalent method for slow pathway ablation but carries risk of atrioventricular node injury. Focal cryoablation has been utilized as an alternative ablation modality; however, there has been concern about decreased efficacy, resulting in a higher rate of recurrence postablation. We also report outcomes from two international centers using an 8-mm cryocatheter and complete a thorough comparison of existing data on ablation of AVNRT.
Recent findin...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Consumer wearable technologies to identify and monitor exercise-related arrhythmias in athletes
Purpose of review
The aim of this study was to synthesize the current evidence supporting and against the use of wearable devices to detect underlying heart conditions in athletes and the most significant limitations.
Recent findings
Although several large studies have been conducted to evaluate the ability of wearables devices to identify atrial fibrillation among the general population, no studies evaluating their ability to detect other exercise-related arrhythmias in athletes are very sparse. Most of the studies or case reports are focused on the wearables’ reliability and accuracy compared with standard E...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Pulsed field ablation: a promise that came true
Purpose of review
Pulsed field ablation is a nonthermal ablative modality that uses short living, strong electrical field created around catheter to create microscopic pores in cell membranes (electroporation). When adequately dosed/configured it shows a preference for myocardial tissue necrosis. Thus, it holds a promise to become a ‘perfect’ energy source for cardiac ablation to treat arrhythmias. Herein, we present update on platforms in clinical development.
Recent findings
First in human series using pulsed field ablation for atrial fibrillation ablation have been completed and data published for several...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Cybersecurity threats to cardiac implantable devices: room for improvement
Purpose of review
For over a decade, vulnerabilities in the healthcare industry have been identified. Medical devices such as cardiovascular implantable electronic devices (CIEDs) are particularly concerning because of direct threats to patient safety and protected health information (PHI). Although these vulnerabilities have been identified and changes have been made, there is significant room for improvement. We identify changes and improvements to be made in the industry, by providers, and by patients.
Recent findings
Cybersecurity threats in cardiac implantable devices are legitimate concerns for patient saf...
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: ARRHYTHMIAS: Edited by Wilber W. Su Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - December 7, 2020 Category: Cardiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Ischaemia without obstructive coronary artery disease: the pathophysiology of microvascular dysfunction
Purpose of review
Nearly one-third of patients presenting with angina have unobstructed epicardial coronary arteries and evidence of coronary microvascular disease. Up until recently, the pathophysiology of coronary microvascular disease has been poorly understood, resulting in limited effective therapeutic options in these patients. As a result, patients with coronary microvascular disease continue to suffer from a poor quality of life and adverse cardiovascular outcomes.
Recent findings
Recent mechanistic studies have improved our understanding of the pathophysiology underlying coronary microvascular dysfunction; th...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Preemptive percutaneous coronary intervention for coronary artery disease: identification of the appropriate high-risk lesion
Purpose of review
Management of patients with coronary artery disease (CAD) has been based on identification of a coronary obstruction causing ischemia and performing a revascularization procedure to reduce that ischemia, with the goal of thereby preventing subsequent major adverse cardiac events (MACEs) in that vascular territory. Recent investigations demonstrate that preemptive percutaneous coronary intervention (PCI) of nonculprit coronary lesions (NCLs) that may not cause ischemia in patients with ST-segment elevation myocardial infarction (STEMI) reduces MACE. In this review, we focus on preemptive PCI, discuss its...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Thin, very thin, or ultrathin-strut biodegradable or durable polymer-coated drug-eluting stents
Purpose of review
The current article will review recently published clinical studies that evaluate very thin or ultrathin-strut drug-eluting stents (DES), focusing on major randomized clinical trials in broad patient populations.
Recent findings
Multiple randomized trials recently assessed the clinical performance of novel very thin to ultrathin-strut DES. Most randomized trials established noninferiority of the novel device. To date, only one major randomized clinical trial (i.e., BIOFLOW V) showed superiority of an ultrathin-strut biodegradable polymer-coated sirolimus-eluting stent over a very thin-strut durable p...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Mechanisms of myocardial infarction with nonobstructive coronary atherosclerosis: a multifaceted play of different actors with guarded prognosis
Purpose of review
Myocardial infarction (MI) with nonobstructive coronary atherosclerosis (MINOCA) on invasive angiography (stenosis severity (Source: Current Opinion in Cardiology)
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Adverse events beyond 1 year after percutaneous coronary intervention
Purpose of review
To provide a summary and critical appraisal of recent literature pertaining to very late adverse events (>1 year) after revascularization with percutaneous coronary intervention (PCI) with coronary stents.
Recent findings
Recent studies, including an individual patient-level pooled analysis of randomized trials and network meta-analysis have demonstrated that all coronary stents, including contemporary drug-eluting stents (DES), are associated with an ongoing risk of major adverse cardiovascular events related to the stented region beyond the first year after stent implantation, with rates ranging fr...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: ISCHEMIC HEART DISEASE: Edited by Peter H. Stone Source Type: research
Temporal improvements in perioperative stroke rates following coronary artery bypass grafting
Purpose of review
Perioperative stroke remains one of the most dreaded complications following coronary artery bypass grafting. In this review, we highlight the significant advances in understanding and preventing stroke in patients undergoing bypass surgery and offer our center's current best-practice recommendations to help avoid this debilitating outcome.
Recent findings
The incidence of stroke has significantly reduced since the advent of coronary artery bypass graft surgery. Improvements in our understanding of the cause, mechanisms, risk factors, and diagnosis of stroke as well as refinements in medical optimiza...
Source: Current Opinion in Cardiology - October 11, 2020 Category: Cardiology Tags: CORONARY ARTERY SURGERY: Edited by Marc Ruel Source Type: research
