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Main determinants of physician-driven amiodarone discontinuation in clinical practice
ConclusionStudy showed that within the first two years of treatment, despite persistent indication, amiodarone was discontinued in 1 out of 10 patients in the absence of side effects, mostly in younger patients with less comorbidities, which may not always be justified. There is a need for qualitative research to elucidate the reasons for such physicians ’ decisions. Table.Multivariable Cox Proportional HAZARD Regression analysis of permanent Amiodarone discontinuation due to physician decisionVariableHR95% CIP valueAge0.9700.95-0.990.003VT/VF/electrical storm0.1390.04-0.450.001VKA therapy0.5980.38-0.940.026Ablation of A...
Source: Europace - May 24, 2021 Category: Cardiology Source Type: research

How to estimate the potential clinical benefit associated with left atrial appendage closure? Authors ’ reply
In response to the letter by Fauchier et al.,1 we wish to highlight numerous erroneous statements they have made with regards the data and analysis in our published article2 Firstly Fauchieret al. claim that ‘8% of patients still had oral anticoagulation (OAC) at 2-year follow-up, with no information on OAC use in the preceding follow-up visits’. However, the article states that 94% of patients stopped OAC at the first follow-up visit (2–3 months post-procedure) and patients who were recommenced on OAC during follow-up are individually described in the results leading to 8% of patients taking OAC at the end of 2-ye...
Source: Europace - July 16, 2020 Category: Cardiology Source Type: research

Apixaban enhances endogenous fibrinolysis in patients with atrial fibrillation
ConclusionApixaban enhances endogenous fibrinolysis, with maximal effect in those with impaired fibrinolysis pre-treatment. Apixaban-treated patients exhibit more favourable fibrinolysis profiles than those taking warfarin or aspirin. Whether apixaban may confer additional thrombotic risk reduction in NVAF patients with impaired fibrinolysis, compared to warfarin, merits further study.
Source: Europace - June 25, 2019 Category: Cardiology Source Type: research

Thromboembolism after electrical isolation of the left atrial appendage: a new indication for interventional closure?
ConclusionAfter electrical LAAI for rhythm control in AF patients, interventional LAAC was associated with fewer thromboembolic complications when compared with OAC.
Source: Europace - June 23, 2019 Category: Cardiology Source Type: research

Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin
Conclusions This analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin.
Source: Europace - June 28, 2016 Category: Cardiology Authors: Reddy, V. Y., Akehurst, R. L., Armstrong, S. O., Amorosi, S. L., Brereton, N., Hertz, D. S., Holmes, D. R. Tags: Atrial fibrillation Source Type: research

Ischaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis
Conclusion In CKD patients on PD with AF, who had similar ischaemic stroke risk as non-CKD counterparts, warfarin therapy is associated with reduction in risk of ischaemic stroke without a higher risk of ICH.
Source: Europace - May 24, 2016 Category: Cardiology Authors: Chan, P.-H., Huang, D., Yip, P.-S., Hai, J., Tse, H.-F., Chan, T.-M., Lip, G. Y. H., Lo, W.-K., Siu, C.-W. Tags: Atrial fibrillation Source Type: research

Cost effectiveness of LAA closure in patients with AF and contraindications to warfarin: comment
This study evaluated the costs of percutaneous left atrial appendage closure (LAAC) using the Watchman device (Boston Scientific, Marlborough, MA). As pointed out by the authors, procedures to implement percutaneous devices are associated with a 6.7% short-term risk of major complications (air embolism, major bleeding, and pericardial effusion). Moreover, the device and technical platform necessary for the procedure come at a significant cost (€9136). Despite these downsides, assuming a willingness-to-pay threshold of€30 000 per quality-adjusted life-year gained, the authors found that relative to both aspirin and apix...
Source: Europace - May 18, 2016 Category: Cardiology Source Type: research

Management of atrial fibrillation in patients with chronic kidney disease in Europe Results of the European Heart Rhythm Association Survey
The purpose of this European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey was to assess ‘real-world’ practice in the management of patients with atrial fibrillation (AF) and chronic kidney disease (CKD) in the European Eelectrophysiology centres. Of 41 responding centres, 39 (95.1%) and 37 (90.2%) routinely evaluated renal function in AF patients at first presentation and during follow-up, respectively, but 13 centres (31.7%) re-assessed advanced CKD only at ≥1-year intervals. While the use of oral anticoagulants (OACs) in mild-to-moderate CKD patients was mostly guided by individual p...
Source: Europace - January 4, 2016 Category: Cardiology Authors: Potpara, T. S., Lenarczyk, R., Larsen, T. B., Deharo, J.-C., Chen, J., Dagres, N., Conducted by the Scientific Initiatives Committee, European Heart Rhythm Association, Conducted by the Scientific Initiatives Committee, European Heart Rhythm Association, Tags: EP WIRE Source Type: research

Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban
Conclusion Using interrupted OAC, low target intraprocedural ACT, and irrigated-tip RF, the rate of peri-procedural groin, haemorrhagic, and thromboembolic complications was extremely low. There were only minimal differences between OACs. Low-risk patients may remain on aspirin/no OAC pre-ablation. There are no problems changing from one OAC pre-ablation to another post-ablation.
Source: Europace - September 29, 2014 Category: Cardiology Authors: Winkle, R. A., Mead, R. H., Engel, G., Kong, M. H., Patrawala, R. A. Tags: Ablation for atrial fibrillation Source Type: research

A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry
Conclusion The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal.
Source: Europace - February 25, 2014 Category: Cardiology Authors: Lip, G. Y. H., Laroche, C., Dan, G.-A., Santini, M., Kalarus, Z., Rasmussen, L. H., Oliveira, M. M., Mairesse, G., Crijns, H. J. G. M., Simantirakis, E., Atar, D., Kirchhof, P., Vardas, P., Tavazzi, L., Maggioni, A. P. Tags: Atrial fibrillation Source Type: research