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Utilization and procedural adverse outcomes associated with Watchman device implantation
Conclusion  Percutaneous LAAO with the Watchman device in the USA is associated with low in-hospital complications and a similar safety profile to a recently published EWOLUTION cohort. The complication rates were lower than those reported in the major randomized clinical trials (RCTs). We report the frequency of peri-procedural complications of the LAAO using the Watchman device from the NIS database. We also compare the frequency of peri-procedural complications with the previously published RCTs and EWOLUTION cohort. Our findings are in concordance with findings from EWOLUTION cohort and compare favourably with RCTs.
Source: Europace - September 14, 2020 Category: Cardiology Source Type: research

Major bleeding in patients with atrial fibrillation receiving vitamin K antagonists: a systematic review of randomized and observational studies
Conclusion The median rate of major bleeding in observational studies and RCTs is similar. The larger heterogeneity in bleeding rates observed in a real-life setting could reflect a high variability in standard of care of patients on VKAs and/or methodological differences between observational studies and/or variability in data sources.
Source: Europace - May 24, 2013 Category: Cardiology Authors: Roskell, N. S., Samuel, M., Noack, H., Monz, B. U. Tags: Atrial Fibrillation 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

Drug persistence with rivaroxaban therapy in atrial fibrillation patients--results from the Dresden non-interventional oral anticoagulation registry
Conclusion Our data indicate that overall persistence with rivaroxaban therapy is high, with a discontinuation rate of ~15% in the first year of treatment and few additional discontinuations thereafter.
Source: Europace - April 1, 2015 Category: Cardiology Authors: Beyer-Westendorf, J., Forster, K., Ebertz, F., Gelbricht, V., Schreier, T., Gobelt, M., Michalski, F., Endig, H., Sahin, K., Tittl, L., Weiss, N. Tags: Atrial fibrillation Source Type: research

Preference for oral anticoagulation therapy for patients with atrial fibrillation in Europe in different clinical situations: results of the European Heart Rhythm Association Survey
The purpose of this European Heart Rhythm Association Survey was to assess the clinical practice in relation to the use of oral anticoagulation therapy for patients with atrial fibrillation (AF) in Europe. Of special interest were patients undergoing percutaneous coronary intervention (PCI), cardioversion procedures, catheter ablation, surgery, and those suffering from anticoagulation-related bleeding. Of 38 responding centres, non-vitamin K antagonist oral anticoagulants (NOACs) were used for stroke prophylaxis and were preferred (33.3%) or considered equal (48.5%) to vitamin K antagonists (VKAs). Only 3% did not use NOAC...
Source: Europace - April 29, 2015 Category: Cardiology Authors: Larsen, T. B., Potpara, T., Dagres, N., Proclemer, A., Sciarrafia, E., Blomstrom-Lundqvist, C., Scientific Initiative Committee, European Heart Rhythm Association, Scientific Initiative Committee, European Heart Rhythm Association, Blomstrom-Lundqvist, Bo Tags: EP WIRE Source Type: research

Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings
Conclusion In a nationwide cohort of non-valvular AF patients, outpatients were much more likely to receive OAC therapy and had a significantly lower risk of stroke/TE compared with inpatients and ED patients. However, across all settings investigated, OAC therapy was far from optimal.
Source: Europace - May 11, 2016 Category: Cardiology Authors: Mikkelsen, A. P., Hansen, M. L., Olesen, J. B., Hvidtfeldt, M. W., Karasoy, D., Husted, S., Johnsen, S. P., Brandes, A., Gislason, G., Torp-Pedersen, C., Lamberts, M. Tags: Atrial fibrillation Source Type: research

Data on procedural handling and complications of pulmonary vein isolation using the pulmonary vein ablation catheter GOLD(R)
Conclusion The PVAC GOLD® seems to have an acceptable safety profile. The handling is comparable with the previous generation PVAC®.
Source: Europace - May 24, 2016 Category: Cardiology Authors: Leitz, P., Güner, F., Wasmer, K., Foraita, P., Pott, C., Dechering, D. G., Zellerhoff, S., Kochhäuser, S., Lange, P. S., Eckardt, L., Mönnig, G. Tags: Ablation for atrial fibrillation Source Type: research

Rationale and design of AXAFA-AFNET 5: an investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation
Conclusion</div>The results of AXAFA-AFNET 5 will provide evidence informing about the safety of apixaban in ablation patients and on its efficacy including effects on silent brain lesions. AXAFA – AFNET 5 is an investigator-initiated trial sponsored by AFNET. The trial is supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) and by Bristol-Myers Squibb/Pfizer Alliance.</span>
Source: Europace - October 13, 2016 Category: Cardiology 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

88 One-year outcomes of triple therapy and adherence with ESC guidelines in patients with AF undergoing PCI in a teaching hospital
Background/Introduction: Oral anticoagulation is the corner-stone for stroke prevention in Atrial Fibrillation (AF).Following Percutaneous Coronary Intervention (PCI) the risk of bleeding increase due to concomitant prescription of antiplatelet agents. The 2016 European Society of Cardiology( ESC) guidelines for non valvular AF provide clear recommendations for triple therapy  , Combination of two anti-platelet and oral anticoagulant in patients with underlying AF undergoing PCI, either electively or for acute coronary syndrome (ACS). The risk of such therapy is based on treatment duration and patient characteristics.
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

124 GP-led anticoagulation counselling for non-valvular atrial fibrillation (AF) in the community is neither comprehensive nor accurate: Results from a service improvement project.
Background: Stroke risk in NVAF can be reduced significantly by anticoagulation with either warfarin or the non- vitamin K antagonist (NOACs). NICE recommendations state that NOACs are as efficacious but also associated with significantly less intracranial bleeding compared to Warfarin and in this sense are safer than warfarin. Additionally NOACs do not require regular monitoring of their anticoagulant effects and therefore offer convenience to the patient. However they are not as tried and tested as warfarin and at the time of our study, did not have an available agent to reverse their effects in the event of a bleeding c...
Source: Europace - October 5, 2017 Category: Cardiology Source Type: research

Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients undergoing elective cardioversion
ConclusionThrombotic and bleeding complications related to NOACs were uncommon (<0.5%) in real life AF patients undergoing elective cardioversion.
Source: Europace - July 10, 2017 Category: Cardiology Source Type: research

Shifting to a non-vitamin K antagonist oral anticoagulation agent from vitamin K antagonist in atrial fibrillation
ConclusionIn a contemporary setting among VKA-experienced NVAF patients; VKA is still prevalent although about 30% by December 2015 had shifted to a NOAC.
Source: Europace - June 28, 2017 Category: Cardiology Source Type: research

How to estimate the potential clinical benefit associated with left atrial appendage closure?
We read the article by Phillipset al. about combined left atrial appendage (LAA) closure and catheter ablation for atrial fibrillation (AF) and its related editorial.1,2 The rate of ischaemic stroke was 0.36% per year which would represent a 93% relative risk reduction (RRR) vs. predicted rate by the CHA2DS2-VASc score without oral anticoagulation (OAC). For non-procedural major bleeding rate, estimated RRR was 70% when compared to the expected bleeding risk on warfarin according to the HAS-BLED score.
Source: Europace - July 2, 2020 Category: Cardiology Source Type: research

Sex-related differences in risk factors, outcome, and quality of life in patients with permanent atrial fibrillation: results from the RACE II study
ConclusionIn this permanent AF population, women had more accumulation of AF risk factors than men. The observed higher cardiovascular event rate in women was no longer significant after adjusting for the number of risk factors. Further, QoL was negatively influenced by the higher number of risk factors in women. This suggests that sex differences may be driven by the greater risk factor burden in women.
Source: Europace - November 20, 2019 Category: Cardiology Source Type: research

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