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The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients with Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors
Atrial fibrillation is the most common sustained cardiac arrhythmia affecting nearly 2% of the population of the United States.1 Patients with atrial fibrillation are twice as likely to have a myocardial infarction and five-times as likely to have a stroke.1 Current guidelines recommend antiarrhythmic pharmacotherapy in patients with symptomatic atrial fibrillation as first-line management.2-4 Amiodarone is a very effective, and therefore, a commonly prescribed agent for this purpose.5 Anticoagulation is a key tenet in the management of atrial fibrillation due to the increased tendency of left atrial appendage clot formati...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 10, 2023 Category: Anesthesiology Authors: Nicolas Kumar, Manoj H. Iyer, Adam Dalia, Amit Bardia Tags: Editorial Source Type: research

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

The CHA2DS2-VASc score and Geriatric Multidimensional Assessment tools in elderly patients with persistent atrial fibrillation undergoing electrical cardioversion. A link with arrhythmia relapse?
CONCLUSIONS: The CHA2DS2-VASc score significantly correlated with neuro-cognitive performance, depressive symptoms and physical functioning. It was also associated with AF relapse. Accordingly, in the elderly, the CHA2DS2-VASc could help quantify thrombo-embolic risk, give an indication of frailty status and help to choose between a rate- and a rhythm-control strategy. PMID: 32709545 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - July 21, 2020 Category: Internal Medicine Authors: Fumagalli S, Pelagalli G, Montorzi RF, Marozzi I, Migliorini M, D'Andria MF, Lip GYH, Marchionni N Tags: Eur J Intern Med Source Type: research

One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: Data from the BLITZ-AF study.
CONCLUSIONS: The follow-up of the BLITZ-AF study provide an up to date picture of the clinical course of patients with AF, who appear frequently affected by heart failure and severe comorbidities which might have led to the high mortality rate. PMID: 31952984 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - January 13, 2020 Category: Internal Medicine Authors: Cemin R, Colivicchi F, Maggioni AP, Boriani G, De Luca L, Di Lenarda A, Di Pasquale G, Fabbri G, Lucci D, Gulizia MM, On the behalf of BLITZ-AF Investigators Tags: Eur J Intern Med Source Type: research

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation.
CONCLUSIONS: There is high-certainty evidence of increased mortality associated with sotalol treatment, and low-certainty evidence suggesting increased mortality with quinidine, when used for maintaining sinus rhythm in people with atrial fibrillation. We found few data on mortality in people taking disopyramide, flecainide and propafenone, so it was not possible to make a reliable estimation of the mortality risk for these drugs. However, we did find moderate-certainty evidence of marked increases in proarrhythmia and adverse effects with flecainide.Overall, there is evidence showing that antiarrhythmic drugs increase adv...
Source: Cochrane Database of Systematic Reviews - September 3, 2019 Category: General Medicine Authors: Valembois L, Audureau E, Takeda A, Jarzebowski W, Belmin J, Lafuente-Lafuente C Tags: Cochrane Database Syst Rev Source Type: research

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.
Authors: Brieger D, Amerena J, Attia JR, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani HM, Hendriks J, Hespe CM, Hung J, Kalman JM, Sanders P, Worthington J, Yan T, Zwar NA Abstract INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult ...
Source: Medical Journal of Australia - August 3, 2018 Category: General Medicine Tags: Med J Aust Source Type: research

Atrial Fibrillation and Injected Aripiprazole: A Case Report
Conclusion In summary, although it is not possible to exclude confounding factors, the timing and dose-dependent effect of aripiprazole administration in our patient suggests an association between an initial intramuscular injection of long-acting aripiprazole and new onset of AF. This observation calls for clinical vigilance, not only in patients with additional risk factors for stroke but also in younger patients who might have predisposing factors for arrhythmias. References CPS (Canadian Pharmacists Association). Available at: http://www.e-therapeutics.ca. Accessed January 1, 2017. Polcwiartek C, Sneider B, Graff C,...
Source: Innovations in Clinical Neuroscience - May 1, 2018 Category: Neuroscience Authors: ICNS Online Editor Tags: Case Report Current Issue adverse effects aripiprazole atrial fibrillation schizoaffective disorder Source Type: research

Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy.
Conclusions -Transient symptomatic episodes of AF, although relatively uncommon in HCM, are unpredictable in frequency and timing, amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity, nor a cause of arrhythmic sudden death, and when treated is associated with low-disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy. PMID: 28916640 [PubMed - as supplied by publisher]
Source: Circulation - September 15, 2017 Category: Cardiology Authors: Rowin EJ, Hausvater A, Link MS, Abt P, Gionfriddo W, Wang W, Rastegar H, Estes NAM, Maron MS, Maron BJ Tags: Circulation Source Type: research

Management strategies for atrial fibrillation.
Abstract Atrial fibrillation is the most prevalent cardiac arrhythmia, affecting 10% of those aged over 80 years. Despite multiple treatment options, it remains an independent prognostic marker of mortality due to its association with clinical sequelae, particularly cerebrovascular events. Management can be broadly divided into treatment of the arrhythmia, via rhythm or rate control, and stroke thromboprophylaxis via anticoagulation. Traditional options for pharmacotherapy include negatively chronotropic drugs such as β-blockers, and/or arrhythmia-modifying drugs such as amiodarone. More recently, catheter ablati...
Source: J R Soc Med AND (has... - December 31, 2016 Category: Journals (General) Authors: Patel PA, Ali N, Hogarth A, Tayebjee MH Tags: J R Soc Med Source Type: research

Iodine-induced hyperthyroidism as combination of different etiologies: an overlooked entity in the elderly.
We report the case of an elderly man who was diagnosed with tachyfibrillation secondary to hyperthyroidism. Thyroid hyperfunction was subsequently related both to previous amiodarone therapy (probably mixed form) and the recent use of iodinated contrast medium for computed tomography scan. Thyroid ultrasonography showed a plongeant multinodular goitre. After initial worsening, thyroid function improved slowly but progressively on high-dose thyreostatic therapy combined with steroid therapy; tachyfibrillation caused heart failure and a thrombus in the left atrium, and proved initially resistant to combined antiarrhythmic tr...
Source: Aging Clinical and Experimental Research - November 4, 2015 Category: Geriatrics Authors: Foppiani L, Cascio C, Pinto GL Tags: Aging Clin Exp Res Source Type: research

Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation.
CONCLUSIONS: Several class IA, IC and III drugs, as well as class II drugs (beta-blockers), are moderately effective in maintaining sinus rhythm after conversion of atrial fibrillation. However, they increase adverse events, including pro-arrhythmia, and some of them (disopyramide, quinidine and sotalol) may increase mortality. Possible benefits on clinically relevant outcomes (stroke, embolism, heart failure) remain to be established. PMID: 25820938 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - April 2, 2015 Category: Journals (General) Authors: Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J Tags: Cochrane Database Syst Rev Source Type: research

Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland.
CONCLUSIONS: Conversion to sinus rhythm was attempted in < 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. Electrical cardioversion was successful in ~90% of the patients, while pharmacological cardioversion in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%). PMID: 24526513 [PubMed - as supplied by publisher]
Source: Cardiology Journal - February 14, 2014 Category: Cardiology Authors: Kiliszek M, Opolski G, Włodarczyk P, Dąbrowski R, Ponikowski P Tags: Cardiol J Source Type: research

Non-standard dose dronedarone in treating atrial fibrillation patients
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia requiring medical care . Dronedarone is derived from amiodarone, but has different electrophysiological effects . Dronedarone has been approved to treat paroxysmal or persistent AF, which is associated with a reduction of AF-related hospitalization, stroke or mortality . However, dronedarone should be avoided in patients with decompensated heart failure or permanent AF due to an increased mortality .
Source: International Journal of Cardiology - January 23, 2014 Category: Cardiology Authors: Jen-Hung Huang, Yung-Kuo Lin, Ming-Hsiung Hsieh, Shih-Ann Chen, Yi-Jen Chen Tags: Online Letters to the Editor Source Type: research