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Source: The American Journal of Cardiology
Condition: Atrial Fibrillation
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Total 336 results found since Jan 2013.
Direct Oral Anticoagulants: Patients Benefit When Prescribers Get the Message
Direct oral anticoagulants (DOACs) have demonstrated similar or better efficacy to warfarin in reducing stroke and systemic embolic events in large-scale prospective trials.1 –4 In addition, these trials demonstrated either noninferiority or superiority in reducing bleeding events compared with warfarin. To treat high-risk patients with atrial fibrillation (AF) and avoid bleeding in low-risk patients, current guidelines recommend oral anticoagulants in high-risk patien ts with AF with CHA2DS2VASc scores of ≥2 in men and ≥3 in women.
Source: The American Journal of Cardiology - September 5, 2023 Category: Cardiology Authors: Gerald V. Naccarelli Tags: Editorial Source Type: research
Electrocardiographic Morphology-Voltage-P-Wave-Duration (MVP) Score to Select Patients for Continuous Atrial Fibrillation Screening to Prevent Stroke
Morphology-voltage-P-wave-duration (MVP) score combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) has been demonstrated to predict atrial fibrillation (AF). Therefore, this study aimed to examine MVP score and its P-wave components as potential predictors of AF screening effects on stroke prevention. This was a secondary analysis of the LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) which randomized older persons (aged 70 to 90 years) with additional stroke risk factors to either c...
Source: The American Journal of Cardiology - September 2, 2023 Category: Cardiology Authors: Lucas Yixi Xing, S øren Zöga Diederichsen, Søren Højberg, Derk Krieger, Claus Graff, Morten Salling Olesen, Jonas Bille Nielsen, Axel Brandes, Lars Køber, Ketil Jørgen Haugan, Jesper Hastrup Svendsen Source Type: research
Trends in Cardiovascular Mortality in Patients With Atrial Fibrillation and Cancer in the United States (1999 to 2020)
Cancer has been identified as an independent risk factor for atrial fibrillation (AF). Although the development of novel therapeutic agents has led to significant improvement in cancer-related outcomes, there is also a rising concern regarding the long-term impact of treatment-emergent cardiac adverse events such as AF.1 AF portends a poor prognosis in patients with cancer and is also associated with a twofold increase in the risk of stroke as compared with patients with AF without cancer.2 However, population-level data on the impact of AF on overall cardiovascular mortality in patients with cancer remain limited.
Source: The American Journal of Cardiology - August 19, 2023 Category: Cardiology Authors: Aakash R. Sheth, Udhayvir S. Grewal, Sahith R. Thotamgari, Harsh P. Patel, Paari Dominic Tags: Brief Report Source Type: research
Direct Oral Anticoagulants in the Setting of Percutaneous Coronary Intervention: “There Will Be Blood”
Direct oral anticoagulants (DOACs) are being increasingly used in clinical practice for various indications ranging from treatment of venous thromboembolism1 to stroke thromboprophylaxis in atrial fibrillation.2 Clinical practice guidelines now endorse DOACs in preference to vitamin K antagonists (VKAs) for thromboprophylaxis in patients with atrial fibrillation and after venous thromboembolism, reflecting the favorable efficacy and safety profile of this anticoagulant class compared with VKA.3 Despite increasing DOAC utilization, the optimal periprocedural antithrombotic management for patients treated with DOAC who under...
Source: The American Journal of Cardiology - August 12, 2023 Category: Cardiology Authors: Maximillian T. Bourdillon, Konstantinos Charitakis Tags: Editorial Source Type: research
Systematic Review and Meta-Analysis of Direct Oral Anticoagulants Versus Warfarin in Atrial Fibrillation With Low Stroke Risk
Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) has been shown to prevent thromboembolic complications, but concerns about the increased risk of major bleeding warrant judicious consideration of the risks and benefits.1 Current guidelines recommend OAC prescription for patients with AF at high risk of stroke, as measured by CHA2DS2-VASc scores of ≥2 and ≥3 in men and women respectively.2–4 Men and women with scores of 1 and 2 respectively (i.e., a single nongender-related stroke risk factor) are deemed to be at low-moderate risk of stroke and OAC prescription may be considered to reduce thromboem...
Source: The American Journal of Cardiology - August 11, 2023 Category: Cardiology Authors: Khi Yung Fong, Yiong Huak Chan, Colin Yeo, Gregory Y.H. Lip, Vern Hsen Tan Source Type: research
Meta-Analysis of the Outcomes of Peri-Device Leak After Left Atrial Appendage Closure
Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE).
Source: The American Journal of Cardiology - August 10, 2023 Category: Cardiology Authors: Mostafa Reda Mostafa, Mohamed Magdi Eid, Mohamed Abuelazm, Ahmad Al-Abdouh, Mostafa Najim, Abdul Rhman Hassan, Amro A. El-Sakka, Sarath Lal Mannumbeth Renjithal, Muhammad Ahmed Malik, Sarah Mohamed, Mallory Balmer-Swain, Timir K. Paul, Andrew M. Goldsweig Source Type: research
Trends in the Longitudinal Utilization of Oral Anticoagulants Among Newly Diagnosed Atrial Fibrillation Patients With Commercial, Medicare, and Medicaid Insurance
Long-term oral anticoagulation (OAC) is recommended for stroke prevention for most patients with atrial fibrillation (AF) and elevated stroke risk.1 While trends in initiation of OAC have been described,2,3 long-term trends in utilization of OAC in patients continuously followed for AF have not been adequately explored. Some healthcare systems adapted anticoagulation services to respond to disruptions during the COVID-19 pandemic.4 We thus investigated how OACs were utilized in patients with newly diagnosed AF from 2018 to 2021 across 3 insurance types: Medicare, Medicaid, and commercial.
Source: The American Journal of Cardiology - July 28, 2023 Category: Cardiology Authors: Jun Soo Lee, Sola Han, Nicole L. Therrien, Chanhyun Park, Feijun Luo, Utibe R. Essien Tags: Brief report Source Type: research
Atrial Myopathy and Ischemic Stroke in Heart Failure With Preserved Ejection Fraction
We examined the hypothesis that atrial myopathy may be associated with ischemic stroke in patients with heart failure with preserved ejection fraction. This is an exploratory, post hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Patients with sinus rhythm documented at baseline electrocardiogram and without known AF were included in this analysis.
Source: The American Journal of Cardiology - July 27, 2023 Category: Cardiology Authors: Kassem Farhat, Khaled Elkholey, Zain Ul Abideen Asad, Stavros Stavrakis Source Type: research
Quest for the Perfect Anticoagulant
The current referenced meta-analysis study by Selvaraj et al1 examines the relative merits of anticoagulation with a direct oral anticoagulant (DOAC) versus vitamin K antagonist (VKA) after transcatheter aortic valve implantation (TAVI) in patients meeting the indications for anticoagulation because of atrial fibrillation (AF). Although guidelines vary, the general consensus appears to indicate noninferiority to superiority of DOACs in the treatment of nonvalvular AF. In the landmark Apixiban for Reduction In Stroke and Other Thromboemoblic Events in Atrial Fibrillation trial comparing apixaban to warfarin in patients with...
Source: The American Journal of Cardiology - July 27, 2023 Category: Cardiology Authors: Bryant Fisher, Danny Chu Source Type: research
A Commentary on “Low Utility of Short-Term Rhythm Assessment Before Long-Term Rhythm Monitoring in Patients With Cryptogenic Stroke”
Cryptogenic stroke, defined as acute ischemic stroke without a clear identifiable cause, accounts for approximately 1/3 of acute ischemic stroke cases. Undiagnosed atrial fibrillation (AF) is likely the leading underlying cause of such presentations; hence, cardiac rhythm monitoring is key to the diagnostic work-up. Commonly, long-term monitoring (LTM) using implantable cardiac monitors (ICMs) is indicated after a negative period of short-term monitoring (STM). However, the low diagnostic yield of STM prompts the question: would directly proceeding to LTM represent a more cost-effective approach?
Source: The American Journal of Cardiology - July 22, 2023 Category: Cardiology Authors: Michael Griffin, Gregory Y.H. Lip Tags: Editorial Source Type: research
Gender Differences in Atrial Fibrosis and Cardiomyopathy Assessed by Left Atrial Low-Voltage Areas During Catheter Ablation of Atrial Fibrillation
This study aimed to delineate gender differences in the prevalence, predictors, and prognostic impact of left atrial low-voltage areas (LVAs). This observational study included 1,488 consecutive patients who underwent initial ablation for AF. Voltage mapping was performed after pulmonary vein isolation during sinus rhythm.
Source: The American Journal of Cardiology - July 21, 2023 Category: Cardiology Authors: Masaharu Masuda, Yasuhiro Matsuda, Hiroyuki Uematsu, Ayako Sugino, Hirotaka Ooka, Satoshi Kudo, Subaru Fujii, Mitsutoshi Asai, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takuya Tsujimura, Yosuke Hata, Taku Toyoshima, Naoko Higashino, Sho Source Type: research
Effectiveness and Safety of Direct Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Patients With Extreme Obesity
Direct oral anticoagulants (DOACs) are a favored treatment to prevent stroke in patients with atrial fibrillation (AF). There are limited data concerning the efficacy and safety of DOACs in obese. Obesity leads to wide structural and physiological changes that may affect the pharmacokinetics and pharmacodynamics of drugs. The optimal dosing strategies for DOACs in this significant and growing sub-group remain unknown. The study aimed to evaluate on a large scale the safety and efficacy of DOAC treatment in extreme obese patients with AF.
Source: The American Journal of Cardiology - July 18, 2023 Category: Cardiology Authors: Boaz Elad, Nimra Maman, Snait Ayalon, Lee Hilary Goldstein Source Type: research
Percutaneous Left Atrial Appendage Closure Among Patients With Diabetes (Insights from a National Database)
Atrial fibrillation is a major risk factor for stroke. Left atrial appendage closure (LAAC) has emerged as an alternative to anticoagulation for patients with high risk of bleeding. Diabetes mellitus (DM) is associated with adverse events after cardiac procedures. We sought to compare procedural and hospital outcomes in patients who underwent LAAC with and without DM. The Nationwide Inpatient Database was queried for patients with atrial fibrillation who underwent LAAC between January 1, 2016, and December 31, 2019.
Source: The American Journal of Cardiology - July 11, 2023 Category: Cardiology Authors: Mohamed Hamed, Ramez Morcos, Ayman Elbadawi, Ahmed Osman, Hani Jneid, Wissam Khalife, Brijeshwar Maini, Houman Khalili Source Type: research
Low Utility of Short-Term Rhythm Assessment Before Long-Term Rhythm Monitoring in Patients With Cryptogenic Stroke
Implantable cardiac monitors are routinely placed for long-term monitoring (LTM) after a period of negative short-term monitoring (STM) to increase atrial fibrillation (AF) detection after a cryptogenic stroke or transient ischemic attack (TIA). Optimizing AF monitoring after a cryptogenic stroke is critical to improve outcomes and reduce costs. We sought to compare the diagnostic yield of STM versus LTM, assess the impact of routine STM on hospitalization length of stay, and perform a financial analysis comparing the current model to a theoretical model wherein patients can proceed directly to LTM.
Source: The American Journal of Cardiology - July 11, 2023 Category: Cardiology Authors: Samuel J. Apple, David Flomenbaum, Matthew Parker, Sanya Chhikara, Aaron Stolarov, Jack Moser, Sheetal Vasundara Mathai, Jiyoung Seo, Neal Ferrick, Jay J. Chudow, Luigi Di Biase, Andrew Krumerman, Kevin J. Ferrick Source Type: research
Long-Term Imaging and Clinical Outcomes of Surgical Left Atrial Appendage Occlusion With AtriClip
Surgical left atrial appendage (LAA) occlusion with an AtriClip (AtriCure, West Chester, Ohio) is frequently performed for stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a retrospective analysis of all patients with long-standing persistent AF who underwent hybrid convergent ablation and LAA clipping. Contrast-enhanced cardiac computed tomography was performed at 3 to 6 months after LAA clipping to assess the degree of complete closure and the residual LAA stump. A total of 78 patients (64 ± 10 years, 72% male) underwent LAA clipping as part of hybrid convergent AF ablation, from 2019 to 2020.
Source: The American Journal of Cardiology - June 28, 2023 Category: Cardiology Authors: Adnan Ahmed, Naga Venkata K. Pothineni, Vasvi Singh, Danish Bawa, Douglas Darden, Rajesh Kabra, Angad Singh, Saira Memon, Ahmed Romeya, Justin Van Meeteren, Senthil Thambidorai, Dhanunjaya Lakkireddy, Rakesh Gopinathannair Source Type: research
