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Atrial Fibrillation and Cognitive Decline —Another Piece for a Big Puzzle
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its prevalence is increasing over time.1, 2 AF is associated with an increased risk of stroke,3 heart failure,4 and death.5-7 In recent years, evidence has emerged to indicate that AF is associated with another growing public health problem: cognitive impairment and dementia.8 Although the evidence is compelling, existing studies suffer from several limitations such as reliance on the Mini-Mental State Examination, cross-sectional design, and lack of attention to domain-specific changes.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: Lin Y. Chen, Win-Kuang Shen Source Type: research
Percutaneous Left Atrial Appendage Closure is Not Ready for Routine Clinical Use
Both Watchman and NOACs are treatment strategies designed to prevent stroke in patients with atrial fibrillation (AF). For practical reasons device trials cannot enroll as many patients as drug trials, however, a comparison of the Watchman and NOAC trials serves to highlight the challenge of predicting efficacy of a treatment when event rates are low. Four large noninferiority trials compared NOAC to warfarin therapy for stroke prevention in patients with AF. 1-4 We will focus on the RELY and ARISTOTLE trials because they enrolled patients with similar stroke-risk (age, CHADS2 score, etc.) to those in the Watchman trials.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: John Mandrola, Andrew Foy, Gerald Naccarelli Source Type: research
Left Atrial Appendage Closure Devices: A Reasonable Therapeutic Alternative
Preventing stroke is arguably the most important goal in the management of atrial fibrillation (AF). For decades, oral anticoagulation (OAC) has been the therapeutic mainstay for stroke prophylaxis – initially warfarin, and more recently, non-warfarin oral anticoagulants (NOACs). However, many patients are poor candidates for lifelong OAC therapy. This clinical need prompted the emergence of the therapeutic alternative, left atrial appendage closure (LAAC). Herein, I discuss the clinical evi dence supporting LAAC’s role as a reasonable stroke prevention alternative.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: Vivek Y. Reddy Source Type: research
Atrial fibrillation and cognitive decline: Another piece for a big puzzle
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its prevalence is increasing over time.1,2 AF is associated with an increased risk of stroke,3 heart failure,4 and death.5 –7 In recent years, evidence has emerged to indicate that AF is associated with another growing public health problem: cognitive impairment and dementia.8 Although the evidence is compelling, existing studies suffer from several limitations, such as reliance on the Mini-Mental State Examination, c ross-sectional design, and lack of attention to domain-specific changes.
Source: Heart Rhythm - October 10, 2017 Category: Cardiology Authors: Lin Y. Chen, Win-Kuang Shen Tags: Editorial Commentary Source Type: research
Utility and Limitations of Long-Term Monitoring of Atrial Fibrillation Using an Implantable Loop Recorder
Atrial fibrillation (AF) is the most common cardiac arrhythmia diagnosed and treated in the world. The treatment of patients ’ symptoms as well as the prevention of stroke and heart failure is dependent on accurate detection and characterization of AF. A variety of electrocardiographic (ECG) monitoring techniques are being used for these purposes. However, these intermittent ECG monitoring techniques have been shown to under diagnose AF events, while having limited ability to characterize AF burden and density.
Source: Heart Rhythm - September 13, 2017 Category: Cardiology Authors: Randall Lee, Suneet Mittal Source Type: research
EP News: Basic and Translational
Atrial fibrillation affects more than 33 million people worldwide and increases the risk of stroke, heart failure, and death. Fourteen genetic loci have been associated with atrial fibrillation in European and Asian ancestry groups. To further define the genetic basis of atrial fibrillation, Christophersen et al (Nat Genet 2017;49:946, PMID 28416818) performed large-scale, transancestry meta-analyses of common and rare variant association studies. The genome-wide association studies included 17,931 individuals with atrial fibrillation and 115,142 referents; the exome-wide association studies and rare v ariant association...
Source: Heart Rhythm - August 23, 2017 Category: Cardiology Authors: Penelope A. Boyden Tags: EP News: Basic and Translational Source Type: research
EWOLUTION —The next evolution in appendage closure?
Oral anticoagulation (OAC) is a class I indication for patients with nonvalvular atrial fibrillation (AF) and ≥2 risk factors for stroke.1 However, many patients with AF are ineligible for OAC because of prohibitive bleeding. Subsequently, as a result of the pivotal role of the left atrial appendage (LAA) in the formation of thrombi, an alternative strategy to OAC is occlusion of the LAA.2 The WATCHMAN de vice (Boston Scientific Corporation, Marlborough, MA) is the only US Food and Drug Administration (FDA)–approved LAA occlusion product that has been studied in randomized control trials (RCTs) (Table).
Source: Heart Rhythm - June 22, 2017 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Tags: Editorial Commentary Source Type: research
EWOLUTION – The Next Evolution in Appendage Closure?
Oral anticoagulation (OAC) is a class I indication for patients with non-valvular atrial fibrillation (AF) and 2 or more risk factors for stroke.1 However, many patients with AF are ineligible for OAC due to prohibitive bleeding. Subsequently, as a result of the pivotal role of the left atrial appendage (LAA) in the formation of thrombi, an alternative strategy to OAC is occlusion of the LAA.2 The WATCHMAN device (Boston Scientific Corporation, Marlborough, Massachusetts) is the only FDA approved LAA occlusion product studied in the randomized control trials (RCT) (Table 1).
Source: Heart Rhythm - June 22, 2017 Category: Cardiology Authors: Muhammad R. Afzal, Emile G. Daoud Source Type: research
The who, how, and why of screening patients for atrial fibrillation: More questions than answers
An estimated 100,000 –125,000 of the 610,000 strokes per year in the United States are associated with atrial fibrillation (AF).1 AF-related strokes cause larger cortical loss, disability, cost, and mortality compared with strokes not related to AF. In a pooled trial analysis, oral anticoagulation with warfarin lowere d AF stroke incidence by 64%.2 However, many AF patients have minimal to no symptoms and remain undiagnosed until complications occur. Given the devastating consequences of stroke and the high prevalence of AF, the value of screening to detect asymptomatic AF for the purpose of initiating anticoagul ation p...
Source: Heart Rhythm - June 17, 2017 Category: Cardiology Authors: Anne B. Curtis, Alexander Hattoum Tags: Editorial Commentary Source Type: research
PREdicting Determinants of Atrial Fibrillation for Therapy Elucidation in Patients at Risk for Thromboembolic Events (PREDATE AF) Study
AF is the most common, clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke and OAC has been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long term outcomes but the optimal patient population and screening intensity are unknown.
Source: Heart Rhythm - May 12, 2017 Category: Cardiology Authors: Javed M. Nasir, William Pomeroy, Adam Marler, Matthew Hann, Tina Baykaner, Ronald Jones, Richard Stoll, Katherine Hursey, Angela Meadows, Jennifer Walker, Steve Kindsvater Source Type: research
Predicting Determinants of Atrial Fibrillation or Flutter for Therapy Elucidation in Patients at Risk for Thromboembolic Events (PREDATE AF) Study
Atrial fibrillation (AF) is the most common clinically significant cardiac rhythm disorder. There is considerable interest in screening for AF, as it is a leading cause of stroke, and oral anticoagulants (OACs) have been shown to significantly reduce the risk of stroke in patients with AF. Improved screening for AF with subsequent treatment may help improve long-term outcomes, but the optimal patient population and screening intensity are unknown.
Source: Heart Rhythm - May 12, 2017 Category: Cardiology Authors: Javed M. Nasir, William Pomeroy, Adam Marler, Matthew Hann, Tina Baykaner, Ronald Jones, Richard Stoll, Katherine Hursey, Angela Meadows, Jennifer Walker, Steve Kindsvater Source Type: research
Preventing Heart Failure in Atrial Fibrillation: In the Middle of Difficulty Lies Opportunity
Atrial fibrillation increases the risk of several adverse cardiovascular events. While a great deal of attention is focused on the prevention of stroke, relatively little attention is paid to the prevention of heart failure in patients with atrial fibrillation (AF) despite the fact that heart failure (HF) complicates AF more often than stroke does. The risk of developing heart failure is 3-4 times greater in patients with AF1 and as many as half of all patients with long-standing persistent AF have HF.
Source: Heart Rhythm - February 22, 2017 Category: Cardiology Authors: Jonathan P. Piccini, Benjamin A. Steinberg Source Type: research
Anticoagulation for atrial fibrillation in dialysis patients: What is known and what does the future hold?
The association between atrial fibrillation and stroke is well established, and in the general population, anticoagulation with warfarin can reduce the incidence of stroke by 60% with an acceptable bleeding risk.1,2 Patients who are on hemodialysis have an increased prevalence of atrial fibrillation, possibly secondary to comorbid conditions and hemodialysis itself causing dramatic swings in fluid and electrolytes and affecting cardiac dimensions.3 There are also substantially higher rates of ischemic stroke in this population attributable both to frequently co-occurring traditional stroke risk factors and to the increased...
Source: Heart Rhythm - February 18, 2017 Category: Cardiology Authors: Timothy M. Markman, Saman Nazarian Tags: Editorial Commentary Source Type: research
Editorial Commentary: Anticoagulation for atrial fibrillation in dialysis patients: What is known and what does the future hold?
The association between atrial fibrillation and stroke is well established and, in the general population, anticoagulation with warfarin can reduce the incidence of stroke by 60% with an acceptable bleeding risk.1, 2 Patients who are on hemodialysis have an increased prevalence of atrial fibrillation possibly secondary to comorbid conditions and hemodialysis itself causing dramatic swings in fluid and electrolytes and affecting cardiac dimensions.3 There are also substantially higher rates of ischemic stroke in this population attributable both to frequently co-occurring traditional stroke risk factors as well as the incre...
Source: Heart Rhythm - February 18, 2017 Category: Cardiology Authors: Timothy M. Markman, Saman Nazarian Source Type: research
Atrial fibrillation ablation, stroke and mortality. Evaluating the effects of therapy in the era of big data
Atrial fibrillation (AF) is associated with an increased stroke and mortality risk. The logical extension of this is that if AF is controlled or eliminated then patient outcomes with respect to stroke and mortality should improve. The AFFIRM trial comparing rate and rhythm control strategies unfortunately did not demonstrate an improvement in either of these endpoints in the rhythm control population (1). An interesting sub-analysis of the AFFIRM trial did however indicate that patients who were in sinus rhythm more often at the time of their follow-up had a reduced mortality (2).
Source: Heart Rhythm - February 9, 2017 Category: Cardiology Authors: Steven J. Kalbfleisch Source Type: research
