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Heartbeat: Left atrial appendage occlusion for stroke prevention
Stroke prevention is the primary goal of therapy in patients with atrial fibrillation (AF).1 Heart has published numerous papers on early AF detection,2 approaches for restoring normal sinus rhythm, risk scores for determining which AF patients benefit most from anti-thrombotic therapy, and transcatheter occlusion of the left atrial appendage (LAA) to prevent thrombus formation.3–6 Early studies of LAA occlusion compared this procedure to vitamin K antagonist (VKA) therapy for stroke prevention. Now, direct oral anticoagulants (DOACs) have replaced VKA therapy in many AF patients due to an improved risk/benefit profi...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Otto, C. M. Tags: Heartbeat Source Type: research

To occlude or not? Left atrial appendage occlusion for stroke prevention in atrial fibrillation
The cornerstone of atrial fibrillation (AF) management is effective stroke prevention, which by now remains the only proven method of improved survival in patients with AF. Oral anticoagulation with the use of vitamin K antagonists (eg, warfarin) or non-vitamin K antagonist oral anticoagulants (NOACs) has been shown to substantially reduce the risk of AF-related strokes and thus is presently the standard of care for stroke prevention in non-valvular AF. Approximately 90% of thrombi being formed in AF are localised in left atrial appendage (LAA).1 Thus, LAA exclusion seems a tempting method of prophylaxis against stroke, pa...
Source: Heart - January 4, 2017 Category: Cardiology Authors: Mazurek, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials
Conclusions The findings of this meta-analysis suggest that LAAC is superior to placebo and APT, and comparable to NOAC for preventing mortality and stroke or SE, with similar bleeding risk in patients with non-valvular AF. However, these results should be interpreted with caution and more studies are needed to further substantiate this advantage, in view of the wide CIs with some variables in the current meta-analysis.
Source: Heart - January 4, 2017 Category: Cardiology Authors: Sahay, S., Nombela-Franco, L., Rodes-Cabau, J., Jimenez-Quevedo, P., Salinas, P., Biagioni, C., Nunez-Gil, I., Gonzalo, N., de Agustin, J. A., del Trigo, M., Perez de Isla, L., Fernandez-Ortiz, A., Escaned, J., Macaya, C. Tags: Editor's choice, Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

Why should we screen for atrial fibrillation?
Atrial fibrillation (AF) constitutes an increasing challenge to the medical community and healthcare providers. With a prevalence of almost 3% in the adult Swedish population1 and a forecasted twofold or threefold increase by 2050 in the USA, we are facing a diagnosis with epidemic proportions. Apart from increased mortality, AF also increases the risk of heart failure, hospitalisations and ischaemic stroke.2 Of these complications, ischaemic stroke gives a particularly heavy burden on patients, their family and society. Ischaemic stroke is the most common reason for permanent neurological disability in the adult Western p...
Source: Heart - December 8, 2016 Category: Cardiology Authors: Svennberg, E., Engdahl, J. Tags: Press releases, Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Screening for atrial fibrillation in 13 122 Hong Kong citizens with smartphone electrocardiogram
Conclusion Community screening for AF with SL-ECG was feasible and it identified a significant proportion of citizens with newly diagnosed AF. The prevalence of AF in a Chinese population in Hong Kong was comparable with that of contemporary Western counterparts. Apart from age and sex, different anthropometric parameters and cardiovascular comorbid conditions were identified as independent predictors of AF.
Source: Heart - December 8, 2016 Category: Cardiology Authors: Chan, N.-y., Choy, C.-c. Tags: Editor's choice, Press releases, Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology, Metabolic disorders Arrhythmias and sudden death Source Type: research

Atrial appendage occlusion for stroke prevention in patients with atrial fibrillation
In the developed countries, stroke is an important cause of mortality and disability. Cardioembolism is the most frequent cause of ischaemic stroke, in the presence of atrial fibrillation (AF).1 AF is the most common cardiac arrhythmia in the general population and its prevalence increases with age; the lifetime risk of AF development is 25% in people over 40 years old.2 Anticoagulation has been established as an effective treatment strategy for stroke prevention in patients with AF and risk factors for stroke.3 The new oral anticoagulants (NOACs) seem to be similarly efficacious compared with vitamin K antagonists (V...
Source: Heart - November 24, 2016 Category: Cardiology Authors: Swaans, M. J., Boersma, L. V. A. Tags: Drugs: cardiovascular system, Echocardiography, Hypertension, Interventional cardiology, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation
Conclusions Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up.
Source: Heart - November 24, 2016 Category: Cardiology Authors: Berti, S., Pastormerlo, L. E., Rezzaghi, M., Trianni, G., Paradossi, U., Cerone, E., Ravani, M., De Caterina, A. R., Rizza, A., Palmieri, C. Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests Cardiac risk factors and prevention Source Type: research

Antithrombotic drug use: scientific breakthroughs, biological limits and physician behaviour
During the past 25 years, there has been a dramatic surge in the use of antithrombotic drugs as documented in the Heart paper by Adelborg et al.1 The authors derived their findings from the Danish drug utilisation database, which is unique in its comprehensiveness and ability to capture over-the-counter aspirin. The increased prescription of antithrombotic drugs is fuelled by a better understanding of disease and risk, population growth, ageing societies, improved methods of detection, and rising global rates of obesity, a recognised risk factor for atrial fibrillation (AF), venous thromboembolic (VTE) disease, and ca...
Source: Heart - November 10, 2016 Category: Cardiology Authors: Hylek, E. M. Tags: Drugs: cardiovascular system, Venous thromboembolism, Epidemiology Editorials Source Type: research

Stroke and death in elderly patients with atrial fibrillation in Japan compared with the United Kingdom
Conclusions Elderly (age ≥75 years) patients with AF in both Japan and the UK are at similarly high risk of stroke and death, with OAC still underused in both populations. Ethnicity was not independently associated with the risk of stroke, regardless of OAC use or non-use.
Source: Heart - November 10, 2016 Category: Cardiology Authors: Senoo, K., An, Y., Ogawa, H., Lane, D. A., Wolff, A., Shantsila, E., Akao, M., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology, Diabetes, Metabolic disorders Health care delivery, economics and global health care Source Type: research

Direct oral anticoagulants: unique properties and practical approaches to management
Since 2009, four direct oral anticoagulants (DOACs) have been introduced for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation. While they are currently first-line therapy for a majority of patients, there are a number of clinical situations where warfarin is preferable. In both randomised trials and real-world populations, use of DOACs significantly reduces the risk of intracranial haemorrhage as compared with warfarin. While drug-specific reversal agents are currently only available for dabigatran, andexanet alpha is pending approval for reversal of factor Xa inhibitors, reduci...
Source: Heart - September 26, 2016 Category: Cardiology Authors: Barnes, G. D., Kurtz, B. Tags: Review articles Reviews Source Type: research

Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery
Conclusions Patients with HCM undergoing high-risk and intermediate-risk non-cardiac surgeries have a low perioperative event rate, at an experienced centre. However, they have a higher risk of composite events versus matched patients without HCM.
Source: Heart - September 26, 2016 Category: Cardiology Authors: Dhillon, A., Khanna, A., Randhawa, M. S., Cywinski, J., Saager, L., Thamilarasan, M., Lever, H. M., Desai, M. Y. Tags: Hypertrophic cardiomyopathy, Drugs: cardiovascular system, Heart failure, Acute coronary syndromes, Clinical diagnostic tests, Epidemiology Heart failure and cardiomyopathies Source Type: research

Catheter ablation for atrial fibrillation in hypertrophic cardiomyopathy: a systematic review and meta-analysis
Conclusions The observed complication rate of catheter ablation of AF in patients with HCM was low. Even though the risk of relapse is twofold higher, catheter ablation can be effective in patients with HCM and AF, particularly in patients with paroxysmal AF and smaller atria.
Source: Heart - September 12, 2016 Category: Cardiology Authors: Providencia, R., Elliott, P., Patel, K., McCready, J., Babu, G., Srinivasan, N., Bronis, K., Papageorgiou, N., Chow, A., Rowland, E., Lowe, M., Segal, O. R., Lambiase, P. D. Tags: Tachyarrhythmias, Editor's choice, Hypertrophic cardiomyopathy, Drugs: cardiovascular system, Clinical diagnostic tests Heart failure and cardiomyopathy Source Type: research

Obesity and atrial fibrillation: can adipokines help to solve this puzzle
Obesity is a major public health problem increasing risk for hypertension, diabetes mellitus, cardiovascular diseases, heart failure, stroke, left atrial enlargement and obstructive sleep apnoea. Conventionally, body mass index (BMI) is used in many studies to diagnose and classify obesity. However, epidemiological studies have shown that waist:hip ratio is a better predictor for myocardial infarction and sudden cardiac death compared with BMI. Nevertheless, some subjects who have ‘healthy obese phenotype’ have a benign cardiometabolic profile due to greater deposition of the fat tissue in the subcutaneous area...
Source: Heart - August 10, 2016 Category: Cardiology Authors: Güngör, B. Tags: Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Epidemiology, Diabetes, Metabolic disorders Editorials Source Type: research

Significance of apical cavity obliteration in apical hypertrophic cardiomyopathy
Conclusions The ratio of obliteration to cavity could provide useful information to predict the occurrence of adverse events in apical HCM.
Source: Heart - July 10, 2016 Category: Cardiology Authors: Kim, H., Park, J.-H., Won, K.-B., Yoon, H.-J., Park, H.-S., Cho, Y.-K., Nam, C.-W., Han, S., Hur, S.-H., Kim, Y.-N., Kim, K.-B. Tags: Hypertrophic cardiomyopathy, Drugs: cardiovascular system, Hypertension, Epidemiology Heart failure and cardiomyopathies Source Type: research

Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban
Conclusions We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. Trial registration number NCT00403767; Post-results.
Source: Heart - June 9, 2016 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Lokhnygina, Y., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Califf, R. M., Fox, K. A. A., Patel, M. R., for th Tags: Open access, Drugs: cardiovascular system, Interventional cardiology, Aortic valve disease, Mitral valve disease Valvular heart disease Source Type: research

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