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Close the appendage, open the future
Left atrial appendage closure is a proven method for prevention against stroke in patients with non-valvular atrial fibrillation. This method is proven for having clinical utility as well as safety. The need for coverage in this area is immense. Atrial fibrillation affects 1%–2% of the entire adult population.1 Of all ischaemic strokes, 15% are associated with atrial fibrillation. Both the CHADS2 and the CHA2DS2-VASc risk scores have been used for determining the level of anticoagulation in these patients. Multiple anticoagulants have been used for prevention of ischaemic stroke, including warfarin, dabigatran, rivar...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Gafoor, S., Sievert, H., Matic, P. Tags: Drugs: cardiovascular system, Epidemiology Editorials Source Type: research

Not all thromboembolism comes from the left atrial appendage in atrial fibrillation
Atrial fibrillation (AF) confers a substantial risk of stroke and thromboembolism, which is effectively reduced by oral anticoagulation (OAC), whether as a vitamin K antagonist (VKA, eg, warfarin) or one of non-VKA oral anticoagulants (NOACs). With the use of OACs, the risk of bleeding remains a problem associated with these agents. Thus, a clinical dilemma remains in the optimal management of patients with AF who are at high risk of stroke but have a history of bleeding. Among patients with non-valvular AF, over 90% of the thrombus is formed in the left atrial appendage (LAA).1 Thus, the exclusion of LAA could greatly dec...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Senoo, K., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology Editorials Source Type: research

Left atrial appendage occlusion
Left atrial appendage (LAA) occlusion for stroke and thromboembolism prevention in patients with atrial fibrillation (AF) represents a significant advancement in the field of cardiovascular disease. Prevention and avoidance of the devastating consequences of thromboembolic complications from AF continues to be central in the management of these patients. The role of LAA as a nidus for thrombus formation is well documented. Multiple approaches to exclude the LAA from the circulation either percutaneously or surgically have been described and are undergoing testing. Although pharmacological therapy for stroke prevention rema...
Source: Heart - May 12, 2015 Category: Cardiology Authors: Alli, O., Holmes, D. Tags: Review articles Reviews Source Type: research

What can rhythm control therapy contribute to prognosis in atrial fibrillation?
This article addresses important aspects of rhythm control strategies, which may have the potential of a beneficial contribution to the prognosis of AF patients.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Rolf, S., Kornej, J., Dagres, N., Hindricks, G. Tags: Review articles Reviews Source Type: research

Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up
Conclusions Our large prospective study showed for the first time that silent AF is associated with worse 1-year prognosis after AMI. Systematic screening and specific management should be investigated in order to improve outcomes of patients after AMI.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Stamboul, K., Zeller, M., Fauchier, L., Gudjoncik, A., Buffet, P., Garnier, F., Guenancia, C., Lorgis, L., Beer, J. C., Touzery, C., Cottin, Y. Tags: Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology, Tobacco use Coronary artery disease Source Type: research

Two-year clinical outcome from the Iberian registry patients after left atrial appendage closure
Conclusions LAA closure with an occlusion device in patients contraindicated for oral anticoagulants is a therapeutic option associated with fewer thromboembolic and haemorrhagic events than expected from risk scores, particularly in the second year postimplantation.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Minguez, J. R. L., Asensio, J. M. N., Gragera, J. E., Costa, M., Gonzalez, I. C., de Carlos, F. G., Diaz, J. A. F., Yuste, V. M., Gonzalez, R. M., Dominguez-Franco, A., Buendia, A. B., Garibi, J. H., Hernandez, F. H., Ribeiro, V. G. Tags: Congenital heart disease in adult patients, Editor's choice, Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology Arrhythmias and sudden death Source Type: research

Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients
Conclusions This hospital-based study revealed high AF prevalence rates (16.8%). Patients with AF were present in all hospital zones and almost all patients were at high risk for stroke. Anticoagulation management was likely inappropriate in 48.7%, indicating the need for better guideline implementation initiatives to guarantee hospital-wide optimised care for patients with AF.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Berti, D., Moors, E., Moons, P., Heidbuchel, H. Tags: Drugs: cardiovascular system, Hypertension Arrhythmias and sudden death Source Type: research

Heart rate is associated with progression of atrial fibrillation, independent of rhythm
Conclusions Within 1.5 years, almost a quarter of the patients with paroxysmal or persistent AF progress to a more sustained form. Progression is strongly associated with heart rate, and age.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Holmqvist, F., Kim, S., Steinberg, B. A., Reiffel, J. A., Mahaffey, K. W., Gersh, B. J., Fonarow, G. C., Naccarelli, G. V., Chang, P., Freeman, J. V., Kowey, P. R., Thomas, L., Peterson, E. D., Piccini, J. P., on behalf of the ORBIT-AF Investigators Tags: Open access, Drugs: cardiovascular system Arrhythmias and sudden death Source Type: research

Prognosis importance of low flow in aortic stenosis with preserved LVEF
Conclusions In patients with severe AS and preserved LVEF, LF, as assessed using cardiac catheterisation is frequent, and is an independent predictor of mortality. Consequently, the measurement of SVi should be systematically included in the assessment of these patients.
Source: Heart - April 24, 2015 Category: Cardiology Authors: Magne, J., Mohty, D., Boulogne, C., Boubadara, F. E., Deltreuil, M., Echahidi, N., Cassat, C., Laskar, M., Virot, P., Aboyans, V. Tags: Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests, Epidemiology Valvular heart disease Source Type: research

Atrial fibrillation and stroke after atrial septal defect closure. Is earlier closure warranted?
Atrial septal defects (ASDs) are the most common congenital cardiac abnormalities in adults. Patients frequently present with symptoms for the first time at adult age. One of the most common late complications of an ASD is the development of atrial tachyarrhythmias (ATs), especially atrial fibrillation (AF). In a large population-based study from Ontario, the prevalence of AT was 19% in adult patients with ASD, which is fourfold higher than that in the general population.1 The incidence of AT continues to increase with age.2 3 This vulnerability to AT is not surprising considering the long-standing haemodynamic derangement...
Source: Heart - April 9, 2015 Category: Cardiology Authors: Yap, S.-C. Tags: Congenital heart disease, Drugs: cardiovascular system, Hypertension, Interventional cardiology, Epidemiology Editorials Source Type: research

Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure
Conclusions Patients with ASD had a higher risk of first-time AF after closure than the comparison cohort. There was no effect of closure on the use of AF-related medicine in patients with prevalent AF.
Source: Heart - April 9, 2015 Category: Cardiology Authors: Nyboe, C., Olsen, M. S., Nielsen-Kudsk, J. E., Hjortdal, V. E. Tags: Congenital heart disease in adult patients, Congenital heart disease, Drugs: cardiovascular system, Epidemiology Source Type: research

Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation
Conclusions ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR.
Source: Heart - February 12, 2015 Category: Cardiology Authors: Magne, J., Donal, E., Mahjoub, H., Miltner, B., Dulgheru, R., Thebault, C., Pierard, L. A., Pibarot, P., Lancellotti, P. Tags: Drugs: cardiovascular system, Echocardiography, Hypertension, Mitral valve disease, Clinical diagnostic tests Valvular heart disease Source Type: research

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation
Conclusions Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.
Source: Heart - November 9, 2014 Category: Cardiology Authors: Steinberg, B. A., Hammill, B. G., Daubert, J. P., Bahnson, T. D., Douglas, P. S., Qualls, L. G., Pokorney, S. D., Calkins, H., Curtis, L. H., Piccini, J. P. Tags: Health policy, Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests Arrhythmias and sudden death Source Type: research

Combined anticoagulation and antiplatelet therapy in AF patients: why do we not follow guidelines?
While current European guidelines recommend oral anticoagulation treatment over antiplatelet therapy for the prevention of ischaemic stroke in patients with non-valvular atrial fibrillation (AF) with a 64% stroke risk reduction by warfarin treatment versus placebo and a 39% risk reduction versus aspirin,1 single or dual antiplatelet therapy is the guideline recommended first-line treatment strategy for patients with peripheral and/or coronary artery disease with and without intervention to prevent recurrences and major adverse cardiac events.2–7 Antiplatelet therapy is also recommended in patients with ischaemic stro...
Source: Heart - September 23, 2014 Category: Cardiology Authors: Brandes, A. Tags: Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism Editorials Source Type: research

Prediction of stroke in patients without atrial fibrillation using the CHADS2 and CHA2DS2-VASc scores: a justification for more widespread thromboprophylaxis?
The CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke/transient ischaemic attack (TIA) (double)) and more recently, the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (double score), diabetes mellitus, previous stroke/TIA (double score), vascular disease, age 65–74 years, sex category (female)) scores are validated clinical prediction tools commonly used to estimate the stroke risk in atrial fibrillation (AF) patients. More recently, the focus has been on initially identifying those patients at ‘low risk’ (ie, CHA2DS...
Source: Heart - September 9, 2014 Category: Cardiology Authors: Senoo, K., Lip, G. Y. H. Tags: Drugs: cardiovascular system, Heart failure, Hypertension, Epidemiology, Diabetes, Metabolic disorders Editorials Source Type: research

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