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Outcomes of Percutaneous Left Atrial Appendage Occlusion Device Implantation in Patients with Rheumatic Atrial Fibrillation
Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD) disease have a 17-fold increased risk of stroke, and in comparison, those with AF without RHD have a 5-fold increased risk of stroke (1). However, the contemporary trials of pharmaceutical and device therapies have systematically excluded patients with AF and RHD. While Vitamin K antagonist remains the favored approach to mitigate stroke risk in patients with RHD and AF, the optimal strategy for preventing stroke in patients with RHD-associated AF who cannot tolerate oral anticoagulation therapy remains unknown (1).
Source: Heart Rhythm - May 12, 2023 Category: Cardiology Authors: Siddharth Agarwal, Muhammad Bilal Munir, Agam Bansal, Christopher V. DeSimone, Abhishek Deshmukh, Mohamad Alkhouli, Zain Ul Abideen Asad Source Type: research

Po-04-216 patient enabled inr optimization : a multicenter prospective study
For patients using Vitamin K antagonists (VKA), maximizing time within the therapeutic range (TTR) reduces stroke, major hemorrhage, and death. Despite improvements in counselling and patient education, patients using Vitamin K antagonists have a poor TTR.
Source: Heart Rhythm - May 1, 2023 Category: Cardiology Authors: Muthiah Subramanian, Walli Mohammed, Hetan Shah, Sachin D. Yalagudri, Daljeet K. Saggu, Calambur Narasimhan Source Type: research

Po-718-05 prescribing patterns of direct anticoagulants versus vitamin k antagonists in patients with non-valvular atrial fibrillation and extreme obesity
Anticoagulation is an effective treatment in prevention of stroke in patients with atrial fibrillation (AF). Direct anticoagulants (DOACs) have been favored over vitamin K dependent antagonists (VKAs) given their safety and efficacy. However, there is limited real-world data on DOAC use among patients with extreme obesity.
Source: Heart Rhythm - April 29, 2022 Category: Cardiology Authors: Sherry J. Saxonhouse, Kamala SWAYAMPAKALA, Stephen Perle, Sophia E. Saxonhouse Source Type: research

EP News: Allied Professionals
In this non-prespecified, post hoc analysis of the AUGUSTUS (The Open-Label, 2 x 2 Factorial, Randomized, Controlled Clinical Trial to Evaluate the Safety of Apixaban vs. Vitamin K Antagonist and Aspirin vs. Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome and/or Percutaneous Coronary Intervention) trial (Harskamp et al. J Am Coll Cardiol. 2022;79:417-27. PMID-35115097), the authors sought to evaluate whether the risk of bleeding or stroke as assessed by baseline HAS-BLED and CHA2DS2-VASc scores affected the results of the trial.
Source: Heart Rhythm - March 9, 2022 Category: Cardiology Authors: Erica S. Zado Source Type: research

EP News: Clinical
Hohnloser et  al (Circulation 2019;139:2315, PMID 30976787) assessed the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients indicated for dose reduction) vs vitamin K antagonists (VKAs) in patients with atrial fibrillation undergoing catheter ablation in a multinational, multicenter, random ized, open-label, parallel-group trial. Patients were randomized 2:1 to edoxaban vs VKA. The primary end point was the time to first occurrence of all-cause death, stroke, or major bleeding during the period from the end of the ablation procedure to the end of treatment (90 days).
Source: Heart Rhythm - June 24, 2019 Category: Cardiology Authors: N.A. Mark Estes Tags: EP News Source Type: research

Use of the SAMe-TT2R2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients treated with vitamin K antagonists: A review
Identifying patients who are likely to achieve and maintain a therapeutic INR when prescribed a vitamin K antagonist (VKA) for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) is challenging. The SAMe-TT2R2 score was developed based on common clinical factors that can highlight patients who may be unable to achieve and maintain good anticoagulation control and for whom a ‘trial of warfarin’ would be inadvisable. This review summarises the main published prospective and retrospective studies that have validated the SAMe-TT2R2 score in AF and VTE patients treated with a VKA and how the SAMe-...
Source: Heart Rhythm - November 24, 2017 Category: Cardiology Authors: Hanis Zulkifly, Gregory Y.H. Lip, Deirdre A. Lane Source Type: research

Use of the SAMe-TT2R2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients receiving vitamin K antagonists: A review
Identifying patients who are likely to achieve and maintain a therapeutic international normalized ratio when prescribed a vitamin K antagonist for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) is challenging. The SAMe-TT2R2 score was developed on the basis of common clinical factors that can highlight patients who may be unable to achieve and maintain good anticoagulation control and for whom a “trial of warfarin” would be inadvisable. This review summarizes the main published prospective and retrospective studies that have validated the SAMe-TT2R2 score in patients with AF and VTE tre...
Source: Heart Rhythm - November 24, 2017 Category: Cardiology Authors: Hanis Zulkifly, Gregory Y.H. Lip, Deirdre A. Lane Tags: Contemporary Review Source Type: research

Benefits of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation go beyond stroke prevention
Source: Heart Rhythm - January 15, 2017 Category: Cardiology Authors: Jay A. Montgomery, Gregory F. Michaud Source Type: research

Benefits of non –vitamin K antagonist oral anticoagulants in patients with atrial fibrillation go beyond stroke prevention
The last decade has produced a large body of robust randomized controlled trial (RCT) data investigating the use of non –vitamin K antagonist oral anticoagulants (NOACs) in nonvalvular atrial fibrillation (AF).1–4 Compared with warfarin, dabigatran and apixaban have been found to reduce the combined outcome of stroke and systemic embolism. In addition, apixaban and edoxaban significantly reduce major bleeding. Fu rthermore, a pooled meta-analysis has demonstrated superior efficacy and overall safety of the NOACs.
Source: Heart Rhythm - January 15, 2017 Category: Cardiology Authors: Jay A. Montgomery, Gregory F. Michaud Tags: Editorial Commentary Source Type: research

Extracranial arterial and venous thromboembolism in patients with atrial fibrillation: A meta-analysis of randomized controlled trials
Thromboembolism prevention is central to atrial fibrillation (AF) management. Randomized controlled trials (RCTs) have primarily focused on stroke prevention. Detailed analyses of extracranial thromboembolic events, particularly in patients with low dose non-vitamin K antagonist oral anticoagulants (NOACs), are scarce.
Source: Heart Rhythm - January 2, 2017 Category: Cardiology Authors: Kang-Ling Wang, Harry R. B üller, Shinya Goto, Chun-Yi Lin, En-Yu Lai, Chun-Chih Chiu, Chern-En Chiang, Robert P. Giugliano Source Type: research

Stroke prevention using dabigatran in elderly Chinese patients with atrial fibrillation
Little is known about the clinical benefit of a non–vitamin K antagonist oral anticoagulant compared with warfarin in elderly Chinese patients with atrial fibrillation (AF).
Source: Heart Rhythm - September 18, 2015 Category: Cardiology Authors: Pak-Hei Chan, Duo Huang, Jojo Hai, Wen-Hua Li, Li-Xue Yin, Esther W. Chan, Ian C.K. Wong, Chu-Pak Lau, Chern-En Chiang, Jun Zhu, Hung-Fat Tse, Chung-Wah Siu Source Type: research

Stroke Prevention Using Dabigatran in the Very Elderly with Atrial Fibrillation
Little is known about the clinical benefit of a non-vitamin K antagonist oral anticoagulant (NOAC) compared with warfarin in elderly Chinese patients with atrial fibrillation (AF).
Source: Heart Rhythm - September 18, 2015 Category: Cardiology Authors: Pak-Hei CHAN, Duo HUANG, Jojo HAI, Wen-Hua LI, Li-Xue YIN, Esther W. CHAN, Ian C.K. WONG, Chu-Pak LAU, Chern-En Chiang, Jun ZHU, Hung-Fat TSE, Chung-Wah SIU Source Type: research

Stroke prevention in atrial fibrillation—An Asian stroke perspective
Despite relatively lower prevalence of atrial fibrillation (AF) in Asians (~1%) than in Caucasians (~2%), Asia has a much higher overall disease burden because of its proportionally larger aged population. For example, on the basis of reported age-adjusted prevalence rates and projected population figures in China, there will be an estimated 5.2 million men and 3.1 million women with AF older than 60 years by year 2050. Stroke is a disabling complication of AF that is of increasing cause for concern in Asians patients. Implementing consensus expert recommendations for managing stroke risk in patients with AF can considerab...
Source: Heart Rhythm - March 18, 2013 Category: Cardiology Authors: Hung-Fat Tse, Yong- Jun Wang, Moheeb Ahmed Ai-Abdullah, Annette B. Pizarro-Borromeo, Chern-En Chiang, Rungroj Krittayaphong, Balbir Singh, Amit Vora, Chun-Xue Wang, Mohammad Zubaid, Andreas Clemens, Paul Lim, Dayi Hu Tags: Contemporary Review--Associate Editor: Sami Viskin Source Type: research

Right superior vena cava drainage into the left atrium revealed by multiples strokes after pacemaker implantation
An 84-year-old woman had undergone dual-chamber pacemaker implantation in a primary care hospital for sick sinus syndrome. The leads were inserted through the right subclavian vein because the patient was left-handed. One year later, she suffered from an ischemic stroke. During ventricular pacing, ECG showed a right bundle branch block pattern, and chest radiography (A) suggested that pacing lead tips were in the left atrium (LA) and left ventricle. After transthoracic and transesophageal echocardiography, it was initially thought that the leads passed through a patent foramen ovale. A thrombus on the ventricular lead was ...
Source: Heart Rhythm - August 2, 2012 Category: Cardiology Authors: Pierre-Yves Courand, Nicolas Girerd, Samuel Chauveau, Philippe Chevalier Tags: Images Source Type: research