Medical Directors Atrial Fibrillation Center
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Factors Associated With Major Bleeding Events Insights From the ROCKET AF Trial (Rivaroxaban Once-daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation)
Journal of the American College of Cardiology: Cardiovascular Interventions
3/3/2014 4:03:11 PM
This study sought to report additional safety results from the ROCKET AF (Rivaroxaban Once-daily oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).BackgroundThe ROCKET AF trial demonstrated similar risks of stroke/systemic embolism and major/nonmajor clinically relevant bleeding (principal safety endpoint) with rivaroxaban and warfarin.MethodsThe risk of the principal safety and component bleeding endpoints with rivaroxaban versus warfarin were compared, and factors associated with major bleeding were examined in a multivariable model.ResultsThe principal safety endpoint was similar in the rivaroxaban and warfarin groups (14.9 vs. 14.5 events/100 patient-years; hazard ratio: 1.03; 95% confidence interval:...

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Antioxidant supplementation attenuates oxidative stress in patients undergoing coronary artery bypass graft surgery.
The Tohoku Journal of Experimental Medicine
2/28/2014 10:30:03 PM
Authors: Stanger O, Aigner I, Schimetta W, Wonisch W Abstract Ischemia-reperfusion has been reported to be associated with augmented oxidative stress in the course of surgery, which might be causally involved in the onset of atrial fibrillation (AF), the most common arrhythmia after cardiac surgery. We hypothesized that supplementation of antioxidants and n-3 polyunsaturated fatty acids (n-3 PUFAs) might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. In the present study, by monitoring oxidative stress in the course of CABG surgery, we analyzed the efficacy of vitamins (ascorbic acid and α-tocopherol) and/or n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid). Subjects (n = 75) were divided into 4 subgroups: control, vitamins, n-3 PUFAs, an...
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Central Sleep Apnea and Cardiovascular Disease
Sleep Medicine Clinics
2/28/2014 7:00:00 PM
Central sleep apnea (CSA) syndromes have been studied extensively in the setting of heart failure (HF). CSA is generally thought to occur as a consequence of HF. Some data suggest, however, that CSA may play an important role in outcomes in the HF population. For a similar degree of HF, does the presence of CSA portend a worse outcome? If so, does directed treatment of CSA impact those outcomes? The evidence to answer these questions is reviewed here. Beyond HF, the relationship between CSA and other cardiovascular diseases has been minimally explored, with the exception of atrial fibrillation. (Source: Sleep Medicine Clinics)
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Percutaneous pulmonary vein stenosis angioplasty complicated by rupture: Successful stenting with a polytetrafluoroethylene‐covered stent
Catheterization and Cardiovascular Interventions
2/28/2014 7:00:00 PM
Abstract A 47‐year‐old‐man with prior pulmonary vein (PV) isolation for atrial fibrillation developed progressive shortness of breath and was found to have total occlusion of the left lower and significant stenosis in left upper PV. A ventilation/perfusion scan showed decreased left lung perfusion. Percutaneous pulmonary vein stenosis angioplasty was complicated by the rupture of left lower PV with pericardial tamponade; successful stenting with a polytetrafluoroethylene‐covered stent was performed. Follow up studies at nine months showed patency of both veins with a normal ventilation perfusion scan. In this article we will discuss acquired PV stenosis following PV isolation, percutaneous PV intervention and the literature supporting the procedure. © 2014 Wiley Periodicals, Inc. ...
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Ranolazine Enhances the Antiarrhythmic Activity of Amiodarone by Accelerating Conversion of New-Onset Atrial Fibrillation After Cardiac Surgery
Angiology
2/27/2014 7:00:00 PM
Ranolazine is a relatively novel antiischemic/antianginal compound with antiarrhythmic properties. We investigated its ability to shorten the time to conversion of postoperative atrial fibrillation (POAF) when added to amiodarone after coronary artery bypass graft (CABG) surgery. In this prospective, randomized, allocation-concealed, single-blind, single-site clinical trial, we enrolled consecutive eligible patients who developed POAF after elective on-pump CABG surgery. Participants were randomized to receive either ranolazine 375 mg twice daily orally plus intravenous amiodarone (active group) or intravenous amiodarone alone (control group). We enrolled 41 patients; 20 in the active and 21 in the control group. There were no significant differences between the groups in terms of age...
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Clinical Predictors of Long-Term Outcomes in Patients With Critical Limb Ischemia Who have Undergone Endovascular Therapy
Angiology
2/27/2014 7:00:00 PM
In this study, clinical predictors of long-term outcomes in EVT-treated patients with CLI were investigated. In this prospective, observational study, we analyzed a total of 253 Taiwanese patients with CLI with 314 limbs who underwent EVT between 2005 and 2012. Cox models were used to estimate hazard ratios of death, limb loss, and sustained clinical success (SCS). Multivariate analysis showed that age, atrial fibrillation (AF), end-stage renal disease (ESRD), and albumin were significant predictors of mortality. Patients with coronary artery disease and low albumin levels had a significant risk of major limb amputation, while AF, ESRD, and albumin were significant, independent predictors of SCS. In addition to previously reported predictors, we showed that AF and malnutrition can be used ...

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Atrial fibrillation in ventricular-paced rhythm: under-recognised, underdiagnosed and potentially dangerous
Heart Asia
2/27/2014 7:00:00 PM
Conclusions Our study demonstrates severe systemic under-recognition of this fairly common condition among hospital doctors. This may lead to a lower rate of anticoagulation and a higher incidence of thromboembolic events (Source: Heart Asia)
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What is atrial fibrillation?
MayoClinic.com Full Feed
2/27/2014 7:00:00 PM
Atrial fibrillation is a common heart disorder. Find out more about this heart rhythm problem, including its symptoms, causes and treatments. (Source: MayoClinic.com Full Feed)
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Rate-control versus Rhythm-control Strategies and Outcomes in Septuagenarians with Atrial Fibrillation: Shariff N, Desai R, Patel, K, et al. Am J Med 2013;126:887–93.
The Journal of Emergency Medicine
2/27/2014 4:22:57 PM
Using data based on a public-use copy of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, the authors analyzed a subgroup of 70–80-year-old patients to compare rhythm vs. rate-controlling strategies. Of the 4060 patients from the original trial, 2248 patients were 70–80 years of age; 1118 were in the rate control group. Propensity-matching scores were used for each of the 2248 patients and they were placed in a cohort of 937 pairs, balanced using 45 baseline characteristics. Outcomes were all-cause mortality as the primary end point and cause-specific mortality, all-cause and cause-specific hospitalization, stroke, and major bleeding. All-cause mortality occurred in 18% of rate-controlled and 23% of rhythm-control strategy with a hazard ratio (HR) of...
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Mortality after ground-level fall in the elderly patient taking oral anticoagulation for atrial fibrillation/flutter: A long-term analysis of risk versus benefit - Inui TS, Parina R, Chang DC, Inui TS, Coimbra R.
SafetyLit: All (Unduplicated)
2/27/2014 8:37:38 AM
BACKGROUND: Elderly patients with atrial fibrillation or flutter who experience ground-level falls are at risk for lethal head injuries. Patients on oral anticoagulation (OAC) for thromboprophylaxis may be at higher risk for these head injuries. Trauma sur... (Source: SafetyLit: All (Unduplicated))

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Biosense Webster Receives FDA Approval For First Catheter Ablation Therapy In The U.S. To Feature Direct Contact Force Technology For Treatment Of Atrial Fibrillation
Medical Design Online News
2/27/2014 12:04:29 AM
Biosense Webster, Inc., a worldwide leader in the diagnosis and treatment of cardiac arrhythmias, announced recently that it has received approval from the United States Food and Drug Administration (FDA) for its THERMOCOOL SMARTTOUCH Catheter. (Source: Medical Design Online News)
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The Effects of Eosinophil on the Left Atrial Thrombus in Patients With Atrial Fibrillation
Clinical and Applied Thrombosis/Hemostasis
2/26/2014 7:00:00 PM
Conclusion: As a result, our study revealed a relationship between eosinophil count and LA thrombus in patients with nonvalvular AF. (Source: Clinical and Applied Thrombosis/Hemostasis)
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Mechanisms of Pulmonary Vein Reconnection after Radiofrequency Ablation of Atrial Fibrillation: The Deterministic Role of Contact Force and Interlesion Distance
Journal of Cardiovascular Electrophysiology
2/26/2014 7:00:00 PM
ConclusionsAcutely durable PVI can be achieved when RF lesions are delivered with a mean CF ≥ 10 g and an interlesion distance < 5 mm. The majority of PVR occur anteriorly due to inadequate CF or long interlesion distances.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Oxidation‐ and CaMKII‐mediated Sarcoplasmic Reticulum Ca2+ Leak Triggers Atrial Fibrillation in Aging
Journal of Cardiovascular Electrophysiology
2/26/2014 7:00:00 PM
ConclusionsAging increases both the oxidation and CaMKII‐phosphorylation of RyR2, which result in diastolic SR Ca2+ leak and facilitate AF initiation. These results contribute to the electrophysiological remodeling of aged atria and suggest a therapeutic strategy for AF treatment in aging.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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Prevalence of Esophageal Ulceration After Atrial Fibrillation Ablation with the Hot Balloon Ablation Catheter: What is the Value of Esophageal Cooling?
Journal of Cardiovascular Electrophysiology
2/26/2014 7:00:00 PM
ConclusionCooling the esophagus by a mix of Lopamidol and saline infusion when the LET exceeds 39 °C during RHB ablation may decrease the incidence and severity of esophageal thermal injury.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Monoamine Oxidase is a Major Determinant of Redox Balance in Human Atrial Myocardium and is Associated With Postoperative Atrial Fibrillation [Cardiovascular Surgery]
JAHA:Journal of the American Heart Association
2/25/2014 7:00:00 PM
Conclusions Our results show that MAO is an important determinant of redox balance in human atrial myocardium, and that this enzyme, in addition to GSHt and GPx, is associated with an increased risk for POAF. Further investigation is needed to validate MAO as a predictive biomarker for POAF, and to explore this enzyme's potential role in arrhythmogenesis. (Source: JAHA:Journal of the American Heart Association)
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J&J's Biosense Webster wins PMA nod from FDA for force-sensing catheter
Mass Device
2/25/2014 4:31:27 PM
Johnson & Johnson's Biosense Webster subsidiary is the 1st to the U.S. market with a force-sensing ablation catheter for atrial fibrillation, the ThermoCool SmartTouch device. Johnson & Johnson (NYSE:JNJ) said its Biosense Webster subsidiary won pre-market approval from the FDA for its ThermoCool SmartTouch force-sensing ablation catheter, making it the 1st such device to hit the U.S. market. BioSense Webster Inc., Endosense SA, Food & Drug Administration (FDA), Johnson & Johnson, St. Jude MedicalNews Well, Cardiac Rhythm Management, Catheters, Pre-Market Approval (PMA), Regulatory/Complianceread more (Source: Mass Device)
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FDA Approves New Catheter For Treatment Of Atrial Fibrillation
Forbes.com Healthcare News
2/25/2014 11:08:00 AM
The FDA has granted marketing approval for the Thermocool Smarttouch ablation catheter for use in patients with drug-resistant paroxysmal atrial fibrillation (AF), sustained monomorphic ischemic ventricular tachycardia and Type I atrial flutter. The device is manufactured by Biosense Webster, a Johnson & Johnson company. (Source: Forbes.com Healthcare News)
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Updated Guidelines Issued on Anticoagulation Prophylaxis for Stroke in NVAF (FREE)
Physician's First Watch current issue
2/24/2014 7:00:00 PM
By Joe Elia The American Academy of Neurology has issued revised guidelines on preventing stroke in the face of nonvalvular atrial fibrillation (NVAF). The … (Source: Physician's First Watch current issue)
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The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation
Cardiovascular Ultrasound
2/24/2014 7:00:00 PM
Conclusion: The diastolic function indices E:e' and e' velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT. (Source: Cardiovascular Ultrasound)

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A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry
Europace
2/24/2014 7:00:00 PM
Conclusion The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. (Source: Europace)
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Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women--the Tromso Study
Europace
2/24/2014 7:00:00 PM
Conclusion This prospective population-based cohort study showed that baseline SUA was associated with an increased risk for future AF in both sexes. (Source: Europace)
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The impact of haemodialysis on the outcomes of catheter ablation in patients with paroxysmal atrial fibrillation
Europace
2/24/2014 7:00:00 PM
Conclusion Haemodialysis was significantly associated with AF recurrence after CA for PAF. However, an ~50% success rate for sinus rhythm maintenance without antiarrhythmic drug therapy in HD patients suggested that CA could be an option for the treatment of AF. (Source: Europace)
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Modified phased radiofrequency ablation of atrial fibrillation reduces the number of cerebral microembolic signals
Europace
2/24/2014 7:00:00 PM
Conclusion Pulmonary vein isolation with ‘modified’ phased RF is associated with a decreased number of cerebral microembolism especially during the delivery of ablation impulses, supporting the significance of electrical interference between ablation electrodes 1 and 10. Deactivation of electrode pairs 1 or 5 might increase the safety of this approach without an increase in procedure duration or RF delivery time. (Source: Europace)

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Current periprocedural management of ablation for atrial fibrillation in Europe: results of the European Heart Rhythm Association survey
Europace
2/24/2014 7:00:00 PM
The purpose of this EP Wire survey was to assess clinical practice in periprocedural management of atrial fibrillation ablation. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were received from 78 centres in 20 countries. The results of the survey have shown that periprocedural management is generally in accordance with guidelines and consensus recommendations on ablation for atrial fibrillation ablation, although there are some areas of variation. Differences between high- and low-volume centres are observed with respect to patient selection, antiarrhythmic drug management, and heparin bridging. (Source: Europace)
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Recurrent intradialytic paroxysmal atrial fibrillation: hypotheses on onset mechanisms based on clinical data and computational analysis
Europace
2/24/2014 7:00:00 PM
Atrial fibrillation (AF) incidence is high in end-stage renal disease (ESRD) patients, and haemodialysis (HD) session may induce paroxysmal AF episodes. Structural atrium remodelling is common in ESRD patients, moreover, HD session induces rapid plasma electrolytes and blood volume changes, possibly favouring arrhythmia onset. Therefore, HD session represents a unique model to study in vivo the mechanisms potentially inducing paroxysmal AF episodes. Here, we present the case report of a patient in which HD regularly induced paroxysmal AF. In four consecutive sessions, heart rate variability analysis showed a progressive reduction of low/high frequency ratio before the AF onset, suggesting a relative increase in vagal activity. Moreover, all AF episodes were preceded by a great increase of ...
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What are the risk factors for atrial fibrillation?
MayoClinic.com Full Feed
2/24/2014 7:00:00 PM
Atrial fibrillation is a common heart disorder. Find out more about the risk factors for this heart rhythm problem. (Source: MayoClinic.com Full Feed)
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Guideline: People with irregular heartbeat should take blood thinners to prevent stroke, experts say
ScienceDaily Headlines
2/24/2014 5:11:37 PM
An updated guideline recommends that people with nonvalvular atrial fibrillation, or irregular heartbeat, take oral anticoagulants, a type of blood thinner pill, to prevent stroke. (Source: ScienceDaily Headlines)
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Blood Thinners Now Recommended for People with Irregular Heartbeat
MedlinePlus Health News
2/24/2014 4:00:00 PM
Updated guideline from American Academy of Neurology aims to reduce stroke risk Source: HealthDay Related MedlinePlus Pages: Atrial Fibrillation, Blood Thinners, Stroke (Source: MedlinePlus Health News)
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Atrial Fibrillation Cycle Length and Atrial Size in Horses with and without Recurrence of Atrial Fibrillation after Electrical Cardioversion
Journal of Veterinary Internal Medicine
2/23/2014 7:00:00 PM
Conclusions and Clinical ImportanceBefore TVEC, assessment of LA size and atrial electrophysiologic characteristics might help to identify horses at increased risk for AF recurrence. (Source: Journal of Veterinary Internal Medicine)
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Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Neurology
2/23/2014 7:00:00 PM
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probably detects occult NVAF. In patients with NVAF, dabigatran, rivaroxaban, and apixaban are probably at least as effective as warfarin in preventing stroke and have a lower r...

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Relationship Between Intrinsic Cardiac Autonomic Ganglionated Plexi and the Atrial Fibrillation Nest.
Circulation Journal
2/23/2014 7:00:00 PM
Conclusions: Catheter ablation of the GP decreased the DF values, AF nest areas and diminished the number of AF nests; particularly those close to the GPs, indicating that the CANS might play an important role in the mechanism of the AF nest. PMID: 24562675 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Glycaemic Control in Cardiac Surgery Patients: A Double-Edged Sword.
Current Vascular Pharmacology
2/23/2014 7:00:00 PM
Authors: Krzych LJ, Wybraniec MT Abstract Glycaemic management is of paramount importance in the cardiac surgery setting. A growing body of evidence confirms a J-shaped relationship between blood glucose (BG) level and perioperative morbidity and mortality. On one hand, acute hypoglycaemia causes irreversible cerebral damage. On the other hand, hyperglycaemia increases the risk of infections, acute kidney injury, atrial fibrillation, low cardiac output syndrome, cerebrovascular accidents and cognitive impairment. Also, high BGvariability, even within the therapeutic window, may deteriorate the outcome. Therefore, moderate perioperative insulin management is usually recommended, with target BGadjusted to individual needs and possibilities. Continuous BGmonitoring is a promising tool...
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Response to Letter Regarding Article, "Dabigatran Versus Warfarin: Effects on Ischemic and Hemorrhagic Strokes and Bleeding in Asians and Non-Asians With Atrial Fibrillation" [Letters to the Editor]
Stroke
2/23/2014 7:00:00 PM
(Source: Stroke)
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Usefulness of N-Terminal Pro-B-Type Natriuretic Peptide Levels for Stroke Risk Prediction in Anticoagulated Patients With Atrial Fibrillation [Clinical Sciences]
Stroke
2/23/2014 7:00:00 PM
Conclusions— In real-world cohort of anticoagulated patients with AF, NT-proBNP provided complementary prognostic information to an established clinical risk score (CHA2DS2–VASc) for the prediction of stroke/systemic embolism. NT-proBNP was also predictive of all-cause mortality, suggesting that this biomarker may potentially be used to refine clinical risk stratification in anticoagulated patients with AF. (Source: Stroke)
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Supraventricular Premature Beats and Short Atrial Runs Predict Atrial Fibrillation in Continuously Monitored Patients With Cryptogenic Stroke [Brief Reports]
Stroke
2/23/2014 7:00:00 PM
Conclusions— Numerous SPBs and SVRs demonstrated a high risk for future AF in patients with cryptogenic stroke. (Source: Stroke)
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Oral anticoagulant treatment in geriatric patients with nonvalvular atrial fibrillation in the era of direct oral anticoagulant agents.
European Journal of Internal Medicine
2/22/2014 7:00:00 PM
Authors: Kayser M, Frances Y, Bonello L, Paganelli F, Peyrol M PMID: 24569004 [PubMed - as supplied by publisher] (Source: European Journal of Internal Medicine)
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Incomplete recovery of mechanical and endocrine left atrial functions one month after electrical cardioversion for persistent atrial fibrillation: a pilot study
BioMed Central
2/21/2014 7:00:00 PM
Conclusion: These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group. (Source: BioMed Central)
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PodMed: A Medical News Roundup From Johns Hopkins (with audio)
MedPage Today Psychiatry
2/21/2014 12:43:06 PM
(MedPage Today) -- This week's topics include the best treatment for ear infections in kids with tubes, first-line treatment for atrial fibrillation, how to manage asymptomatic AVMs, and citalopram for agitation in Alzheimer's disease. (Source: MedPage Today Psychiatry)
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In a Subanalysis, Eliquis(R) (apixaban) Reduced the Risk of Stroke and Demonstrated Fewer Major Bleeding Events versus Warfarin Consistently across Age Groups, Including Older Patients with Nonvalvular Atrial Fibrillation
HSMN NewsFeed
2/21/2014 10:48:09 AM
Data from Phase 3 ARISTOTLE trial pre-specified subanalysis published in the European Heart Journal PRINCETON, N.J. & NEW YORK--(Healthcare Sales & Marketing Network)--Bristol-Myers Squibb Company (BMY) and Pfizer Inc. (PFE) today announced results of a... Biopharmaceuticals, CardiologyBristol-Myers Squibb, Pfizer, Eliquis, apixaban, atrial fibrillation, stroke (Source: HSMN NewsFeed)

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Postoperative atrial fibrillation and stroke—is it time to act?
Scandinavian Cardiovascular Journal
2/20/2014 11:04:02 PM
Scandinavian Cardiovascular Journal, Volume 0, Issue 0, Page 1-2, Early Online. (Source: Scandinavian Cardiovascular Journal)
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Slowing down the heart rate in permanent atrial fibrillation
European Heart Journal
2/20/2014 7:00:00 PM
(Source: European Heart Journal)
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Moving catheter ablation forward from paroxysmal to persistent atrial fibrillation: progress, limitations, and surprises of the SARA trial
European Heart Journal
2/20/2014 7:00:00 PM
(Source: European Heart Journal)
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The Year in Cardiology 2013: arrhythmias
European Heart Journal
2/20/2014 7:00:00 PM
The Year in Cardiology ‘arrhythmias’ presents an update on the latest studies and innovations published in the field within the last 12 months. Recent advances in the management of atrial fibrillation and novel treatment strategies and technologies are presented. New consensus documents to improve the diagnosis and treatment of patients with inherited cardiac arrhythmias and for paediatric patients with cardiac arrhythmias are summarized. Great progress has also been made in the field of cardiac implantable electronic devices: improvements in implantation techniques and novel technologies have been introduced and successfully applied. In addition, novel data on prevention of implantable cardioverter defibrillator-shocks and cardiac resynchronization therapy will certainly help ...
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Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study)
European Heart Journal
2/20/2014 7:00:00 PM
Conclusion Catheter ablation is superior to medical therapy for the maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up. Clinical Trial Registration Information NCT00863213 (http://clinicaltrials.gov/ct2/show/NCT00863213). (Source: European Heart Journal)

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Device-detected atrial fibrillation and risk for stroke: an analysis of >10 000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices)
European Heart Journal
2/20/2014 7:00:00 PM
Conclusions Device-detected AF burden is associated with an increased risk of ischaemic stroke in a relatively unselected population of CIEDs patients. This finding may add to the basis for timely and clinically appropriate decision-making on anticoagulation treatment. (Source: European Heart Journal)
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Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation
European Heart Journal
2/20/2014 7:00:00 PM
Conclusion Rate-reducing treatment with diltiazem or verapamil preserved exercise capacity and reduced levels of NT-proBNP compared with baseline, whereas treatment with metoprolol or carvedilol reduced the exercise capacity and increased levels of NT-proBNP. (Source: European Heart Journal)
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Impact of Atrial Remodeling on the Outcome of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation.
Circulation Journal
2/20/2014 7:00:00 PM
Conclusions: Preprocedural echocardiographic estimation of atrial remodeling was a useful predictor of AF/AT recurrence following a single RFCA of PAF. PMID: 24562637 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Medtronic's Reveal XT bests standard care for heart monitoring in stroke patients
Mass Device
2/20/2014 9:04:18 AM
Medtronic's Reveal XT continuous heart monitor detected atrial fibrillation more often than current standards of care, including electrocardiograms and short-term diagnostic tests. Results from Medtronic's (NYSE:MDT) CRYSTAL AF clinical trial found that the company's tiny Reveal XT continuous monitor performed better at detecting heart problems in stroke patients than current standards of care, the company reported. MedtronicNews Well, Clinical Trials, Cardiac Rhythm Management, Minnesota, Patient Monitoring, Remote Patient Monitoringread more (Source: Mass Device)

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Outcomes associated with comorbid atrial fibrillation and heart failure in medicare beneficiaries with acute coronary syndrome
BMC Health Services Research
2/19/2014 7:00:00 PM
Conclusion: Using a nationally representative sample of Medicare beneficiaries, we observed a significantly higher clinical and economic burden of patients hospitalized for ACS with comorbid AF and HF compared with those without these conditions. (Source: BMC Health Services Research)
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Progression to the Persistent Form in Asymptomatic Paroxysmal Atrial Fibrillation.
Circulation Journal
2/19/2014 7:00:00 PM
Conclusions: Irrespective of low-risk profile, patients with asymptomatic paroxysmal AF had greater progression of AF compared with symptomatic patients. This paradoxical result appeared to be the result of less intensive clinical management, including invasive rhythm control. PMID: 24553324 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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New oral anticoagulants for stroke prevention in atrial fibrillation: impact of study design, double counting and unexpected findings on interpretation of study results and conclusions.
Thrombosis and Haemostasis
2/19/2014 7:00:00 PM
Authors: Chan NC, Paikin JS, Hirsh J, Lauw MN, Eikelboom JW, Ginsberg JS Abstract Four recently introduced new oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban) have been shown to be at least as efficacious and safe as warfarin for stroke prevention in patients with atrial fibrillation in their respective trials. The first three have been approved, while edoxaban is awaiting regulatory approval. Several guidelines have endorsed the approved new oral anticoagulants over warfarin because of their favourable risk-benefit ratio, low propensity for food and drug interactions, and lack of requirement for routine coagulation monitoring. In this invited review, we summarise the results of the four studies and discuss widely held conclusions. We take a step further and di...
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Postoperative atrial fibrillation predicts cause-specific late mortality after coronary surgery
Scandinavian Cardiovascular Journal
2/18/2014 11:03:46 PM
Scandinavian Cardiovascular Journal, Volume 0, Issue 0, Page 1-8, Early Online. (Source: Scandinavian Cardiovascular Journal)

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Trial Offers Little Support for Early Use of Radiofrequency Ablation in Atrial Fibrillation (FREE)
Physician's First Watch current issue
2/18/2014 7:00:00 PM
By Larry Husten A new, industry-supported trial offers little support for early use of radiofrequency ablation to treat atrial fibrillation. The findings appear in JAMA.Some 130 patients with paroxysmal AF were randomized to … (Source: Physician's First Watch current issue)
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Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review
Heart
2/18/2014 7:00:00 PM
Conclusions AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated. (Source: Heart)
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Dehydroepiandrosterone sulfate levels and risk of atrial fibrillation: The Rotterdam Study
European Journal of Preventive Cardiology
2/18/2014 7:00:00 PM
Conclusion DHEAS can be regarded as an important indicator of future atrial fibrillation in both men and women, independent of known cardiovascular risk factors. (Source: European Journal of Preventive Cardiology)
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Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population: a nationwide propensity score-matched study
European Journal of Preventive Cardiology
2/18/2014 7:00:00 PM
Conclusions Statin therapy was significantly associated with less new-onset AF in a nationwide cohort of post-MI patients. Furthermore, statins showed a type-dependent effect in preventing new-onset AF. These results support the beneficial effect of statin therapy beyond lipid lowering in patients with MI and underline the importance of statin adherence and choice of statin type. (Source: European Journal of Preventive Cardiology)

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Heavy Alcohol Consumption and Risk of Atrial Fibrillation.
Circulation Journal
2/18/2014 7:00:00 PM
Conclusions: Heavy alcohol consumption is associated with a higher risk of AF. PMID: 24553265 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Quantitative Proteomics of Changes in Energy Metabolism-Related Proteins in Atrial Tissue From Valvular Disease Patients With Permanent Atrial Fibrillation.
Circulation Journal
2/18/2014 7:00:00 PM
Conclusions: Atrial myocardium energy production in valvular disease patients is impaired during permanent AF, and this impairment in energy production may be involved in the matrix of AF formation. PMID: 24553264 [PubMed - as supplied by publisher] (Source: Circulation Journal)
http://www.medworm.com/rss/comments.php?id=14185663
Outcomes of Temporary Interruption of Rivaroxaban Compared with Warfarin in Patients with Nonvalvular Atrial Fibrillation: Results from ROCKET AF.
Circulation
2/18/2014 7:00:00 PM
CONCLUSIONS: TI of oral anticoagulation is common and associated with substantial stroke risks and bleeding risks that were similar among patients treated with rivaroxaban or warfarin. Further investigation is needed to determine the optimal management strategy in AF patients requiring TI of anticoagulation. CLINICAL TRIAL REGISTRATION INFORMATION: www.ClinicalTrials.gov. Identifier: NCT00403767. PMID: 24552831 [PubMed - as supplied by publisher] (Source: Circulation)
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Zapping Artery Tops Drugs for Controlling Afib (CME/CE)
MedPage Today Primary Care
2/18/2014 4:47:53 PM
(MedPage Today) -- Paroxysmal atrial fibrillation recurred significantly less often in patients initially treated with radiofrequency ablation (RFA) instead of medication, results of a randomized trial showed. (Source: MedPage Today Primary Care)
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Zap Tops Drug for Afib Control (CME/CE)
MedPage Today Cardiovascular
2/18/2014 4:43:00 PM
(MedPage Today) -- Paroxysmal atrial fibrillation recurred significantly less often in patients initially treated with radiofrequency ablation (RFA) instead of medication, results of a randomized trial showed. (Source: MedPage Today Cardiovascular)

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Artery Zapping Little Better Than Drugs In Atrial Fibrillation Patients
Forbes.com Healthcare News
2/18/2014 4:28:00 PM
Atrial fibrillation is the most common heart rhythm disorder. Although AF is not as lethal as some other arrhythmias, AF patients are at high risk for stroke and other serious complications. AF is also very difficult to treat. Although drugs are ineffective in a large percentage of patients, drugs are considered first line therapy in current guidelines. (Source: Forbes.com Healthcare News)
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Surgery Might Top Drugs as First Therapy for Irregular Heartbeat
MedlinePlus Health News
2/18/2014 4:00:00 PM
But safety issues may still make medications better choice for many patients, experts say Source: HealthDay Related MedlinePlus Page: Atrial Fibrillation (Source: MedlinePlus Health News)
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Zapping Vein Tops Drugs for Controlling Afib (CME/CE)
MedPage Today Cardiovascular
2/18/2014 3:00:00 PM
(MedPage Today) -- Paroxysmal atrial fibrillation recurred significantly less often in patients initially treated with radiofrequency ablation (RFA) instead of medication, results of a randomized trial showed. (Source: MedPage Today Cardiovascular)
http://www.medworm.com/rss/comments.php?id=13785734
Apama Medical Announces Claim Coverage In China For Electrode-Based Ablation Balloon For The Treatment Of Atrial Fibrillation (AF)
HSMN NewsFeed
2/18/2014 8:59:38 AM
CAMPBELL, Calif., Feb. 18, 2014 -- (Healthcare Sales & Marketing Network) -- Apama Medical, a privately held medical device company formed by Shifamed's medical incubator, today announced receipt of a Chinese notice of allowance for claims covering their ... Devices, Interventional, RegulatoryShifamed, Apama Medical, atrial fibrillation, ablation catheter (Source: HSMN NewsFeed)
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One-quarter of high risk patients denied anticoagulation after AF ablation
ESC News and Press
2/18/2014 6:53:29 AM
Very good long-term results for AF ablation across Europe:  The EORP Atrial Fibrillation Ablation Pilot Study reveals that 65% of patients were taking anticoagulants one year after ablation of AF. But up to 25% of patients at high risk of stroke (defined as a CHA2DS2-VASc score >1) were not taking any anticoagulant drug. And around half of patients with a low stroke risk (CHA2DS2-VASc score of 0) were still anticoagulated one year after the procedure.   Topics: Atrial Fibrillation (Source: ESC News and Press)

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Attenuated response of L-type calcium current to nitric oxide in atrial fibrillation
Cardiovascular Research
2/17/2014 7:00:00 PM
Conclusion NO exerts dual effects on ICa,L in SR with an increase of basal and inhibition of cAMP-stimulated current, and in AF NO inhibits only stimulated ICa,L. We conclude that in AF, cGMP regulation of PDE2 is preserved, but regulation of PDE3 is lost. (Source: Cardiovascular Research)
http://www.medworm.com/rss/comments.php?id=13617133
Pitx2, an Atrial Fibrillation Predisposition Gene, Directly Regulates Ion Transport and Intercalated Disc Genes [Original Articles]
Circulation: Cardiovascular Genetics
2/17/2014 7:00:00 PM
Conclusions— Our findings, revealing that Pitx2 has genetically separable postnatal and developmental functions, unveil direct Pitx2 target genes that include channel and calcium handling genes, as well as genes that stabilize the intercalated disc in postnatal atrium. (Source: Circulation: Cardiovascular Genetics)
http://www.medworm.com/rss/comments.php?id=13617908
Management of Antiplatelet and Anticoagulant Therapy in Patients With Atrial Fibrillation in the Setting of Acute Coronary Syndromes or Percutaneous Coronary Interventions [Advances in Interventional Cardiology]
Circulation: Cardiovascular Interventions
2/17/2014 7:00:00 PM
(Source: Circulation: Cardiovascular Interventions)
http://www.medworm.com/rss/comments.php?id=13617982
Left Atrial Fibrosis by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Predicts Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation: Do You See What I See? [Editorials]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
(Source: Circulation: Arrhythmia and Electrophysiology)

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Atrial Fibrillation Ablation Outcome Is Predicted by Left Atrial Remodeling on MRI [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— Atrial SRM is identified on LGE-MRI, and extensive LGE (≥30% LA wall enhancement) predicts poor response to catheter ablation therapy for AF. (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618931
A Randomized Controlled Trial of Catheter Ablation Versus Medical Treatment of Atrial Fibrillation in Heart Failure (The CAMTAF Trial) [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— Catheter ablation is effective in restoring sinus rhythm in selected patients with persistent AF and HF, and can improve LV function, functional capacity, and HF symptoms compared with rate control. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01411371 (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618932
In Vivo Contact Force Analysis and Correlation With Tissue Impedance During Left Atrial Mapping and Catheter Ablation of Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— Excessively high and low CF values can be observed during left atrial mapping and ablation. The low CF obtained at the mitral isthmus and anterior segments of the left pulmonary veins may explain why reconnection after ablation occurs more frequently at these sites. CF and impedance do correlate; however, the impedance for a given CF ranges widely, limiting its use in clinical practice. (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618934
Selective Complex Fractionated Atrial Electrograms Targeting for Atrial Fibrillation Study (SELECT AF): A Multicenter, Randomized Trial [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— Continuous electric activity ablation+PVI result in a similar incidence of acute AF termination with significantly less radiofrequency time. However, incidence of repeat procedures and long-term recurrence of AF/atrial flutter/atrial tachycardia are significantly lower using generalized CFAE ablation+PVI. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00926783 (Source: Circulation: Arrhythmia and Electrophysiology)

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Target Indices for Clinical Ablation in Atrial Fibrillation: Insights From Contact Force, Electrogram, and Biophysical Parameter Analysis [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— During nonparoxysmal atrial fibrillation ablation, an FTI of 500 g·s should be targeted with ablation duration of ≥10 s. Clinical Trials Registration— URL: http://clinicaltrials.gov/. Unique Identifier: NCT01587404. (Source: Circulation: Arrhythmia and Electrophysiology)
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Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation: Insights From the Multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— ERAF after cryoballoon ablation occurs in 50% of patients and is strongly associated with LR. Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF. (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618937
Effect of Radiofrequency Catheter Ablation for Atrial Fibrillation on Morbidity and Mortality: A Nationwide Cohort Study and Propensity Score Analysis [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— RFA did not reduce mortality or hospitalization for HF during the immediate 3.5-year follow-up. Although a beneficial effect on stroke prevention associated with RFA was suggested, residual confounding attributable to unmeasured factors remains a concern. (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618938
Time Course of Inflammation, Myocardial Injury, and Prothrombotic Response After Radiofrequency Catheter Ablation for Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
2/17/2014 7:00:00 PM
Conclusions— Patients undergoing radiofrequency ablation for AF exhibit an inflammatory response within 3 days. The extent of inflammatory response predicts early AF recurrence but not late recurrence. Prothrombotic markers are elevated at 1 week after ablation and may contribute to increased risk of early thrombotic events after AF ablation. (Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13618939
Warfarin and atrial fibrillation: from ideal to real the warfarin affaire
Thrombosis Journal
2/17/2014 7:00:00 PM
Vitamin K Antagonists (VKAs) are widely used in clinical practice and nearly 1% of the entire population receives oral anticoagulation at least once in life. However, the rate of prescription of anticoagulation is low, compared to what it should be. No more than 50-60% of patients affected by atrial fibrillation (AF) receive anticoagulation. In the setting of AF, VKAs are safe and effective when properly managed, reducing stroke and systemic embolism by more than 60%. VKAs safety and effectiveness are closely related to the quality of anticoagulation (e.g. time in therapeutic range), and anticoagulation clinics offer the best management of anticoagulant therapy. However, a sizeable proportion of patients are managed elsewhere. In clinical practice, in the setting of AF, a low prescription ...

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Review: Novel oral anticoagulants reduce stroke more than ASA in nonvalvular atrial fibrillation.
Annals of Internal Medicine
2/17/2014 7:00:00 PM
Authors: Neumann I, Brignardello-Petersen R, Guyatt G PMID: 24534937 [PubMed - in process] (Source: Annals of Internal Medicine)
http://www.medworm.com/rss/comments.php?id=13732125
Automatic online detection of atrial fibrillation based on symbolic dynamics and Shannon entropy
BioMedical Engineering OnLine
2/16/2014 7:00:00 PM
Conclusions: Overall, in contrast to the other available techniques, the test results indicate that the newly developed approach outperforms traditional methods using these databases under assessed various experimental situations, and suggest our technique could be of practical use for clinicians in the future. (Source: BioMedical Engineering OnLine)
http://www.medworm.com/rss/comments.php?id=13436536
Risk of Stroke or Transient Ischemic Attack after Atrial Fibrillation Ablation with Oral Anticoagulant Use Guided by ECG Monitoring and Pulse Assessment
Journal of Cardiovascular Electrophysiology
2/16/2014 7:00:00 PM
ConclusionsPost‐AF ablation with OAC guided by TTM and pulse assessment: 1) Overall stroke or TIA rate risk is low and risk is due to recurrent AF and 2) OAC can be stopped in 40% of CHADS2 ≥2 patients with low stroke and hemorrhagic risk.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Outcomes of Atrioesophageal Fistula Following Catheter Ablation of Atrial Fibrillation Treated With Surgical Repair versus Esophageal Stenting
Journal of Cardiovascular Electrophysiology
2/16/2014 7:00:00 PM
ConclusionsEsophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
http://www.medworm.com/rss/comments.php?id=13446512
Beliefs about medicines in Dutch acenocoumarol and phenprocoumon users
British Journal of Clinical Pharmacology
2/16/2014 7:00:00 PM
ConclusionsCoumarin users score higher on the necessity scale than on the concerns scale, which is also the case in users of other cardiovascular drugs. Patients with atrial fibrillation have a less positive attitude towards these drugs than patients with venous thromboembolism, and could therefore benefit more from specific attention. (Source: British Journal of Clinical Pharmacology)

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Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: Insights from the International RealiseAF Survey.
Archives of Cardiovascular Diseases
2/16/2014 7:00:00 PM
CONCLUSION: There is substantial deviation from international guidelines in antithrombotic use for AF in routine clinical practice, with overuse and underuse of antithrombotics in about 50% of the cases and important geographical differences. These findings emphasize the need for improved medical education worldwide and a better understanding of geographical disparities in the implementation of guidelines. PMID: 24556189 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)
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Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients
Interactive CardioVascular and Thoracic Surgery
2/14/2014 7:00:00 PM
CONCLUSIONS Real-life OAC prescription in AF patients showed a moderate guideline adherence, with high-risk patients being undertreated and low-risk patients being overtreated. These findings stress the importance that antithrombotic treatment in patients undergoing AF surgery needs to be critically re-evaluated. (Source: Interactive CardioVascular and Thoracic Surgery)
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Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection
Interactive CardioVascular and Thoracic Surgery
2/14/2014 7:00:00 PM
CONCLUSIONS While the majority of PAF is uncomplicated and transient, one-third of cases lead to persistence or major intervention. Age, coronary artery disease and extent of surgery/stage increase the risk of PAF following pulmonary resection. Identifying patients with elevated risk may lead to targeted prophylaxis to reduce the incidence of PAF. (Source: Interactive CardioVascular and Thoracic Surgery)
http://www.medworm.com/rss/comments.php?id=13008223
Insertable Heart Monitor Finds Elusive Atrial Fibrillation After Unexplained Stroke
MedlinePlus Health News
2/14/2014 5:24:19 PM
Source: American Heart Association Related MedlinePlus Pages: Atrial Fibrillation, Stroke (Source: MedlinePlus Health News)

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Long term follow-up of DDD pacing mode.
Polish Heart Journal
2/13/2014 7:00:00 PM
Conclusions: 1) Effective DDD pacing from originally implanted system was noted in high percentage (72%) of patients in long-term obserwation (15 years). 2) Progression to permanent atrial fibrillation is the most common reason for loss of DDD pacing; a history of paroxysmal AF and old age are the risk factors. 3) Subclavian vein puncture is associated with higher rate of atrial lead damage. PMID: 24526555 [PubMed - as supplied by publisher] (Source: Polish Heart Journal)
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Cardioversion of Atrial Fibrillation (RHYTHM-AF) International Registry in Poland.
Cardiology Journal
2/13/2014 7:00:00 PM
CONCLUSIONS: Conversion to sinus rhythm was attempted in < 60% of the patients with AF admitted to the hospital with an intention to terminate arrhythmia. Electrical cardioversion was successful in ~90% of the patients, while pharmacological cardioversion in ~75% of the patients (amiodarone and propafenone were most commonly used). The rate of complications was low (2.8%). PMID: 24526513 [PubMed - as supplied by publisher] (Source: Cardiology Journal)
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Impact of Renal Dysfunction on Clinical Outcome in Patients With Low Risk of Atrial Fibrillation.
Circulation Journal
2/12/2014 7:00:00 PM
Conclusions: Impaired renal function has an additive prognostic value for thromboembolic events and cardiovascular mortality in low-risk AF patients with CHA2DS2-VASc score 0-1. PMID: 24521763 [PubMed - as supplied by publisher] (Source: Circulation Journal)
http://www.medworm.com/rss/comments.php?id=13308378
Prognostic Value of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Imaging in Japanese Hypertrophic Cardiomyopathy Patients.
Circulation Journal
2/12/2014 7:00:00 PM
Conclusions: The presence of LGE, increased myocardial mass index, reduced left ventricular ejection fraction and atrial fibrillation were independent predictors of adverse prognosis in Japanese HCM patients. PMID: 24521762 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Postoperative Arrhythmias after Cardiac Surgery: Incidence, Risk Factors, and Therapeutic Management.
Cardiology Research and Practice
2/12/2014 10:13:15 AM
Authors: Peretto G, Durante A, Limite LR, Cianflone D Abstract Arrhythmias are a known complication after cardiac surgery and represent a major cause of morbidity, increased length of hospital stay, and economic costs. However, little is known about incidence, risk factors, and treatment of early postoperative arrhythmias. Both tachyarrhythmias and bradyarrhythmias can present in the postoperative period. In this setting, atrial fibrillation is the most common heart rhythm disorder. Postoperative atrial fibrillation is often self-limiting, but it may require anticoagulation therapy and either a rate or rhythm control strategy. However, ventricular arrhythmias and conduction disturbances can also occur. Sustained ventricular arrhythmias in the recovery period after cardiac surgery m...
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Use of Ranolazine in the Prevention and Treatment of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery.
The Annals of Pharmacotherapy
2/11/2014 7:00:00 PM
CONCLUSIONS: In these current small trials, ranolazine appears to be a safe and efficacious therapeutic alternative for the treatment and prevention of POAF in patients undergoing cardiac surgery. However, larger randomized controlled trials are needed before ranolazine should be considered for the treatment or prevention of POAF. It is an attractive option compared with current treatments for this indication-primarily β-blockers and amiodarone-because ranolazine has minimal effects on heart rate and blood pressure. PMID: 24523397 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)

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Bifurcations, sustained oscillations and torus bursting involving ionic concentrations dynamics in a canine atrial cell model.
Mathematical Biosciences
2/11/2014 7:00:00 PM
Authors: Grégoire-Lacoste F, Jacquemet V, Vinet A Abstract Atrial fibrillation is a disorganization of the electrical propagation in the atria often initiated by ectopic beats. This spontaneous activity might be associated with the appearance of sustained oscillations in some portion of the tissue. Adrenergic stress and specific gene polymorphisms known to promote atrial fibrillation are notably related to calcium and potassium channel conductances. We performed codimension-one and two bifurcation analysis along these conductances in an ionic canine atrial myocyte model. Two Hopf bifurcations were found, related to two distinct mechanisms: (1) a fast calcium gating-driven oscillator, and (2) a slow concentration-driven oscillator. These two mechanisms interact through a double Hop...
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Shared decision making in atrial fibrillation: where we are and where we should be going.
Circulation
2/10/2014 7:00:00 PM
Authors: Seaburg L, Hess EP, Coylewright M, Ting HH, McLeod CJ, Montori VM PMID: 24515956 [PubMed - in process] (Source: Circulation)
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Diagnosis and Treatment of Obstructive Sleep Apnea Is Key to Achieving Optimal Results After Catheter Ablation of Atrial Fibrillation
Journal of the American College of Cardiology: Cardiovascular Interventions
2/10/2014 4:24:40 PM
Fein et al. (1) report that obstructive sleep apnea (OSA) adversely affects the results of ablation for paroxysmal or persistent atrial fibrillation (AF) except in those who reported using continuous positive airway pressure. Clearly, the study advances our understanding of the role that OSA may play in AF and its management. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Reply Diagnosis and Treatment of Obstructive Sleep Apnea Is Key to Achieving Optimal Results After Catheter Ablation of Atrial Fibrillation
Journal of the American College of Cardiology: Cardiovascular Interventions
2/10/2014 4:24:40 PM
The association between obstructive sleep apnea (OSA) and cardiovascular morbidity is well established (1,22). In particular, OSA has been shown to potentiate atrial fibrillation (AF) substrate in both animal and human studies (3,4,5,6,7). Our study not only demonstrated that OSA adversely affects the results of AF ablation, but also highlighted the beneficial effect of OSA treatment on AF ablation outcome in this patient population (8). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Left Atrial Size and Function Role in Prognosis
Journal of the American College of Cardiology: Cardiovascular Interventions
2/10/2014 4:24:32 PM
The author examines the ability of left atrial size and function to predict cardiovascular outcomes. Data are sufficient to recommend evaluation of left atrial volume in certain populations, and although analysis of atrial reservoir, conduit, and booster pump function trails in that regard, the gap is rapidly closing. In this state-of-the-art paper, the author reviews the methods used to assess left atrial size and function and discusses their role in predicting cardiovascular events in general and referral populations and in patients with atrial fibrillation, cardiomyopathy, ischemic heart disease, and valvular heart disease. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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What to Choose? The Bad or The Worse? A Case of Atrial Fibrillation and Recurrent Hematuria
Journal of the American Medical Directors Association
2/10/2014 10:33:55 AM
We describe a case of atrial fibrillation with recurrent CVA and recurrent hematuria. (Source: Journal of the American Medical Directors Association)
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Economic evaluation of rivaroxaban in stroke prevention for patients with atrial fibrillation in Greece
BioMed Central
2/9/2014 7:00:00 PM
Conclusion: Rivaroxaban may represent for payers a dominant option for the prevention of thromboembolic events in moderate to high risk AF patients in Greece. (Source: BioMed Central)
http://www.medworm.com/rss/comments.php?id=12521833
Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis
Heart
2/9/2014 7:00:00 PM
Conclusions Percutaneous closure of PFO in patients with cryptogenic stroke does not appear superior to medical therapy according to currently available randomised data. Furthermore, it is associated with an increased incidence of atrial fibrillation. However, there are signals pointing towards a potential benefit and more research should be strongly encouraged. (Source: Heart)

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Current and new oral antithrombotics in non-valvular atrial fibrillation: a network meta-analysis of 79 808 patients
Heart
2/9/2014 7:00:00 PM
Conclusions In this network meta-analysis, novel oral anticoagulants were the most promising treatments to reduce stroke, stroke or systemic embolism, and all-cause mortality in patients with AF. (Source: Heart)
http://www.medworm.com/rss/comments.php?id=12590738
Association of hyperuricemia with cardiac events in patients with atrial fibrillation
International Journal of Cardiology
2/9/2014 7:00:00 PM
Elevated serum uric acid has emerged as an independent predictor of adverse cardiovascular events in various diseases, including chronic heart failure and chronic renal disease . Hyperuricemia was reported to be a novel risk factor for the development of atrial fibrillation (AF) . However, the prognostic value of hyperuricemia in AF patients has never been evaluated. Accordingly, the aim of the present study was to examine the ability of hyperuricemia in prediction of cardiac outcomes in patients with AF. Besides, we also sought whether elevated serum uric acid could offer an additional prognostic benefit over conventional clinical and echocardiographic parameters in these patients. (Source: International Journal of Cardiology)
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The type of sinus node dysfunction might predict the severity of atrial remodeling and clinical outcome after catheter ablation of atrial fibrillation
International Journal of Cardiology
2/9/2014 7:00:00 PM
Atrial remodeling has been associated with AF recurrence after RFA and limits the efficacy of this therapy , and it has also been reported to cause remodeling of sinus node, resulting in sinoatrial node dysfunction (SND) or sick sinus syndrome (SSS) . The association between AF and SSS has been long recognized and is thought to form the basis of tachycardia–bradycardia (TB) syndrome . AF develops in up to 50% of patients with TB SSS . However, SSS can also manifest as sinus bradycardia with or without an associated TB component, and this type of SSS is also associated with AF. The purpose of this study is to investigate the relationship between the type of SND and the recurrence rate of AF in patients who have undergone RFA. (Source: International Journal of Cardiology)
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Study Shows 3-D Heart Imaging Can Improve Atrial Fibrillation Treatment
Medical Design Online News
2/7/2014 7:31:27 PM
AUniversity of Utah-led study for treatment of patients with atrial fibrillation (A-fib) provides strong clinical evidence for the use of 3-D MRI to individualize disease management and improve outcomes. (Source: Medical Design Online News)
http://www.medworm.com/rss/comments.php?id=12011435
Maybe Pradaxa (dabigatran) does need blood monitoring after all
The Poison Review
2/7/2014 3:16:55 PM
2.5 out of 5 stars The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients. Reilly PA et al. J Am Coll Cardiol 2014 Feb 4;63:321-8. Abstract A must-read article in yesterday’s New York Times described the internal battle at Boehringer Ingelheim, the maker of Pradaxa (dabiagtran etexilate), concerning the publication of this study. A major marketing point posited in favor of dabigatran over warfarin for the prevention of stroke in patients with atrial fibrillation was that it did not require monitoring with regular blood tests. However, a number of observers, including TPR, have pointed out that dabigatran has a both a complex pharmacokinetic profile  and concentration-depend...
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Assessment of Atrial Electromechanical Delay and P‐Wave Dispersion in Patients with Psoriasis
Echocardiography
2/6/2014 7:00:00 PM
ConclusionThis study demonstrated that atrial electromechanical coupling intervals and P‐wave dispersion were prolonged in patients with psoriasis, which may cause an increased risk of atrial fibrillation in this patient group. (Source: Echocardiography)
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Catheter ablation of extra-pulmonary vein foci improves the clinical outcome in patients with paroxysmal atrial fibrillation
International Journal of Cardiology
2/6/2014 7:00:00 PM
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. AF is associated with multiple symptoms, with significant morbidity and mortality and with decreased quality of life . Pulmonary vein isolation (PVI) is the cornerstone of radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF). However, the success rate for long-term follow-up is limited with recurrence rates up to 40–50%, necessitating multiple procedures . Although recurrent PV conduction has been demonstrated to be the main cause of AF recurrence after RFCA, nonetheless, recent studies reported that extra-PV foci firing from the atrial chambers or thoracic veins also play an important role in initiating and maintaining PAF in about 3.2% to 62% of patients depending on the age...
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AF burden is important – fact or fiction?
International Journal of Clinical Practice
2/5/2014 7:00:00 PM
Summary Asymptomatic atrial fibrillation (AF) is common and in view of its prognostic impact (the same as of clinically overt AF) knowledge of the overall AF burden (defined as the amount of time spent in AF) appears to be important, both for scientific and clinical reasons. Data collected on more than 12,000 patients indicate that cardiac implantable electrical devices (CIEDs) are validated tools for measuring AF burden and that AF burden is associated with an increased risk of stroke. A maximum daily AF burden of ≥ 1 h carries important negative prognostic implications and may be a clinically relevant parameter for improving risk stratification for stroke. Decision‐making should primarily consider the context in which asymptomatic, subclinical arrhythmias are detected (i.e. primary...
http://www.medworm.com/rss/comments.php?id=11956717
Renal function, attributes and coagulation treatment in atrial fibrillation (R‐FACT Study): Retrospective, observational, longitudinal cohort study of renal function and antithrombotic treatment patterns in atrial fibrillation patients with documented eGFR in real‐world clinical practices in Germany
International Journal of Clinical Practice
2/5/2014 7:00:00 PM
ConclusionsModerate‐to‐severe renal dysfunction is prevalent (~38%) in German AF patients with documented eGFR managed in actual clinical practices. The risk of stroke, as measured by the CHADS2 score, was associated with decreased renal function. Treatment with anticoagulation therapies decreased with decreasing renal function, despite increasing risk of stroke. Anticoagulation treatments remain suboptimal during the 12‐month follow up in patients with moderate or severe renal impairment. (Source: International Journal of Clinical Practice)
http://www.medworm.com/rss/comments.php?id=11956721
Stroke prevention in atrial fibrillation: An Asian perspective.
Thrombosis and Haemostasis
2/5/2014 7:00:00 PM
Authors: Chiang CE, Wang KL, Lip GY Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. In 2050, it is estimated that there will be 72 million AF patients in Asia, accounting for almost 2.9 million patients suffering from AF-associated stroke. Asian AF patients share similar risk factor profiles as non-Asians, except that more Asians have a history of previous stroke. Clinical challenges are evident in the field of stroke prevention in AF, amongst Asians. Existing stroke and bleeding risk scores have not been well-validated in Asians. Asians are prone to bleeding when treated with warfarin, and the optimal international normalised ratio (INR) for warfarin use is yet to be determined in Asians, though Asian physicians tend to keep it in a lower range (...
http://www.medworm.com/rss/comments.php?id=12672573
Twenty-Year Single-Center Experience With the Medtronic Open Pivot Mechanical Heart Valve.
The Annals of Thoracic Surgery
2/5/2014 7:00:00 PM
CONCLUSIONS: This 20-year experience demonstrated excellent clinical outcomes with no structural valve failure. Odds ratio defined aortic patients as the lowest risk for adverse events. By contrast atrial fibrillation and elderly age, in combination with instable anticoagulation, yielded the worst long-term results. PMID: 24507942 [PubMed - as supplied by publisher] (Source: The Annals of Thoracic Surgery)

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Predictors of complete arrhythmia free survival in patients undergoing surgical ablation for atrial fibrillation. PRAGUE-12 randomized study sub-analysis
International Journal of Cardiology
2/5/2014 7:00:00 PM
We examined the data from the PRAGUE-12 trial and grouped patients according to complete AF-free survival. All patients had regular check-ups at 3, 6, 9months, some of them with Holter recordings, and a final check-up at 12months with Holter recording.Results: One hundred ninety-four patients were analyzed; 104 originally randomized to surgery with adding SA (SA group) and 90 without it (non-SA group). Complete AF-free status was found in 46 patients from the SA group (44.2%) and 25 patients (27.8%) from the non-SA group (p (Source: International Journal of Cardiology)
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Hot Topics: Anticoagulation, Ablation for Afib
MedPage Today Cardiovascular
2/5/2014 11:00:00 AM
(MedPage Today) -- Anticoagulation, rate and rhythm control, and catheter ablation are all effective treatments for patients with nonvalvular atrial fibrillation, according to three leading cardiologists asked to talk about what works and what doesn't in that population. (Source: MedPage Today Cardiovascular)
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The Prevalence of Sinus Rhythm in Patients with “Permanent” Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
2/4/2014 7:00:00 PM
ConclusionsNSR is common in many device patients thought to have permanent AF, suggesting that continuous arrhythmia monitoring could be useful in identifying permanent AF patients who may benefit from renewed rhythm control efforts. Alternatively, some permanent AF patients undergoing atrioventricular nodal ablation may benefit from dual‐chamber devices due to likely periods of NSR. (Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=11993347
Score Associated with the Outcome after Multiple Ablation Procedures in Patients with Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
2/4/2014 7:00:00 PM
ConclusionThe moderate success rate after index procedure of CAAF can be further improved with multiple ones and AAD. (Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=11993350
Different locations but common associations in subcortical hypodensities of presumed vascular origin: cross-sectional study on clinical and neurosonologic correlates
BMC Neurology
2/4/2014 7:00:00 PM
Background: Subcortical hypodensities of presumed vascular etiology (SHPVO) are a clinical, radiological and neuropathological syndrome with a still largely unexplained pathophysiology. Parallel to the clinical heterogeneity, there is also recognised cerebral topographical diversity with undetermined etiological implications. Our aim is to assess clinical and neurosonological predictors of SHPVO according to their location. Methods: Cross sectional analysis of consecutive patients that underwent neurosonologic evaluation and head CT within one month, during a one year period. We excluded patients with absent temporal sonographic window, any pathology with a possible confounding effect on cerebral arterial pulsatility, atrial fibrillation and other etiologies of white matter diseases. The m...

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Cost-Effectiveness of Apixaban Versus Other New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation.
Clinical Therapeutics
2/4/2014 7:00:00 PM
CONCLUSIONS: Although our analysis was limited by the absence of head-to-head trials, based on the indirect comparison data available, our model projects that apixaban may be a cost-effective alternative to dabigatran 150 mg BID, dabigatran 110 mg BID, and rivaroxaban 20 mg once daily for stroke prevention in AF patients from the perspective of the United Kingdom National Health Services. PMID: 24508420 [PubMed - as supplied by publisher] (Source: Clinical Therapeutics)
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Neural network and wavelet average framing percentage energy for atrial fibrillation classification
Computer Methods and Programs in Biomedicine
2/4/2014 7:00:00 PM
Abstract: ECG signals are an important source of information in the diagnosis of atrial conduction pathology. Nevertheless, diagnosis by visual inspection is a difficult task. This work introduces a novel wavelet feature extraction method for atrial fibrillation derived from the average framing percentage energy (AFE) of terminal wavelet packet transform (WPT) sub signals. Probabilistic neural network (PNN) is used for classification. The presented method is shown to be a potentially effective discriminator in an automated diagnostic process. The ECG signals taken from the MIT-BIH database are used to classify different arrhythmias together with normal ECG. Several published methods were investigated for comparison. The best recognition rate selection was obtained for AFE. The classificati...
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The efficacy of glucocorticoids for the prevention of atrial fibrillation, or length of intensive care unite or hospital stay after cardiac surgery:A meta‐analysis
Cardiovascular Therapeutics
2/3/2014 7:00:00 PM
ConclusionsPooled evidence suggests that glucocorticoid prophylaxis may reduce the incidence of POAF. The beneficial effect on POAF is associated with reduced length of ICU and hospital stay, and infection rate.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)
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Leukoaraiosis and ambulatory blood pressure load in a healthy elderly cohort study: The PROOF study
International Journal of Cardiology
2/3/2014 7:00:00 PM
Abstract: Background: Old age and hypertension are consistently reported to be the main risk factors of leukoaraiosis. The association between white matter lesions (WMLs) and other cardiovascular risk factors (CVRF) remains controversial. We evaluated the association between CVRF and WMLs in a cohort study and determined the blood pressure variables that could predict WML severity.Methods: 830 subjects (65+/−1years of age, 60% women) from the PROOF study, with a reliable ABPM and brain MRI, were included. The exclusion criteria included prior myocardial infarction, stroke, heart failure, atrial fibrillation, type 1 diabetes mellitus, and pacing. White matter changes on MRI were defined as hyperintensities >5mm on FLAIR images. We used the total degree of WML (range: 0–30) by adding the...

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Arrhythmias: AF recurrence after cryoablation
Nature Reviews Cardiology
2/3/2014 7:00:00 PM
Nature Reviews Cardiology 11, 127 (2014). doi:10.1038/nrcardio.2014.8 Author: Bryony M. Mearns Little is known about the prognostic significance of the recurrence of atrial fibrillation (AF) early (within the first 3 months) after cryoballoon ablation, or whether reablation of this early recurrence of AF (ERAF) within the first 3 months after the initial procedure is beneficial for (Source: Nature Reviews Cardiology)
http://www.medworm.com/rss/comments.php?id=14126274
Can white blood cell count be used as a predictor of atrial fibrillation following cardiac surgery? A short literature review.
The Anatolian Journal of Cardiology
2/3/2014 7:00:00 PM
Authors: Soleimani A, Kiabi FH, Zeydi AE, Habibi MR PMID: 24566487 [PubMed - as supplied by publisher] (Source: The Anatolian Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=14992196
Simultaneous onset of myocardial infarction and ischemic stroke in a patient with atrial fibrillation: Multiple territory injury revealed on angiography and magnetic resonance
International Journal of Cardiology
2/3/2014 7:00:00 PM
An 84-year-old man with a history of hypertension and paroxysmal atrial fibrillation (AF) who received no anticoagulant drugs experienced acute chest pain and transient loss of consciousness. He was transferred to our emergency room. His initial electrocardiogram showed sinus rhythm with ST-segment elevation in the I, aVL, and V1–V6 leads. His blood pressure was 158/92mmHg and his pulse was regular at 70beats per minute. A chest radiograph showed increased heart size and pulmonary vascular congestion. His troponin T level was elevated (more than 0.1ng/mL). He was diagnosed with ST-elevation myocardial infarction (MI) and we decided to perform percutaneous coronary intervention as a priority, though he also complained of left hemiparesthesia. Emergency coronary angiography (CAG) showed a ...
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An unusual presentation of heparin-induced thrombocytopenia in the setting of catheter-directed ablation of atrial fibrillation
Blood Coagulation and Fibrinolysis
2/3/2014 4:07:13 PM
We describe one such case of rapid-onset, heparin-induced thrombocytopenia with thrombosis that developed in the setting of catheter-directed ablation of atrial fibrillation, several months after a brief exposure to low-molecular-weight heparin. The clinical scenario as well as the risk of progressing to catastrophic complications prompted immediate discontinuation of all heparin products and treatment with a direct thrombin inhibitor, despite a low pretest clinical score. (Source: Blood Coagulation and Fibrinolysis)
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Mean platelet volume, in predicting severity of mitral regurgitation and left atrial appendage thrombosis
Blood Coagulation and Fibrinolysis
2/3/2014 4:07:10 PM
The incidence of thromboembolism is higher in mitral regurgitation. Mean platelet volume (MPV), which is calculated automatically in the complete blood count tests, indicates platelet production, function and activation. Elevated MPV levels in cardiovascular diseases and some heart valve diseases have been shown before. We aimed to investigate the relationship between MPV and mitral regurgitation, and to evaluate the MPV levels according to the presence of atrial fibrillation or left atrial appendage thrombus in patients with mitral regurgitation for the first time. The study included 57 patients who had undergone transthoracic and transesophageal echocardiography for the classic symptoms and diagnosed with primary (organic) mitral regurgitation. The control group was composed of 46 age, s...

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Psoriasis is associated with subsequent atrial fibrillation in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint study
Journal of Hypertension
2/3/2014 2:59:17 PM
Conclusion:Psoriasis has a similar prevalence in hypertensive patients as in the general population. Psoriasis independently predicted new-onset atrial fibrillation despite lower age and electrocardiographic LVH in psoriasis patients than in patients without psoriasis. (Source: Journal of Hypertension)
http://www.medworm.com/rss/comments.php?id=11820743
Hypertension, inflammation and atrial fibrillation
Journal of Hypertension
2/3/2014 2:59:11 PM
No abstract available (Source: Journal of Hypertension)
http://www.medworm.com/rss/comments.php?id=11820722
A National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation.
Circulation
2/2/2014 7:00:00 PM
CONCLUSIONS: This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States. PMID: 24493817 [PubMed - as supplied by publisher] (Source: Circulation)
http://www.medworm.com/rss/comments.php?id=12578145
Infiltrated atrial fat characterizes underlying atrial fibrillation substrate in patients at risk as defined by the ARIC atrial fibrillation risk score
International Journal of Cardiology
2/2/2014 7:00:00 PM
Abstract: Background: It is known that expanded epicardial fat is associated with atrial fibrillation (AF). However, infiltrated intraatrial fat has not been previously quantified in individuals at risk as determined by the ARIC AF risk score.Methods: Patients in sinus rhythm (N=90, age 57±10years; 55 men [63.2%]), in 3 groups at risk of AF as determined by the ARIC AF risk score [low (≤11 points; n=15), moderate (12–18 points; n=40), high (≥19 points; n=23) risk of AF], and paroxysmal AF (n=12) underwent cardiac magnetic resonance study. Intraatrial and epicardial fat was analyzed with a Dark-blood DIR-prepared Fat-Water-separated sequence in the horizontal longitudinal axis. OsiriX DICOM viewer (Geneva, Switzerland) was used to quantify the intraatrial fat area. Width of the cepha...
http://www.medworm.com/rss/comments.php?id=13616871
Autophagy: A potential novel mechanistic contributor to atrial fibrillation
International Journal of Cardiology
2/2/2014 7:00:00 PM
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with pronounced morbidity and mortality . Accumulating studies have revealed that atrial remodeling (including electric, structural and autonomic remodeling) is critical to most acquired forms of AF. Among them, atrial fibrosis and apoptosis have been demonstrated playing important roles in AF-promoting pathologies . Autophagy, type II programmed cell death, is an intracellular lysosomal degradative process that is essential for survival, differentiation, development, and homeostasis . It was found that AMP-induced protein kinase (AMPK) and beclin-1 dependent pathways play distinct roles in the process of autophagy . Recently, more attention has been paid to the crucial role of autophagy in heart diseases ....

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Amiodarone toxicity showing high liver density on CT scan with normal liver function and plasma amiodarone levels in a long-term amiodarone user
International Journal of Cardiology
2/2/2014 7:00:00 PM
Amiodarone is a class III anti-arrhythmic drug, and it is frequently used as a medical agent to treat atrial fibrillation and supra ventricular tachycardia. However, because amiodarone can cause side effects including pulmonary fibrosis, peripheral neuropathy, tremor, corneal microdeposits, and toxic hepatitis, its application is limited . Abnormal liver function test (LFT) results are commonly observed in cases of amiodarone toxicity, although it is also common to see patients showing no symptoms even if hepatotoxicity is present. The North American Society of Pacing and Electrophysiology recommends the performance of periodic follow-up LFT every 6months to monitor amiodarone toxicity in patients with chronic use . (Source: International Journal of Cardiology)
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Atrial fibrillation in essential hypertension: an issue of concern
Journal of Cardiovascular Medicine
2/1/2014 1:00:00 AM
This article reviews many aspects of atrial fibrillatio in essential hypertension patients to provide the foundation of atrial fibrillatio treatment. (Source: Journal of Cardiovascular Medicine)
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Erratum
The Journal for Nurse Practitioners
1/31/2014 7:00:00 PM
The article “Contemporary Management of Atrial Fibrillation,” written by Leslie L. Davis, Guest Editor of the November/December 2013 issue, contained an error. On page 645, this sentence should have read, “Likewise, patients who are on a newer antithrombotic agent (dabigatran [Pradaxa®], rivaroxaban [Xarelto®], and apixaban [Eliquis®]) should also start taking these medications for at least 30 days before the attempt to restore sinus rhythm by chemical or DCCV.” (Source: The Journal for Nurse Practitioners)
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Multi-Part Modeling and Segmentation of Left Atrium in C-Arm CT for Image-Guided Ablation of Atrial Fibrillation
IEE Transactions on Medical Imaging
1/31/2014 7:00:00 PM
As a minimally invasive surgery to treat atrial fibrillation (AF), catheter based ablation uses high radio-frequency energy to eliminate potential sources of abnormal electrical events, especially around the ostia of pulmonary veins (PV). Fusing a patient-specific left atrium (LA) model (including LA chamber, appendage, and PVs) with electro-anatomical maps or overlaying the model onto 2-D real-time fluoroscopic images provides valuable visual guidance during the intervention. In this work, we present a fully automatic LA segmentation system on nongated C-arm computed tomography (C-arm CT) data, where thin boundaries between the LA and surrounding tissues are often blurred due to the cardiac motion artifacts. To avoid segmentation leakage, the shape prior should be exploited to guide the s...
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[Efficacy and safety of apixaban compared with warfarin regarding time within the therapeutic range].
Orvosi Hetilap
1/31/2014 7:00:00 PM
Authors: Havasi K Abstract Prevention of thromboembolism by lifelong anticoagulation is an important therapeutic goal in patients with atrial fibrillation according to recent guidelines. Major drawback of vitamin K antagonists are their narrow therapeutic range and interactions with other drugs and food. These have significant impact on the pharmacokinetics and pharmacodynamics requiring regular measurements of the international normalized ratio. Efficiency of the anticoagulant therapy depends considerably on time within the therapeutic range of prothrombin international normalized ratio. Time within the therapeutic range represents the percentage of time within the required range of prothrombin international normalized ratio. Prothrombin international normalized ratio outside the ...
http://www.medworm.com/rss/comments.php?id=11803668
Conversion of atrial fibrillation after levothyroxine in a dog with hypothyroidism and arterial thromboembolism
The Journal of Small Animal Practice
1/31/2014 7:00:00 PM
A six‐year‐old female spayed mixed‐breed dog was referred following a 3‐week history of lameness and progressive neurological deficits in both hindlimbs, and a 1‐week history of a cardiac arrhythmia. The dog was diagnosed with hypothyroidism, atrial fibrillation, myocardial dysfunction and arterial thromboembolism. Cardioversion occurred after 2 weeks of levothyroxine supplementation, with improved systolic function over time. To the authors’ knowledge, this is the first case reported in the veterinary or human literature documenting hypothyroidism with persistent atrial fibrillation being converted to sinus rhythm with levothyroxine as sole therapy. (Source: The Journal of Small Animal Practice)
http://www.medworm.com/rss/comments.php?id=13087955
Influence of Sex on Risk of Bleeding in Anticoagulated Patients: A Systematic Review and Meta‐analysis
Journal of Thrombosis and Haemostasis
1/31/2014 7:00:00 PM
ConclusionsThe risk of major bleeding on anticoagulation appears to be the same in men and women, particularly if patients have atrial fibrillation. This finding is less certain for patients with VTE, in whom the risk of bleeding may be marginally lower in men compared to women.This article is protected by copyright. All rights reserved. (Source: Journal of Thrombosis and Haemostasis)
http://www.medworm.com/rss/comments.php?id=14051864
Effect of catheter radiofrequency ablation on C-reactive protein, brain natriuretic peptide and echocardiograph in patients with persistent and permanent atrial fibrillation.
Chinese Medical Journal
1/31/2014 7:00:00 PM
CONCLUSIONS: Conversion of AF to sinus rhythm by RFCA, has been shown to reduce LA size and improve LVEF. It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure. PMID: 24534211 [PubMed - in process] (Source: Chinese Medical Journal)
http://www.medworm.com/rss/comments.php?id=14368404
Long‐term Changes in Heart Rate Variability after Radiofrequency Catheter Ablation for Atrial Fibrillation: One‐year Follow‐up Study with Irrigation Tip Catheter
Journal of Cardiovascular Electrophysiology
1/31/2014 7:00:00 PM
ConclusionIn contrast to previous reports about long‐term HRV recovery after AF ablation with a conventional catheter, change in cardiac autonomic nervous activity was maintained for 1 year after RFCA when an OITC was used. A reduction in ΔLF/HF ≥0.26 at HRV3mo was independently associated with clinical recurrence of AF after RFCA.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
http://www.medworm.com/rss/comments.php?id=15133289
Prolonged Atrial Fibrillation Precipitated by New-Onset Seizures and Marijuana Abuse
PEDIATRICS
1/30/2014 7:00:00 PM
We report a case of prolonged atrial fibrillation (AF) precipitated by new-onset generalized tonic–clonic convulsions and marijuana abuse in a developmentally normal 18-year-old adolescent with a structurally normal heart. Our case highlights an interesting association and a unique pathophysiology between generalized tonic–clonic convulsions, marijuana abuse, and AF. We suggest that seizures and marijuana abuse should be considered in the differential diagnosis of the etiology of AF in children. (Source: PEDIATRICS)

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[Recurrent atrial fibrillation after pulmonary vein isolation : Myocardial extracellular volume as prognosis marker.]
Der Radiologe
1/30/2014 7:00:00 PM
Authors: Avanesov M, Karul M PMID: 24477839 [PubMed - as supplied by publisher] (Source: Der Radiologe)
http://www.medworm.com/rss/comments.php?id=11959988
Editorial: atrial fibrillation after coronary surgery: the need for an effective pharmacological prophylaxis.
Current Vascular Pharmacology
1/30/2014 7:00:00 PM
Authors: Mariscalco G, Banach M PMID: 24484466 [PubMed - in process] (Source: Current Vascular Pharmacology)
http://www.medworm.com/rss/comments.php?id=12667863
Left ventricular synchronization and systolic function estimated by speckle tracking echocardiography pre-and post-radiofrequency ablation in patients with atrial fibrillation
International Journal of Cardiology
1/30/2014 7:00:00 PM
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and its frequency is increasing along with advancing age. Subjects suffering from AF have significantly increased mortality and morbidity . Radiofrequency catheter ablation has been demonstrated effectively restoring sinus rhythm and providing long-term relief of symptoms. In addition, the restoration of sinus rhythm may result in an improvement in left ventricular (LV) systolic function in patients with systolic heart failure . However, studies have failed to demonstrate a change in LV ejection fraction (LVEF) after catheter ablation in patients with preserved systolic function . It is likely that the effect of ablation on LV systolic function cannot be detected by LV ejection fraction. Two-dimensional speckle tra...
http://www.medworm.com/rss/comments.php?id=13616874
Novel Anticoagulants vs Warfarin: Latest AnalysesNovel Anticoagulants vs Warfarin: Latest Analyses
Medscape Pharmacist Headlines
1/30/2014 12:17:54 PM
For patients with atrial fibrillation, 4 novel anticoagulants appear to be slightly more effective and safer than warfarin for preventing ischemic stroke. Medscape Neurology (Source: Medscape Pharmacist Headlines)
http://www.medworm.com/rss/comments.php?id=11655962
Inefficacy of a Highly Selective T‐Type Calcium Channel Blocker in Preventing Atrial Fibrillation Related Remodeling
Journal of Cardiovascular Electrophysiology
1/29/2014 7:00:00 PM
ConclusionsICaT blockade with the highly selective compound AZ9112 failed to prevent rate‐related atrial remodeling. Thus, prevention of atrial electrophysiological remodeling by mibefradil cannot be attributed exclusively to ICaT blockade. These results indicate that ICaT inhibition is not likely to be a useful approach for AF therapy. (Source: Journal of Cardiovascular Electrophysiology)

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One‐Year Outcome of Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting: An Analysis of the AFCAS Registry
Clinical Cardiology
1/29/2014 7:00:00 PM
ConclusionsIn this large, real‐world population of AF patients undergoing PCI‐S, TT was the antithrombotic regimen most frequently prescribed. Although several limitations need to be acknowledged, in our study the 1‐year efficacy and safety of TT, dual antiplatelet therapy, and VKA plus clopidogrel was comparable. (Source: Clinical Cardiology)
http://www.medworm.com/rss/comments.php?id=11648972
Direct vitamin k antagonist anticoagulant treatment health care costs in patients with non-valvular atrial fibrillation
BMC Health Services Research
1/29/2014 7:00:00 PM
Conclusions: Most direct health care costs associated with the sampled patients arise from the specialist-care monitoring required for the treatment. Good monitoring is inversely related to direct health care costs. (Source: BMC Health Services Research)
http://www.medworm.com/rss/comments.php?id=11664913
Patient's values and preferences for stroke prevention in atrial fibrillation: balancing stroke and bleeding risk with oral anticoagulation.
Thrombosis and Haemostasis
1/29/2014 7:00:00 PM
Authors: Lane DA, Lip GY PMID: 24477628 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
http://www.medworm.com/rss/comments.php?id=11730946
Lactam sulfonamides as potent inhibitors of the Kv1.5 potassium ion channel.
Bioorganic and Medicinal Chemistry Letters
1/29/2014 7:00:00 PM
Authors: Olsson RI, Jacobson I, Iliefski T, Boström J, Davidsson O, Fjellström O, Björe A, Olsson C, Sundell J, Gran U, Gyll J, Malmberg J, Hidestål O, Emtenäs H, Svensson T, Yuan ZQ, Strandlund G, Strand A, Lindhardt E, Linhardt G, Forsström E, Högberg G, Persson F, Andersson B, Rönnborg A, Löfberg B Abstract A series of lactam sulfonamides has been discovered and optimized as inhibitors of the Kv1.5 potassium ion channel for treatment of atrial fibrillation. In vitro structure-activity relationships from lead structure C to optimized structure 3y are described. Compound 3y was evaluated in a rabbit PD-model and was found to selectively prolong the atrial effective refractory period at submicromolar concentrations. PMID: 24513046 [PubMed - as supplied by publisher] (S...

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[Masquerading bundle branch block].
Kardiologia Polska
1/29/2014 9:30:02 AM
Authors: Kukla P, Baranchuk A, Jastrzębski M, Bryniarski L Abstract We here describe a surface 12-lead electrocardiogram (ECG) of a 72-year-old female with a prior history of breast cancer and chemotherapy-induced cardiomyopathy. An echocardiogram revealed left ventricular dysfunction, ejection fraction of 23%, with mild enlarged left ventricle. The 12-lead ECG showed atrial fibrillation with a mean heart rate of about 100 bpm, QRS duration 160 ms, QT interval 400 ms, right bundle branch block (RBBB) and left anterior fascicular block (LAFB). The combination of RBBB features in the precordial leads and LAFB features in the limb leads is known as ''masquerading bundlebranch block''. In most cases of RBBB and LAFB, the QRS axis deviation is located between - 80 to -120 degrees. Rare...
http://www.medworm.com/rss/comments.php?id=11631174
Aspirin still overprescribed for stroke prevention in AF
ESC News and Press
1/29/2014 5:05:41 AM
Data from the EORP Atrial Fibrillation General Pilot Registry of more than 3 100 patients in nine countries provides the most up-to-date picture of European cardiologists’ prescribing of antithrombotic treatment, which includes oral anticoagulation therapy (warfarin and the novel oral anticoagulants) and antiplatelet drugs (mainly aspirin). Topics: Atrial Fibrillation (Source: ESC News and Press)
http://www.medworm.com/rss/comments.php?id=11651684
Dronedarone: an alternate choice to sotalol and amiodarone in the treatment of atrial fibrillation/flutter in patients who have coronary heart disease
Europace
1/28/2014 7:00:00 PM
(Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647819
Risk assessment in atrial fibrillation: not all factors are created equal
Europace
1/28/2014 7:00:00 PM
(Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647820
Pharmacological cardioversion of atrial fibrillation with vernakalant: evidence in support of the ESC Guidelines
Europace
1/28/2014 7:00:00 PM
Pharmacological rhythm control (often including electrical or pharmacological cardioversion) is an integral part of therapy for atrial fibrillation (AF) worldwide. Antiarrhythmic drug strategies would be preferred in many patients provided effective and safe antiarrhythmic agents are available. Also, pharmacological cardioversion could be the preferred option if the limitations of currently available drugs, such as restriction to patients without structural heart disease (flecainide and propafenone), risk of torsade de pointes (ibutilide), and slow onset of action (amiodarone), were overcome. The intravenous formulation of vernakalant (Brinavess, Cardiome) has been approved for pharmacological cardioversion of recent-onset AF (≤7 days) and early (≤3 days) post-operative AF in the Eur...

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Effect of dronedarone on clinical end points in patients with atrial fibrillation and coronary heart disease: insights from the ATHENA trial
Europace
1/28/2014 7:00:00 PM
Conclusion In this post hoc analysis, dronedarone on top of standard care in AF patients with CHD reduced cardiovascular hospitalization or death similar to that in the overall ATHENA population, and reduced a first acute coronary syndrome. Importantly, the safety profile in this subpopulation was also similar to that of the overall ATHENA population, with no excess in proarrhythmias. The mechanism of the cardiovascular protective effects is unclear and warrants further investigation. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647823
Reduced forced expiratory volume is associated with increased incidence of atrial fibrillation: the Malmo Preventive Project
Europace
1/28/2014 7:00:00 PM
Conclusion Impaired lung function is an independent predictor of AF. This may explain some risk of AF that is currently unaccounted for. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647824
Improvement of cerebral oxygen saturation after successful electrical cardioversion of atrial fibrillation
Europace
1/28/2014 7:00:00 PM
Conclusion Cerebral tissue oxygen saturation increases significantly after restoration of sinus rhythm. Near-infrared spectroscopy monitoring can identify changes of SctO2 after successful CV of AF independent from standard monitoring parameters (MAP, SaO2). Near-infrared spectroscopy can be used to detect cerebral oxygen saturation deficits in AF patients or patients at high risk for AF. Clinical applications may include monitoring during ablation procedures and in critical care. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647825
Comparison of CHADS2 and CHA2DS2-VASC anticoagulation recommendations: evaluation in a cohort of atrial fibrillation ablation patients
Europace
1/28/2014 7:00:00 PM
Conclusion Compared with the CHADS2 score, in our AF ablation population, the CHA2DS2-VASC score markedly increases the number of AF patients for whom OAC is recommended. It will be important to determine by randomized trials if this major paradigm shift to greater use of OAC using the CHA2DS2-VASC scoring improves patient outcomes. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647826
CHADS2 and CHA2DS2-VASc scores as predictors of left atrial ablation outcomes for paroxysmal atrial fibrillation
Europace
1/28/2014 7:00:00 PM
Conclusions CHA2DS2-VASc score is an independent predictor of left atrial ablation outcomes for paroxysmal AF, with a similar predictive value to CHADS2. However, the predictive accuracy of both is mediocre. (Source: Europace)

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The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up
Europace
1/28/2014 7:00:00 PM
Conclusion Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647829
Does atrial pacing lead to atrial fibrillation in patients with sick sinus syndrome? Insights from the DANPACE trial
Europace
1/28/2014 7:00:00 PM
Conclusion Atrial fibrillation is very common among patients with SSS. No association between %AP and development of AF was found in patients with SSS. Future trials may randomize patients to different levels of AP exposure. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647835
Treatment of obstructive sleep apnoea improves metabolic conditions and prevents initiation of antiarrhythmic therapy in a patient with atrial fibrillation
Europace
1/28/2014 7:00:00 PM
(Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647836
Management of acute coronary syndrome in patients with non-valvular atrial fibrillation: results of the European Heart Rhythm Association Survey
Europace
1/28/2014 7:00:00 PM
Management of patients with non-valvular atrial fibrillation (AF) presenting with an acute coronary syndrome (ACS) may be particularly challenging. Given the lack of sound evidence-based recommendations for the management of such patients, the aim of this European Heart Rhythm Association survey was to provide an insight into current practice in Europe regarding management of these patients. Overall, 41 centres submitted a valid response. The majority of respondents were university hospitals (85%). The survey has shown that the principal aspects of the European Society of Cardiology guidelines on the management of AF, and those on ACS, have been adopted. The survey highlights two important areas of uncertainty regarding the optimal composition and duration of antithrombotic therapy with mu...

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Atrial tachycardia after cryoballoon ablation of paroxysmal atrial fibrillation
Europace
1/28/2014 7:00:00 PM
(Source: Europace)
http://www.medworm.com/rss/comments.php?id=11647852
Oxidative Status, Inflammation, and Postoperative Atrial Fibrillation With Metoprolol vs Carvedilol or Carvedilol Plus N‐Acetyl Cysteine Treatment
Clinical Cardiology
1/28/2014 7:00:00 PM
ConclusionsCarvedilol plus NAC reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with carvedilol. Postoperative TAC, TOS, and WBC were associated with POAF. (Source: Clinical Cardiology)
http://www.medworm.com/rss/comments.php?id=11648975
Problems Persist Despite Gains In Oral Anticoagulant Use
Forbes.com Healthcare News
1/28/2014 2:36:00 PM
Although significant progress has been made in recent years, a new survey from the European Society of Cardiology finds that there are still too many atrial fibrillation patients who are not taking the best medications to reduce their elevated risk of stroke. Many elderly patients are not receiving oral anticoagulants-- either traditional warfarin or one of the newer anticoagulants (Pradaxa, Boehringer Ingelheim, Xarelto, Johnson & Johnson; and Eliquis (Pfizer and BristolMyers Squibb)-- and overall too many patients are still taking aspirin, despite the fact that it is not recommended for this group of patients. (Source: Forbes.com Healthcare News)
http://www.medworm.com/rss/comments.php?id=11507908
St. Jude Medical Announces Organizational and Executive Leadership Changes
HSMN NewsFeed
1/28/2014 9:42:33 AM
ST. PAUL, Minn.--(Healthcare Sales & Marketing Network)--St. Jude Medical, Inc. (STJ), a global medical device company, today announced organizational and leadership changes designed to improve growth. The company will integrate its two operating divisions... Devices, Cardiology, PersonnelSt. Jude Medical, cardiac rhythm management, atrial fibrillation (Source: HSMN NewsFeed)
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Should Anterior Mitral Block Be Preferred in Persistent Atrial Fibrillation Patients Requiring Nonpulmonary Substrate Ablation?
Pacing and Clinical Electrophysiology : PACE
1/28/2014
(Source: Pacing and Clinical Electrophysiology : PACE)

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Risk Stratification of Nonvalvular Atrial Fibrillation: The Possible Role of Blood Cells
Clinical and Applied Thrombosis/Hemostasis
1/28/2014
(Source: Clinical and Applied Thrombosis/Hemostasis)
http://www.medworm.com/rss/comments.php?id=11489798
Warfarin therapy for atrial fibrillation in general practice - is bleeding risk underestimated?
Tidsskrift for den Norske Laegeforening
1/27/2014 7:00:00 PM
Authors: Bratland B, Hornnes MB Abstract BACKGROUND Atrial fibrillation causes a five-fold increase in the risk of thromboembolic stroke. Warfarin therapy reduces the risk by 64 %, but increases the risk of serious bleeding. We aimed to investigate the quality of warfarin therapy in a general practice and determine which patients would be likely to benefit from the treatment.MATERIAL AND METHOD We carried out retrospective registration of patients with atrial fibrillation, and calculated the risk of thromboembolism (CHA2DS2-VASc score) and of bleeding (HAS-BLED score) for each patient. Two alternative methods were used for calculating the absolute risk of bleeding: one based on the Euro Heart Survey on Atrial Fibrillation (EHS) and the other on SPORTIF. The expected net clinical b...
http://www.medworm.com/rss/comments.php?id=11804079
Anticoagulation therapy: Rivaroxaban is a safe and feasible alternative to warfarin in AF ablation
Nature Reviews Cardiology
1/27/2014 7:00:00 PM
Nature Reviews Cardiology 11, 127 (2014). doi:10.1038/nrcardio.2014.3 Author: Alexandra Roberts Novel oral anticoagulants, such as rivaroxaban, are increasingly being used instead of warfarin for stroke prevention in patients with atrial fibrillation (AF). In addition, radiofrequency catheter ablation for AF that is nonresponsive to antiarrhythmic drug therapy is becoming an ever more common procedure. Thelack of (Source: Nature Reviews Cardiology)
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The Effect of Dabigatran Plasma Concentrations and Patient Characteristics on the Frequency of Ischemic Stroke and Major Bleeding in Atrial Fibrillation Patients The RE-LY Trial (Randomized Evaluation of Long-Term Anticoagulation Therapy)
Journal of the American College of Cardiology: Cardiovascular Imaging
1/27/2014 5:15:51 PM
ConclusionsIschemic stroke and bleeding outcomes were correlated with dabigatran plasma concentrations. Age was the most important covariate. Individual benefit–risk might be improved by tailoring dabigatran dose after considering selected patient characteristics. (Randomized Evaluation of Long Term Anticoagulant Therapy [RE-LY] With Dabigatran Etexilate; NCT00262600) (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)
http://www.medworm.com/rss/comments.php?id=11255386
Left Atrial Appendage Occlusion Opportunities and Challenges
Journal of the American College of Cardiology: Cardiovascular Imaging
1/27/2014 5:15:50 PM
Stroke prevention in patients with atrial fibrillation is a growing clinical dilemma as the incidence of the arrhythmia increases and risk profiles worsen. Strategies in patients with nonvalvular atrial fibrillation have included anticoagulation with a variety of drugs. Knowledge that stroke in this setting typically results from thrombus in the left atrial appendage has led to the development of mechanical approaches, both catheter-based and surgical, to occlude that structure. Such a device, if it were safe and effective, might avoid the need for anticoagulation and prevent stroke in the large number of patients who are currently not treated with anticoagulants. Regulatory approval has been difficult due to trial design challenges, balance of the risk-benefit ratio, specific patient popu...

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Connective Tissue Growth Factor: A Predictor of Recurrence after Catheter Ablation in Patients with Nonparoxysmal Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
1/27/2014
ConclusionOur finding indicates that “baseline serum CTGF level” is an independent predictor for recurrence in patients with nonparoxysmal AF following catheter ablation. Two‐month postablation elevation in CTGF has no association with recurrence. (Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=11306174
Antiplatelet Therapy for Stable Coronary Artery Disease in Atrial Fibrillation Patients on Oral Anticoagulant: A Nationwide Cohort Study.
Circulation
1/27/2014
CONCLUSIONS: In AF patients with stable CAD, adding antiplatelet therapy on top of VKA is not associated with a reduction in risk of recurrent coronary events or thromboembolism, while risk of bleeding is significantly increased. The common practice of adding antiplatelet therapy to oral VKA anticoagulation in patients with AF and stable CAD warrants reassessment. PMID: 24470482 [PubMed - as supplied by publisher] (Source: Circulation)
http://www.medworm.com/rss/comments.php?id=11629451
Awareness of the Role of Atrial Fibrillation as a Cause of Ischemic Stroke [Stroke History]
Stroke
1/26/2014 7:00:00 PM
(Source: Stroke)
http://www.medworm.com/rss/comments.php?id=11804589
To Monitor or to Not Monitor for Paroxysmal Atrial Fibrillation After Transient Ischemic Attack or Stroke: This Is the Question [Editorials]
Stroke
1/26/2014 7:00:00 PM
(Source: Stroke)

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Comparison of Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation [Clinical Sciences]
Stroke
1/26/2014 7:00:00 PM
Conclusions— A direct comparison of 9 risk schemes reveals no profound differences in risk stratification accuracy for high-risk patients. Accurate prediction of low-risk patients is perhaps more valuable in determining those unlikely to benefit from oral anticoagulation therapy. Among our cohort, CHA2DS2-VASc performed best in this purpose. (Source: Stroke)
http://www.medworm.com/rss/comments.php?id=11804671
Detection of Atrial Fibrillation After Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis [Clinical Sciences]
Stroke
1/26/2014 7:00:00 PM
Conclusions— Detection of AF was highly variable, and the review was limited by small sample sizes and marked heterogeneity. Further studies are required to inform patient selection, optimal timing, methods, and duration of monitoring for detection of AF/paroxysmal AF. (Source: Stroke)
http://www.medworm.com/rss/comments.php?id=11804738
Successful management of a twice complicated case by implantation of three CoreValve prostheses
International Journal of Cardiology
1/26/2014 7:00:00 PM
An 80year old man, diabetic on oral medication and with permanent atrial fibrillation with a single chamber pacemaker, was referred to our hospital for severe symptomatic aortic valve stenosis. His trans-thoracic echocardiography confirmed severe aortic stenosis with a mean/peak gradient of 45/85mmHg, an estimated aortic valve area of 0.7cm2 and good systolic function with an ejection fraction of 50%. His past medical history was remarkable for a minor stroke without neurological impairment and moderate kidney dysfunction with creatinine of 2.3mg/dL. A cardiac catheterization revealed no obstructive coronary heart disease. (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=13616888
Effect of sinus rhythm restoration on platelet function in patients with lone atrial fibrillation
International Journal of Cardiology
1/26/2014 7:00:00 PM
Atrial fibrillation (AF) is associated with increased risk of thromboembolic complications. The aim of the study was to assess if arrhythmia, independent of other risk factors leads to increased platelet activation. (Source: International Journal of Cardiology)

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http://www.medworm.com/rss/comments.php?id=13616921
Screening for atrial fibrillation in patients with obstructive sleep apnoea to reduce ischaemic strokes
International Journal of Cardiology
1/26/2014 7:00:00 PM
Abstract: Obstructive sleep apnoea is an independent risk factor for stroke. A number of different mechanisms have been identified which link OSA and stroke including hypertension and oxidative stress. Atrial fibrillation (AF) is likely to play a role in the development of stroke in patients with OSA. Indeed, patients with OSA have a higher incidence of AF than the general population. Given the higher constellation of cardiovascular co-morbidities seen in patients with OSA, we believe that a strategy of actively screening for the presence of AF in patients with OSA and initiating oral anticoagulation therapy when appropriate may reduce the burden of stroke in this population. This is a question that needs to be addressed in a clinical trial. (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=15805616
Prevalence and prognostic implications of different types of atrial fibrillation in patients admitted to a coronary care unit
International Journal of Cardiology
1/26/2014 7:00:00 PM
The objective of the present study was to investigate the prevalence of AF, its prognostic implications in terms of the development of new ischemic stroke, and the all-cause mortality associated with different types of AF in a non-surgical CCU. (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=15806142
The quality of oral anticoagulation in general practice in patients with atrial fibrillation.
European Journal of Internal Medicine
1/25/2014 7:00:00 PM
CONCLUSIONS: For 525 OAC patients (66.8%; patients with at least 2 prospectively documented INR values) the average TTR (target range of 2.0-3.0) was 67.6%. About 34.7% of the patients had a TTR <60%. None of the variables representing characteristics of the medical practices were capable of explaining the occurrence of poor OAC quality. However, with regard to care provision-based variables, the existence of a brief discontinuation of medication was important. As the existence of adherence barriers increased, the probability of poor anticoagulation quality increased. In conclusion, the provision of OAC in the German health care system is to be regarded as good, but far from ideal. Our causal analysis shows that patient-based factors should be addressed through the provision of improved...
http://www.medworm.com/rss/comments.php?id=12067491
Atrial fibrillation alters the microRNA expression profiles of the left atria of patients with mitral stenosis
BioMed Central
1/24/2014 11:10:23 PM
Conclusions: AF alters the miRNA expression profiles of the left atria of MS patients. These findings may be useful for the biological understanding of AF in MS patients. (Source: BioMed Central)
http://www.medworm.com/rss/comments.php?id=10645154
PITX2C loss-of-function mutations responsible for idiopathic atrial fibrillation
Clinics
1/24/2014 2:01:25 PM
CONCLUSION: The findings of this study associate PITX2c loss-of-function mutations with atrial fibrillation, supporting the hypothesis that dysfunctional PITX2c confers enhanced susceptibility to atrial fibrillation and suggesting potential implications for early prophylaxis and allele-specific therapy for this common arrhythmia. (Source: Clinics)

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Variations in Etiology and Management of Atrial Fibrillation in a Prospective Registry of 15,400 Emergency Department Patients in 46 Countries: The RE-LY AF Registry.
Circulation
1/24/2014
CONCLUSIONS: There is a large global variation in age, risk factors, concomitant diseases and treatment of AF between regions. Improving outcomes globally requires an understanding of this variation and the conduct of research focused on AF associated with different underlying conditions and treatment of AF and predisposing conditions in different socioeconomic settings. PMID: 24463370 [PubMed - as supplied by publisher] (Source: Circulation)
http://www.medworm.com/rss/comments.php?id=11629507
Dominant Frequency Increase Rate Predicts Transition from Paroxysmal to Long-Term Persistent Atrial Fibrillation.
Circulation
1/24/2014
CONCLUSIONS: In the sheep model of LS-PAF, the rate of DF increase predicts the time at which AF stabilizes and becomes persistent, reflecting changes in APD and densities of sodium, L-type calcium and inward rectifier currents. PMID: 24463369 [PubMed - as supplied by publisher] (Source: Circulation)
http://www.medworm.com/rss/comments.php?id=11629515
Prolonged atrial fibrillation precipitated by new-onset seizures and marijuana abuse - Singh D, Huntwork M, Shetty V, Sequeira G, Akingbola O.
SafetyLit: All (Unduplicated)
1/23/2014 12:35:18 PM
We report a case of prolonged atrial fibrillation (AF) precipitated by new-onset generalized tonic-clonic convulsions and marijuana abuse in a developmentally normal 18-year-old adolescent with a structurally normal heart. Our case highlights an interestin... (Source: SafetyLit: All (Unduplicated))
http://www.medworm.com/rss/comments.php?id=10333990
Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis
Heart
1/23/2014
Conclusions In the specific setting of AF catheter ablation, this first pooled analysis suggests that patients treated with dabigatran have a similar incidence of thromboembolic events and major bleeding compared to warfarin, with low event rates overall. (Source: Heart)

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Dabigatran in the setting of catheter ablation of atrial fibrillation: the road ahead
Heart
1/23/2014
The Authors' reply We have read with interest the comments by Bin Abdulhak and colleagues1 to our recently published article.2 We share the same opinion concerning the use of dabigatran in this setting. Thus, in our article we have proposed the same posology in face of the similar findings: despite the lack of conclusive evidence in support of any particular dabigatran dosage or timing for interrupting or restarting drug therapy, like Bin Abdulhak and colleagues,1 we also suggested skipping one or two doses of dabigatran before the procedure (or maybe more if renal function was compromised) and restarting the drug 3–4 h after assuring haemostasis.2 However, we admit that the ideal drug regimen is still an unsolved matter, since the role of uninterrupted dabigatran may yet need f...
http://www.medworm.com/rss/comments.php?id=10286504
Pacing or Ablation: Which Is Better for Paroxysmal Atrial Fibrillation‐Related Tachycardia‐Bradycardia Syndrome?
Pacing and Clinical Electrophysiology : PACE
1/23/2014
ConclusionsIn patients with paroxysmal AF‐related tachycardia‐bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation. (Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=10373518
New oral anticoagulant agents - general features and outcomes in subsets of patients.
Thrombosis and Haemostasis
1/23/2014
Authors: Schulman S Abstract During the past four years the phase III trials on stroke prophylaxis in atrial fibrillation and in treatment of venous thromboembolism have been completed for four new oral anticoagulants - dabigatran, apixaban, edoxaban and rivaroxaban. The studies have revealed advantages in terms of a reduced risk of bleeding, most importantly of intracranial bleeding. These anticoagulants also have favourable pharmacokinetics, eliminating the need for routine laboratory monitoring and dose adjustments. There are, however, some differences between the drugs in certain subsets of patients, according to patient characteristics or to indication for treatment. These features are reviewed here. The management of patients in association with invasive procedures or major b...

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Composite risk scores and composite endpoints in the risk prediction of outcomes in anticoagulated patients with atrial fibrillation. The Loire Valley Atrial Fibrillation Project.
Thrombosis and Haemostasis
1/23/2014
In conclusion, composite risk scores did not significantly improve risk prediction of endpoints in patients with NVAF, regardless of how endpoints were defined. This would support individualised prediction of IS/TE and bleeding separately using different separate risk prediction tools, and not the use of composite scores or endpoints for everyday 'real world' clinical practice, to guide decisions on thromboprophylaxis. PMID: 24452108 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
http://www.medworm.com/rss/comments.php?id=10705325
Non-standard dose dronedarone in treating atrial fibrillation patients
International Journal of Cardiology
1/22/2014 7:00:00 PM
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia requiring medical care . Dronedarone is derived from amiodarone, but has different electrophysiological effects . Dronedarone has been approved to treat paroxysmal or persistent AF, which is associated with a reduction of AF-related hospitalization, stroke or mortality . However, dronedarone should be avoided in patients with decompensated heart failure or permanent AF due to an increased mortality . (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=13616997
The CHA2DS2-VASc score predicts 320-slice CT-based coronary artery plaques and >50% stenosis in subjects with chronic and paroxysmal atrial fibrillation
International Journal of Cardiology
1/22/2014 7:00:00 PM
The CHADS2 score is a simple score to evaluate the risk of occurrence of cerebral infarction in subjects with atrial fibrillation (AF) that includes the variables of age (≥75yrs), hypertension, diabetes mellitus, previous stroke, and heart failure. Furthermore the CHA2DS2-VASc score is a more detailed assessment scheme than the CHADS2 score to further stratify the risk of occurrence of cerebral infarction in subjects with AF considering the following factors; female sex, presence of vascular disease, and age (≥65yrs) as stroke risk factors. Since both CHADS2 score and CHA2DS2-VASc score include coronary risk factors, there may be a relationship between these scores and coronary arteriosclerosis . (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=13617004
Patent foramen ovale, transient ischemic attack and Kounis syndrome
International Journal of Cardiology
1/22/2014 7:00:00 PM
In their important meta-analysis of Ntaios et al.'s study published in this Journal , concerning all randomized control trials of patent foramen ovale closure versus medical treatment, the authors found no benefit in the prevention of cryptogenic shock and transient ischemic attack with implantation of unselected devices. However, in a subgroup analysis, selected closure devices may be superior to medical therapy without increasing the risk of new-onset atrial fibrillation. Indeed, in the CLOSURE trial the rate of stroke, transient ischemic attack, or death did not diminish and the risks of major vascular events and atrial fibrillation were increased despite closure of patent foramen ovale, with the StarFlex device, in comparison with the best medical treatment. The benefits of closure see...
http://www.medworm.com/rss/comments.php?id=15806071
CHADS2 score/CHA2DS2‐VASc score and major artery occlusion in cardioembolic stroke patients with nonvalvular atrial fibrillation
International Journal of Stroke
1/22/2014 7:10:19 AM
ConclusionAs the CHADS2 and CHA2DS2‐VASs scores increased, the incidence of concurrent major arterial occlusion, particularly internal carotid artery occlusion, increased in patients with cardioembolic stroke associated with nonvalvular atrial fibrillation. (Source: International Journal of Stroke)
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Hypertrophic Cardiomyopathy with Intermittent Free Mitral Regurgitation–A Surgical Dilemma
Echocardiography
1/22/2014
We describe the case of a 52‐year‐old woman presenting with non‐ST elevation myocardial infarction, atrial fibrillation, and a new diagnosis of hypertrophic cardiomyopathy. Transesophageal echocardiography following hemodynamic deterioration revealed completely restricted mitral leaflet motion with free mitral regurgitation, and severe left ventricular outflow tract (LVOT) obstruction. Surgical intervention was considered; however, repeat imaging following a period of clinical stability revealed resolution of the findings suggesting a transient ischemic etiology. The case is supported by clinical and echocardiographic images with movie clips, and a discussion of the likely pathology in the context of the underlying condition. (Source: Echocardiography)
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Atrial fibrillation is associated with an increased risk of cognitive impairment and dementia with or without a history of clinical stroke
Evidence-Based Medicine
1/22/2014
Commentary on: Kalantarian S, Stern TA, Mansour M, et al.. Cognitive impairment associated with atrial fibrillation: a meta-analysis. Ann Intern Med 2013;158(5 Pt 1):338–46. Context Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. The estimated US prevalence of 2.7–6.1 million is expected to increase to 5.6–12.1 million by the middle of the current century. In addition, AF prevalence dramatically increases with age: <1% in individuals aged 50–59 years are affected, whereas about 10% of those aged 80–84 years and 11–18% of those ≥85 years have AF.1 Cognitive impairment with and without dementia is also a common condition in older age and is associated with higher mortality.2 Cognitive impairment is ...
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Warfarin Use and the Risk for Stroke and Bleeding in Patients with Atrial Fibrillation Undergoing Dialysis.
Circulation
1/22/2014
CONCLUSIONS: Our results suggest that warfarin use is not beneficial in reducing stroke risk but is associated with a higher bleeding risk in patients with AF undergoing dialysis. PMID: 24452752 [PubMed - as supplied by publisher] (Source: Circulation)
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A Pint of Sweat Will Save a Gallon of Blood: A Call for Randomized Trials of Anticoagulation in End Stage Renal Disease.
Circulation
1/22/2014
Authors: Granger CB, Chertow GM Abstract Approximately 430,000 patients were receiving maintenance dialysis in the United States in 2011(1). Compared to the general population, atrial fibrillation is far more common(2) and associated with a much higher risk of stroke in the dialysis population(3). Thus, there is an important need to define and apply strategies to reduce stroke in patients receiving dialysis with atrial fibrillation. PMID: 24452751 [PubMed - as supplied by publisher] (Source: Circulation)

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Atrial fibrillation-induced cardiac troponin I release
International Journal of Cardiology
1/21/2014 7:00:00 PM
We have read with interest the comment by Providência et al. addressing the prognostic value of troponin in patients with atrial fibrillation (AF). They assert that minor elevations of troponin on patients with AF have a major role in predicting thromboembolic events. (Source: International Journal of Cardiology)
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CardioPulse Articles * Changing times in cardiology I * Interview with Dr Iain Simpson, President of the British Cardiovascular Society * The Netherlands Heart Foundation--1964-2014 * Personalized atrial fibrillation management needed to close mortality gap * David Celermajer: new European Heart Journal International Associate Editor * Ajay Shah: new European Heart Journal International Associate Editor
European Heart Journal
1/21/2014
(Source: European Heart Journal)
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Atrial fibrillation and prior MI: searching for balance in ischaemic and bleeding events in patients treated with factor-specific anticoagulants
European Heart Journal
1/21/2014
(Source: European Heart Journal)
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Triple antithrombotic therapy in cardiac patients: more questions than answers
European Heart Journal
1/21/2014
Many cardiac patients require combined antithrombotic therapy consisting of an anticoagulant and inhibition of platelet function. The most frequent indications are atrial fibrillation (AF) in combination with drug-eluting stent implantation and/or the presence of an acute coronary syndrome (ACS). Currently, the optimal combination of anticoagulants and anti-platelet therapy is unknown, but it is well established that the combination of regular doses and regimens as prescribed in AF or after ACS results in increased bleeding rates. In this review, we discuss the current literature and describe approaches to reduce the risk of bleeding hoping not to increase the rate of ischaemic events. (Source: European Heart Journal)

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Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial
European Heart Journal
1/21/2014
Conclusion Apixaban had similar beneficial effects on stroke or systemic embolism and major bleeding compared with warfarin, irrespective of concomitant aspirin use. (Source: European Heart Journal)
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Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial
European Heart Journal
1/21/2014
Conclusion Prior MI was common and associated with substantial risk for subsequent cardiac events. Patients with prior MI assigned rivaroxaban compared with warfarin had a non-significant 14% reduction of ischaemic cardiac events. (Source: European Heart Journal)
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Efficacy and safety of rivaroxaban compared with warfarin in patients with peripheral artery disease and non-valvular atrial fibrillation: insights from ROCKET AF
European Heart Journal
1/21/2014
Conclusion Patients with PAD in ROCKET AF did not have a statistically significant higher risk of stroke or systemic embolism than patients without PAD, and there were similar efficacy outcomes in patients treated with rivaroxaban and warfarin. In PAD patients, there was a higher risk of major bleeding or NMCR bleeding with rivaroxaban when compared with warfarin (interaction P = 0.037). Further investigation is warranted to validate this subgroup analysis and determine the optimal treatment in this high-risk cohort of AF patients with PAD. (Source: European Heart Journal)
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Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke
European Heart Journal
1/21/2014
Conclusion After the diagnosis of incident atrial fibrillation in older adults, mortality was the most frequent major outcome during the first 5 years. Among non-fatal cardiovascular events, heart failure was the most common event. (Source: European Heart Journal)
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Pulmonary Vein in Pathogenesis of Persistent Atrial Fibrillation: An Unsettled Controversy
Journal of Cardiovascular Electrophysiology
1/21/2014
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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Impact of Atrial Fibrillation on Exercise Capacity in Heart Failure With Preserved Ejection Fraction: A RELAX Trial Ancillary Study [Original Articles]
Circulation: Heart Failure
1/21/2014
Conclusions— AF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate or rhythm control strategies on exercise tolerance in patients with HFpEF and AF is warranted. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867. (Source: Circulation: Heart Failure)
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The Consult Guys - Atrial Fibrillation: How Controlled is Well-Controlled?
Annals of Internal Medicine
1/21/2014
Authors: Merli GJ, Weitz HH PMID: 24445707 [PubMed - in process] (Source: Annals of Internal Medicine)
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Rivaroxaban in Clinical Practice for Atrial Fibrillation With Special Reference to Prothrombin Time.
Circulation Journal
1/21/2014
Conclusions: We report the distribution of PT for Japanese NVAF patients under rivaroxaban therapy in real-world clinical practice. PMID: 24451650 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Tachycardia mediated cardiomyopathy: Pathophysiology, mechanisms, clinical features and management
International Journal of Cardiology
1/20/2014 7:00:00 PM
Abstract: Tachycardia mediated cardiomyopathy (TMC) is a reversible form of dilated cardiomyopathy that can occur with most supraventricular and ventricular arrhythmias. Despite the plethora of literature describing this entity in animal models, as well as humans, it remains poorly understood. Over the last decade, new etiologies of TMC, such as frequent premature ventricular complexes in normal hearts, have been identified. Recent advances in catheter-based ablation therapies, particularly for atrial fibrillation and ventricular arrhythmias, have added a new dimension to the treatment of this condition. This review describes the pathophysiology, proposed mechanisms, clinical features and management in various arrhythmic conditions. (Source: International Journal of Cardiology)

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There is a need for independent studies about new oral anticoagulants in atrial fibrillation patients
International Journal of Cardiology
1/20/2014 7:00:00 PM
Dabigatran, rivaroxaban, and apixaban are new oral anticoagulants (NOAC) which have been investigated in patients with atrial fibrillation (AF) for primary and secondary prevention of stroke and thromboembolism . In RELY, ROCKET-AF and ARISTOTLE, NOAC had a similar efficacy and safety profile like vitamin-K-antagonists (VKA). Based on these results, NOAC are recommended by national and international societies as an alternative to VKA or even the first choice drug for the prevention of stroke or embolism in AF-patients. (Source: International Journal of Cardiology)
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Effects of eplerenone on P-wave signal-averaged electrocardiogram in hypertensive patients with coronary artery disease
International Journal of Cardiology
1/20/2014 7:00:00 PM
The signal-averaged electrocardiogram (SAECG) of the P waves has been designed to predict the development of atrial fibrillation by measuring the filtered P wave duration (FPD) as an index of atrial conduction delay with high accuracy in patients with and without coronary artery disease . Recent experimental studies have shown that aldosterone receptor antagonists suppress atrial structural remodeling including myocardial apoptosis, myolysis, fibrosis or dilatation . In the present study, we examined the effects of eplerenone on blood pressure and FPD in hypertensive patients with coronary artery disease. (Source: International Journal of Cardiology)
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EP News: Clinical
Heart Rhythm
1/20/2014 7:00:00 PM
Katritsis et al (J Am Coll Cardiol 2013;62:2318, PMID 23973694) investigated whether conventional pulmonary vein isolation (PVI) through circumferential antral ablation with ganglionated plexus (GP) modification in a single ablation procedure yields higher success rates than does PVI or GP ablation alone. Two hundred forty-two patients with paroxysmal atrial fibrillation were randomized to (1) circumferential PVI (n = 78), (2) anatomic ablation of the main left atrial GP (n = 82), or (3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary end point was verified freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT) for 2 years. Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the ...
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New-Onset Atrial Fibrillation is Associated With Cardiovascular Events Leading to Death in a First Time Myocardial Infarction Population of 89 703 Patients With Long-Term Follow-Up: A Nationwide Study [Coronary Heart Disease]
JAHA:Journal of the American Heart Association
1/20/2014 7:00:00 PM
Conclusions New-onset AF after first-time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post-infarct AF is warranted. (Source: JAHA:Journal of the American Heart Association)
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Prevalence of patent foramen ovale in atrial fibrillation patients with history of cerebral ischemia: A stand-alone additional risk?
International Journal of Cardiology
1/20/2014 7:00:00 PM
Patent foramen ovale (PFO) is generally found in about 20–25% of the general population. The marked association between cryptogenic stroke/TIA and PFO supports the hypothesis that paradoxical embolism could be a major cause . The prevalence of foramen patency gradually decreases with age and probably also with conditions which can increase left atrial filling pressures . (Source: International Journal of Cardiology)

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Circulating serum levels of growth differentiation factor-15 and neuregulin-1 in patients with paroxysmal non-valvular atrial fibrillation
International Journal of Cardiology
1/20/2014 7:00:00 PM
Growth differentiation factor-15 (GDF-15) is a stress-responsive member of the transforming growth factor-β superfamily that was originally cloned as a macrophage-inhibitory cytokine . It rapidly increases following myocardial stretch, volume overload, oxidative stress and inflammatory state . In recent years, it is emerging as a novel biomarker to predict mortality and adverse events in patients with heart failure (HF) , acute coronary syndrome (ACS) and acute pulmonary embolism . Neuregulin-1 (NRG-1) is a member of the epidermal growth factor (EGF) family and plays a critical role in cardiovascular development, cell survival, growth, and metabolism . Recently, NRG-1 was shown to be a stress-related cardiac growth and angiogenic biomarker . (Source: International Journal of Cardiology)
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Prescribing warfarin at discharge for heart failure patients: Findings from the Get With The Guidelines-Heart Failure Registry
International Journal of Cardiology
1/20/2014 7:00:00 PM
American and European guidelines state that the usefulness of anticoagulation is not well established among patients with heart failure (HF) who do not have atrial fibrillation (AF) or a previous thromboembolic event. Despite the lack of clear evidence for anticoagulation, prior clinical trials have shown that more than one-fourth of patients may be receiving anticoagulation without established indications such as AF and prosthetic valves . Nevertheless, the prevalence and variation in warfarin prescription for HF patients in the absence of established indications for anticoagulation in clinical practice is unknown. Using data from the American Heart Association's Get With The Guidelines®-HF (GWTG-HF) Registry, we sought to determine the prevalence and variation, as well as patient charac...
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Atrial Autonomic Innervation A Target for Interventional Antiarrhythmic Therapy?
Journal of the American College of Cardiology: Cardiovascular Interventions
1/20/2014 5:06:01 PM
Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system contributes to the creation of atrial fibrillation substrates. Atrial electrophysiology is influenced differently by sympathetic and parasympathetic activation. Several strategies are available to modulate the complex interaction between the autonomic nervous system and the heart. However, different approaches target the problem differently making the prediction of arrhythmogenic and/or antiarrhythmic effects difficult. We discuss the role of the autonomic nervous system on the development of a substrate for atrial fibrillation and explore the potential antiarrhythmic and/or arrhythmogenic effect of modulation of the autonomic nervous system by renal sy...
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Cardialen brings in close to $3M
Mass Device
1/20/2014 12:29:00 PM
Cardialen raises $2.5 million in an equity round for its low-energy atrial fibrillation treatment. Cardialen is closing in on a $4 million equity round, after raising $2.5 million from 18 unnamed investors. Minneapolis and St. Louis-based Cardialen is developing a low-energy implant for atrial fibrillation designed to control the fibrillation without damaging heart tissue, according to its website. The technology uses series of lower-energy pulses rather than a single high-energy shock to effect the therapy, according to the website. News Well, Cardiac Rhythm Management, Cardiovascular, Funding Roundupread more (Source: Mass Device)
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Cardio Notes: Rivaroxaban Safety; Post-MI Drug Use
MedPage Today Public Health
1/20/2014 10:00:00 AM
(MedPage Today) -- The FDA says it will be examining the safety of rivaroxaban (Xarelto) in new users with atrial fibrillation, and both racial/ethnic and sex disparities continue to be seen in the use of preventive drugs after an acute myocardial infarction. (Source: MedPage Today Public Health)

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Evaluation of dronedarone as a therapeutic option for patients with atrial fibrillation
Journal of Clinical Pharmacy and Therapeutics
1/20/2014
Summary What is known and objectiveAtrial fibrillation (AF) is the predominant dysrhythmia affecting approximately 2·4 million people in the United States and over 6 million Europeans. Dronedarone is a benzofuran derivative of amiodarone newly approved in 2009 for the treatment of AF. Here, we comment on the efficacy and safety of dronedarone in patients with AF. CommentEight randomized controlled trials were analysed in this article. Several trials showed that dronedarone therapy delayed AF recurrence, controlled ventricular rate and reduced incidences of hospitalization or death. However, some of the studies were terminated early due to an excess mortality rate. Further studies on long‐term safety and trials on direct comparison to rate controlling medications are suggested to obtai...
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Transcription factors and atrial fibrillation
Cardiovascular Research
1/20/2014
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with a significant genetic component. In recent years, familial and population-based genetic studies in AF have led to the emergence of transcription factors as potentially important contributors to arrhythmia susceptibility. Further evidence to implicate transcription factors in AF has come from studies in animal models, which demonstrate that these proteins play critical roles during AF-related atrial remodelling. Transcription factors have the potential to create a pro-arrhythmogenic substrate in the pulmonary veins and the atrium. However, further research is necessary to fully characterize the mechanistic links between these proteins and AF pathogenesis. In the future, such studies could potentially lead to the development of ...
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Dr Le Fanu's online health clinic, Friday 17th January 2014
The Telegraph : Health Advice
1/17/2014 11:00:13 AM
Concerned about aches and pains? Worried about a medical condition? You can email your questions confidentially to Dr Le Fanu at drjames@telegraph.co.uk. Answers will be published in the health section of the Telegraph website every Friday. Today - flying with Atrial Fibrillation, statins, rashes, glucosamine and the PSA test.     (Source: The Telegraph : Health Advice)
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CARDIOSTIM-EHRA EUROPACE 2014 - Submit your abstract
ESC News and Press
1/17/2014 10:13:34 AM
Discover the World Congress on Cardiac ElectrophysiologyThe partnership between Cardiostim and EHRA EUROPACE began in 2009 and this collaboration delivers education, guidance and the best scientific content to the cardiac electrophysiology community ever year.Submit your abstract before 27 January to be part of CARDIOSTIM - EHRA EUROPACE 2014! Mark your calendar for EHRA EUROPACE-CARDIOSTIM, 21 - 24 June 2015! Topics: Arrhythmias, Atrial Fibrillation (Source: ESC News and Press)
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Iterative Method to Detect Atrial Activations and Measure Cycle Length From Electrograms During Atrial Fibrillation
IEEE Transactions on Biomedical Engineering
1/17/2014 1:46:40 AM
In this study, we evaluate an algorithm to detect activations and measure CLs from AF electrograms. This algorithm iteratively adjusts the detection threshold level until the mean CL converges with the median CL to detect all individual activations. A total of 291 AF electrogram recordings from 13 patients (11 male, 58 ± 10 years old) undergoing AF ablation were obtained. Using manual markings by two independent reviewers as the standard, we compared the cycle length iteration algorithm with a fixed threshold algorithm and dominant frequency (DF) for the estimation of CL. At segment lengths of 10 s, when comparing the algorithm detected to the manually detected activation, the undersensing, oversensing, and total discrepancy rates were 2.4%, 4.6%, and 7.0...

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Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?
Interactive CardioVascular and Thoracic Surgery
1/17/2014
CONCLUSIONS According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery. (Source: Interactive CardioVascular and Thoracic Surgery)
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Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation in adult cardiac surgery?
Interactive CardioVascular and Thoracic Surgery
1/17/2014
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: Is perioperative corticosteroid administration associated with a reduced incidence of postoperative atrial fibrillation (POAF) in adult cardiac surgery? A total of 70 papers were identified using the search as described below. Of these, eight were identified to provide best evidence to answer the clinical question. These papers consisted of well-designed, double-blinded randomized control trials (RCTs) or meta-analysis of RCTs that presented sufficient data to reach conclusions regarding the issues of interest for this review. Postoperative atrial fibrillation occurrence, outcomes and complications were included in the assessment. The author, date and country of publication,...
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Body fat, body fat distribution, lean body mass and atrial fibrillation and flutter. A danish cohort study.
Obesity
1/17/2014
Conclusion: Higher body fat and higher lean body mass were both associated with higher risk of AF. PMID: 24436019 [PubMed - as supplied by publisher] (Source: Obesity)
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Determinants of quality of life in patients with atrial fibrillation
International Journal of Cardiology
1/16/2014 7:00:00 PM
Atrial fibrillation (AF) is the most common chronic arrhythmia . Lots of studies focused on the impact of therapeutic strategies on reducing morbidity and mortality in patients with AF . However, any therapeutic interventions to control rhythm or rate in patients with AF have not shown to have an impact on mortality or morbidity . Thereafter, it has been suggested that reduction of symptoms and improvement of Quality of Life (QOL) might be better therapeutic target for the management of AF . In the psychosocial aspects, individual differences in personality can affect the QOL. Chronic psychological distress status, like type D personality, has been known to be associated with poor QOL, morbidity and mortality in patients with coronary heart disease, heart failure and peripheral artery dise...

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Draft guidelines set out new treatments for atrial fibrillation
Nursing Times Breaking News
1/16/2014 5:29:00 AM
Guidance on the diagnosis and management of atrial fibrillation, the most common arrhythmia, is being updated by the National Institute for Health and Care Excellence. (Source: Nursing Times Breaking News)
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Surgery in severe mitral regurgitation: focus on patients with no symptoms or complications
ESC News and Press
1/16/2014 5:12:06 AM
Authors: De Bonis M, Al-Attar N. Mitral valve repair is often recommended in severe mitral regurgitation however absence of symptoms and episodes of atrial fibrillation, a preserved left ventricular function and normal pulmonary artery pressure either warrant early repair or watchful waiting depending on 1) the patient's characteristics, 2) surgical risk, 3) likelihood of an effective and durable repair and 4) local expertise. (Source: ESC News and Press)
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The nephrologist's anticoagulation treatment patterns/regimens in chronic hemodialysis patients with atrial fibrillation.
Journal of Nephrology
1/16/2014
CONCLUSION: A high AF prevalence was observed in our HD population, but less than 50 % of these patients received OAT. Patients with permanent AF were more frequently treated with warfarin, while OAT administration was uncommon in those with previous bleedings. The thromboembolic risk score was not associated with warfarin prescription, while there was an inverse relation with the hemorrhagic risk score. PMID: 24430763 [PubMed - as supplied by publisher] (Source: Journal of Nephrology)

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Long-term PT-INR levels and the clinical events in the patients with non-valvular atrial fibrillation: A special reference to low-intensity warfarin therapy.
Journal of Cardiology
1/16/2014
CONCLUSIONS: The event rates were similar between the low- (1.6-1.99) and high- (2.0-2.59) intensity warfarin therapy groups in aged patients: <70 years and ≥70 years. Time in therapeutic range and a transient fall or rise in PT-INR were risks for clinical events. Blunt head trauma and concomitant use of antiplatelets were risks for intracranial hemorrhage. PMID: 24440439 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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NICE: Draft atrial fibrillation guidelines
Nursing in Practice
1/15/2014 5:31:20 AM
Draft updated guidelines on the diagnosis and management of atrial fibrillation have been published by the National Institute for Health and Care Excellence Hide related content:  Show related content read more (Source: Nursing in Practice)
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The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran
Emergency Medicine Journal
1/15/2014
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated partial thromboplastin time (APTT) provides a qualitative measurement of the anticoagulant effect of dabigatran. Knowledge of the time of last dose is important for interp...
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CardioPulse Articles * Cardiovascular health takes centre stage in Brussels * American College of Cardiology/American Heart Association release new guideline for assessing cardiovascular risk in adults * American Heart Association late-breaking clinical trials 2013 * Eating fish and atrial fibrillation * Clinical Research I * Research failure can result in lost lives
European Heart Journal
1/14/2014
(Source: European Heart Journal)
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Avoiding Unnecessary Aggressive ICD Programming After MADIT-RIT and ADVANCE III Trials
Journal of the American College of Cardiology: Cardiovascular Imaging
1/13/2014 5:57:44 PM
Powell et al. (1) reported interesting data on survival after shock therapy in a large cohort of patients enrolled in the ALTITUDE study. The analysis showed that following a first implantable cardioverter-defibrillator (ICD) shock delivered for ventricular episodes or atrial fibrillation, there is an increased risk of death. The same effect is not found when the shock is delivered for a benign rhythm. Powell et al. (1) discussed their results in the context of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial Reduce Inappropriate Therapy) (2) data assessing whether the 2 results are contradicting and concluded that “combining the results of the 2 studies, one could conclude that unnecessary ATP [antitachycardia pacing] may increase mortality, while unnecessary shocks f...
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Left atrial appendage occlusion in atrial fibrillation after intracranial hemorrhage
Neurology
1/13/2014
Conclusions: In this first study of LAAO in patients with previous ICH, LAAO appears feasible and safe. A larger, controlled trial is needed to assess the efficacy and safety of the procedure compared to other preventive measures. Classification of evidence: This study provides Class III evidence that in patients with a history of previous ICH and AF, percutaneous LAAO is safe and feasible. (Source: Neurology)

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A rare case of anomalous origin of the left anterior descending artery from the pulmonary artery
International Journal of Cardiology
1/12/2014 7:00:00 PM
A 71-year-old man with a history of hypertension, aortic regurgitation, atrial fibrillation and chronic heart failure presented to our emergency department with dyspnea and chest pain. Chest X-rays showed severe pulmonary edema. His electrocardiogram revealed atrial fibrillation and ST-segment depression in leads I, aVL and V3–6. In transthoracic echocardiography, wall motion was decreased in the anteroseptal region. After urgent hospitalization, his acute pulmonary edema was improved by non-invasive positive pressure ventilation and intravenous administration of diuretics and nitrates. The ST-segment change was also relieved. His creatine phosphokinase (CK) and CK-MB levels increased marginally to a peak value of 279units/L (reference range: 55–210units/L) and 37units/L, respectively,...
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Prevalence of atrial flutter in patients with and without arrhythmogenic superior vena cava during pulmonary vein isolation
International Journal of Cardiology
1/12/2014 7:00:00 PM
Although the mechanism of atrial fibrillation (AF) is complex and composes of multiple triggers and reentry, the vast majority of trigger/substrate lies in the left atrial (LA) chamber . Actually, radiofrequency (RF) catheter ablation of AF is increasingly performed since it was reported that paroxysmal AF is most often triggered by the sources inside the pulmonary veins (PVs), and nowadays PV isolation is an established therapy of AF . Despite the critical role of PV and PV antrum in AF, right atrial (RA) chamber has also played an important role in atrial tachyarrhythmias . Cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) often and supraventricular tachycardia sometimes coexist with AF and play important roles as the trigger of and in the maintenance of AF. Non-PV foci includin...
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Angina pectoris: First manifestation of a left atrial myxoma
International Journal of Cardiology
1/12/2014 7:00:00 PM
Primary cardiac tumors are rare and myxomas are the most common among them. In the majority of cases myxomas have a benign clinical progress, but it's possible for a coronary artery embolization, which is a potentially lethal complication . We show the case of a man of 55 years, who underwent to a cardiac check-up because of the presence, from the two past days, of angina pectoris. He suffers from arterial hypertension in pharmacological therapy, diabetes mellitus of recent diagnosis and a past episode of atrial fibrillation . The ECG and the hematological tests were normal. Transthoracic echocardiography showed mild regurgitation and mild stenosis of the aortic and mitral valve and a mobile mass attached to the left atrial septum, which was difficult to define for the poor picture quality...
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The Validity of CHADS2 Score as a Predictor of De Novo Postoperative Atrial Fibrillation in Adult Cardiac Surgery Patients
Journal of Surgical Research
1/11/2014 10:06:46 AM
Occurrence of atrial fibrillation (AF) following cardiac surgery portends higher mortality and is associated with increased costs and risk of thromboembolism. While many anatomic and patient factors have been associated with AF, a simple clinical scoring system to identify patients at high risk of developing AF is lacking. The CHADS2 score is widely utilized to predict the risk of stroke in patients with AF. We aimed to assess the utility of this scoring algorithm in predicting the likelihood of de novo postoperative AF in cardiac surgery patients. (Source: Journal of Surgical Research)
http://www.medworm.com/rss/comments.php?id=7938101
Surface Electrocardiographic Markers Do Not Predict Atrial Fibrillation in Postoperative Cardiac Surgery Patients
Journal of Surgical Research
1/11/2014 10:06:29 AM
(Source: Journal of Surgical Research)

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More than a MILLION people in the UK now have a heart condition that can lead to strokes - and many don't know they have it
the Mail online | Health
1/10/2014 10:18:27 PM
Data from the British Heart Foundation suggests more than a million people are now living with atrial fibrillation in the UK. (Source: the Mail online | Health)
http://www.medworm.com/rss/comments.php?id=8173746
Understanding Digoxin
EMS 12-Lead
1/10/2014 3:36:41 PM
 Most of us have heard of, or encountered a patient taking Digoxin at some point in our carreers. But, do we understand what it is and how it affects our patient?    Digoxin (Lanoxin), is a Cardiac Glycoside, derived from the foxglove plant, Digitalis. This medication is often seen in the pre-hospital setting, used for the treatment of:    Heart Failure (HF) with reduced Systolic Function   Atrial Fibrillation (AF) and Atrial Flutter (A-flutter) associated with Rapid Ventricular Response (RVR)   Cardiomyopathies   Often combined with Calcium and Beta Channel Blockers, Angiotensine Receptor Blockers (ARBs) and diuretics    Why does the rate matter?  Well, as ventricular rates increase, ventricular filling times (Preload) durin...
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Caffeine: No Downside, Hint of Benefit in Atrial FibrillationCaffeine: No Downside, Hint of Benefit in Atrial Fibrillation
Medscape FamilyMedicine Headlines
1/10/2014 9:49:40 AM
According to a dose-response meta-analysis of prospective cohort studies, the more caffeine consumed, the higher the reduction in risk of developing atrial fibrillation. Heartwire (Source: Medscape FamilyMedicine Headlines)
http://www.medworm.com/rss/comments.php?id=7925411
Efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in chronic hemodialysis patients
Nephrology Dialysis Transplantation
1/10/2014
Conclusions During 5-years of follow-up, the use of multiple RFCA procedures for AF in patients undergoing HD was favorable, whereas the use of a single procedure was disappointing. Multiple RFCA procedures can be an efficient approach to the treatment of AF in HD patients. (Source: Nephrology Dialysis Transplantation)

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Marijuana Smoking is Associated With Atrial Fibrillation
The American Journal of Cardiology
1/9/2014 7:00:00 PM
In their recent review, Thomas et al provide a concise overview of the cardiovascular effects of marijuana smoking. In fact, marijuana may acutely affect the circulatory system triggering cardiovascular events. Most published reports have focused on incidents of acute coronary syndromes, acute cerebrovascular and peripheral vascular events, and more rarely, ischemia-induced ventricular arrhythmias. However, an increasing number of case reports indicate an association between cannabis use and atrial fibrillation (AF). In a systematic review published in 2008, we analyzed 6 reported cases. In all instances AF was of recent onset occurring shortly after marijuana smoking in young subjects. No patient had a structural heart disease and only 1 had a precipitating factor (hypertension), and all...
http://www.medworm.com/rss/comments.php?id=15805247
Vitamin K Antagonists: Beyond Bleeding
Seminars In Dialysis
1/9/2014
Abstract Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinical routine, yet they deserve special consideration in dialysis patients and should influence the decision of whether or not to prescribe vitamin K antagonists in cases lacking cle...

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Intravenous Metoprolol Versus Diltiazem for Rate Control in Noncardiac, Nonthoracic Postoperative Atrial Fibrillation.
The Annals of Pharmacotherapy
1/9/2014
CONCLUSIONS: In NCNT surgery, patients with POAF, IV diltiazem more effectively controlled HR and hemodynamics compared with metoprolol. Results warrant further research into optimal medical management of POAF in this population using these 2 agents. PMID: 24408816 [PubMed - as supplied by publisher] (Source: The Annals of Pharmacotherapy)
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Pradaxa Being Reevaluated By FDA
Pharmaceutical Online News
1/8/2014 4:49:56 AM
Pradaxa (dabigatran), a relatively new anticoagulant used to treat non-valvular atrial fibrillation is being reassessed for safety by the FDA. Pradaxa is a fixed dose medication that is given twice daily and competes with Coumadin (warfarin), a more commonly used anticoagulant. Patients on Coumadin must have their blood monitored regularly, whereas Pradaxa does not require therapeutic monitoring. (Source: Pharmaceutical Online News)
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Origin and Ablation of the Adenosine Triphosphate Induced Atrial Fibrillation after Circumferential Pulmonary Vein Isolation: Effects on Procedural Success Rate
Journal of Cardiovascular Electrophysiology
1/8/2014
ConclusionsA large proportion of the ATP‐ induced AF post CPVI were initiated by rapid firing in the SVC. Eliminating this response by additional ablation may have an influence on clinical results of paroxysmal AF ablation.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Long‐Term Follow‐Up of Pure Linear Ablation for Persistent Atrial Fibrillation without Circumferential Pulmonary Vein Isolation
Journal of Cardiovascular Electrophysiology
1/8/2014
ConclusionLinear catheter ablation without CPVI is effective for persistent AF. Patients with AF terminated by ablation were associated with a better long‐term outcome than those requiring cardioversion.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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More Caffeine May Lower Afib Risk (CME/CE)
MedPage Today Cardiovascular
1/7/2014 10:00:00 AM
(MedPage Today) -- Habitually consuming caffeine in coffee and other drinks and foods may protect against atrial fibrillation, a meta-analysis suggested. (Source: MedPage Today Cardiovascular)
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Epicardial wave mapping in human long-lasting persistent atrial fibrillation: transient rotational circuits, complex wavefronts, and disorganized activity
European Heart Journal
1/7/2014
Conclusion Human long-lasting PerAF is characterized by heterogeneous and unstable patterns of activation including wavefronts, transient rotational circuits, and disorganized activity. (Source: European Heart Journal)
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Ryanodine-Receptor Mediated Calcium Leak Drives Progressive Development of an Atrial Fibrillation Substrate in a Transgenic Mouse Model.
Circulation
1/7/2014
CONCLUSIONS: RyR2-mediated SR Ca(2+)-leak directly underlies the development of a substrate for sAF in CREM-mice, the first demonstration of a molecular mechanism underlying AF-progression and sAF substrate development in an experimental model. Our work demonstrates that the role of abnormal diastolic Ca(2+) release in AF may not be restricted to the generation of atrial ectopy, but extends to the development of atrial remodeling underlying the AF substrate. PMID: 24398018 [PubMed - as supplied by publisher] (Source: Circulation)

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Multistage Electrotherapy Delivered Through Chronically-Implanted Leads Terminates Atrial Fibrillation With Lower Energy Than a Single Biphasic Shock
Journal of the American College of Cardiology: Cardiovascular Imaging
1/6/2014 7:00:00 PM
ConclusionsLow-energy MSE significantly reduced the atrial defibrillation thresholds compared with BPS in a canine model of AF. MSE may enable painless, device-based AF therapy. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)
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Internal Atrial Defibrillation Revisited How Low Can We Go? ∗
Journal of the American College of Cardiology: Cardiovascular Imaging
1/6/2014 7:00:00 PM
Atrial fibrillation (AF) remains the most common and expensive supraventricular arrhythmia. It is the most frequently encountered diagnosis among hospitalized patients and is estimated to cost the U.S. healthcare system more than $5 billion dollars annually (1). Although catheter ablation holds the promise of reducing or eliminating AF, many patients have significant comorbidities or have infrequent AF episodes and are therefore not ideal candidates for ablative therapy. In addition, patients with underlying cardiomyopathy also have a higher AF recurrence rate after catheter ablation (2). Among patients who are at risk of lethal ventricular arrhythmias and have implantable defibrillators, a history of AF is the most important predictor of inappropriate implantable cardioverter-defibrillat...
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High-Sensitivity Troponin T and Risk Stratification in Patients With Atrial Fibrillation During Treatment With Apixaban or Warfarin
Journal of the American College of Cardiology: Cardiovascular Imaging
1/6/2014 7:00:00 PM
ConclusionsLevels of hs-TnT are often elevated in patients with AF. The hs-TnT level is independently associated with an increased risk of stroke, cardiac death, and major bleeding and improves risk stratification beyond the CHA2DS2VASc risk score. The benefits of apixaban as compared with warfarin are consistent regardless of the hs-TnT level. (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation [ARISTOTLE]; NCT00412984) (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)
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Of Mice and Men Atrial Fibrillation in Veteran Endurance Runners
Journal of the American College of Cardiology: Cardiovascular Imaging
1/6/2014 7:00:00 PM
We commend the efforts of Guasch et al. (1) in using an animal model to understand the association between atrial fibrillation (AF) and chronic high-level endurance exercise (EE). It is clear from their study that a complex interplay culminates in the increased prevalence of AF in individuals performing chronic excessive EE. Caution should be applied in extrapolating the results from an animal study to humans, but their compelling findings add to the growing body of literature that suggests that chronic EE may induce autonomic disturbances and atrial dilation/fibrosis, which might play a major role in the initiation of AF. Prior investigations have consistently found that autonomic perturbations involving fluctuations in sympathetic and/or parasympathetic tone immediately precede the onse...
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Reply Of Mice and Men: Atrial Fibrillation in Veteran Endurance Runners
Journal of the American College of Cardiology: Cardiovascular Imaging
1/6/2014 7:00:00 PM
We appreciate the positive comments from Dr. Bhatti and colleagues regarding our observations in a high-intensity endurance-exercise rat model (1). They point out the consistency between our findings and clinical observations, and discuss evidence related to the mechanisms that we uncovered. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)

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Uric Acid Levels and Atrial Fibrillation
Angiology
1/6/2014
(Source: Angiology)
http://www.medworm.com/rss/comments.php?id=7948918
Response to the Letter: Uric Acid Levels and Atrial Fibrillation
Angiology
1/6/2014
(Source: Angiology)
http://www.medworm.com/rss/comments.php?id=7948919
Predictors of Long-Term Outcomes in Patients with Significant Myxomatous Mitral Regurgitation Undergoing Exercise Echocardiography.
Circulation
1/6/2014
CONCLUSIONS: In patients with ≥III+ myxomatous MR undergoing ExEc, lower %age-gender predicted METS, lower HRR, atrial fibrillation, lower LV ejection fraction and high resting RVSP predicted worse outcomes. PMID: 24396041 [PubMed - as supplied by publisher] (Source: Circulation)
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Documentation of pulmonary vein isolation improves long term efficacy of persistent atrial fibrillation catheter ablation
International Journal of Cardiology
1/6/2014
Conclusions: Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients. (Source: International Journal of Cardiology)
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Inflammation in New‐onset Atrial Fibrillation after Cardiac Surgery: A Systematic Review
European Journal of Clinical Investigation
1/4/2014
ConclusionThe postoperative inflammation response may play a role in the pathogenesis of PNAF. However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF. Pre‐ and perioperative use of statins and several other drugs with anti‐inflammatory properties reduce the incidence of PNAF.This article is protected by copyright. All rights reserved. (Source: European Journal of Clinical Investigation)

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Sleep Apnea and the Risk of Atrial Fibrillation Recurrence: Structural or Functional Effects? [Editorials]
JAHA:Journal of the American Heart Association
1/3/2014
(Source: JAHA:Journal of the American Heart Association)
http://www.medworm.com/rss/comments.php?id=7910055
Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation
Heart Rhythm
1/2/2014 7:00:00 PM
Conclusions: The 28-mm ARC-Adv-CB enabled more efficient ablation of paroxysmal AF and shorter procedures than did the ARC-CB. This higher performance was associated with a higher incidence of PNP, which was predicted by the distance between the CB and the PN. (Source: Heart Rhythm)
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Organizational Index Mapping to Identify Focal Sources During Persistent Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
1/2/2014
ConclusionsAt sites of organized activation, the activation frequency was also significantly more stable over time. This observation is consistent with the existence of focal sources, and inconsistent with a purely random activation pattern. Ablation of such regions is technically feasible, and was associated with organization of AF in remote atrial regions.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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Venous Thromboembolism Increases the Risk of Atrial Fibrillation: The Tromso Study [Arrhythmia and Electrophysiology]
JAHA:Journal of the American Heart Association
1/2/2014
Conclusions We found that incident VTE was associated with future risk of atrial fibrillation. Our findings support the hypothesis that PE may lead to cardiac dysfunctions that, in turn, could trigger atrial fibrillation. (Source: JAHA:Journal of the American Heart Association)
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Atrial fibrillation: A progressive atrial myopathy or a distinct disease?
International Journal of Cardiology
1/2/2014
Abstract: Atrial fibrillation is a complex arrhythmia with multiple possible mechanisms. A lot of experimental and clinical studies have shed light on the pathophysiological mechanisms of arrhythmia, especially on molecular basis. Electrical, contractile and structural remodeling, calcium handling abnormalities, autonomic imbalance and genetic factors seem to play a crucial role in atrial fibrillation initiation and maintenance. However, the exact pathophysiological mechanisms of atrial fibrillation are not completely understood and whether atrial fibrillation is an unclassified cardiomyopathy or a distinct disease still remains to be answered. This review highlights proarrhythmic and pathophysiological mechanisms of atrial fibrillation and approaches the molecular basis underlying atrial ...
http://www.medworm.com/rss/comments.php?id=9860871
Atrial fibrillation: Improvement in identification and stroke preventive therapy —Data from the UK Clinical Practice Research Datalink, 2000–2012
International Journal of Cardiology
1/2/2014
Abstract: Objective: To investigate recent trends in the diagnosis and treatment of atrial fibrillation.Methods: Time trend analysis in the UK Clinical Practice Research Datalink (CPRD —previously the GPRD), 2000–2012.Results: The incidence of AF in men rose from 1.274 (1.271, 1.276) per 1 000 patient years in 2000 to 1.972 (1.969, 1.975) in 2012. In women, it rose from 1.209 (1.207, 1.211) to 1.609 (1.606, 1.611).55847 patients with AF first diagnosed between 2000 and 2012 were included in the study. 54% of men were initiated on anticoagulation therapy in the first year following diagnosis of atrial fibrillation, compared to 45% of women (P (Source: International Journal of Cardiology)

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Increased risk of myocardial infarction with dabigatran: fact or fiction?
Journal of Cardiovascular Medicine
1/1/2014 1:00:00 AM
Dabigatran is a direct, competitive inhibitor of thrombin recently approved for the prophylaxis of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In some of the clinical trials evaluating the efficacy and safety of dabigatran in different clinical settings [i.e., prevention of venous thromboembolism (VTE) after orthopedic surgery, secondary prevention of VTE, and acute coronary syndromes (ACS)], a trend toward an increase in acute coronary events among patients receiving dabigatran has been reported, thus raising concerns of a possible relationship between dabigatran and myocardial infarction, especially in high-risk patients. However, as shown in our article, current evidence is inconclusive on this topic; more data are needed to detail this hypothetical as...
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CHA2DS2-VASc Score Is Directly Associated with the Risk of Pulmonary Embolism in Patients with Atrial Fibrillation
The American Journal of Medicine
1/1/2014
Conclusions: CHA2DS2-VASc score is directly associated with the incidence of pulmonary embolism in atrial fibrillation. (Source: The American Journal of Medicine)

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Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease
Atherosclerosis
1/1/2014
Conclusions: Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKD patients. However, further randomized studies are still needed to assess the association.Highlights: (Source: Atherosclerosis)
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Surgical Repair of Atrio-Oesophageal Fistula Secondary to Transcatheter Ablation for Atrial Fibrillation: A Case Report and Literature Review
Heart, Lung and Circulation
1/1/2014
We report a case of atrio-oesophageal fistula in a patient almost three weeks after an elective transcatheter AF ablation. (Source: Heart, Lung and Circulation)
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Hybrid Approach for Ablation of Atrial Fibrillation—A Systematic Review of the Literature
Heart, Lung and Circulation
1/1/2014
Introduction: The management of atrial fibrillation (AF) is one of ongoing importance with rates as high as up to 10% in selected populations . AF results in increasing hospitalisation due to palipitations, heart failure, syncope or stroke. Catheter ablation has been increasingly utilised as an effective rhythm control strategy; however, the durability of the results have been varied. In this context, a new strategy of a hybrid approach, combining surgical and catheter ablation, is emerging. In this systematic review, we aim to review the literature purporting the use of the hybrid approach. (Source: Heart, Lung and Circulation)
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Surgical Ablation of “Lone” Atrial Fibrillation—A Systematic Review of the Literature
Heart, Lung and Circulation
1/1/2014
Introduction: Atrial fibrillation (AF) is one of the most common cardiovascular causes for hospital admission ; with a lifetime risk of developing AF of approximately 26% for those aged 40 years of age . While catheter ablation techniques are used, the long term durability of lesions have been variable. Surgical intervention is increasingly used in patients undergoing concurrent procedures, its acceptance for “lone” AF is limited. In this context, we aim to undertake a systematic review of the literature to provide data on the use of surgical ablation for the procedure management of “lone” AF. (Source: Heart, Lung and Circulation)

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In response to "Anaphylaxis during intravenous administration of amiodarone" Is amiodarone the best choice for management of atrial fibrillation?
Annals of Cardiac Anaesthesia
1/1/2014
In response to "Anaphylaxis during intravenous administration of amiodarone" Is amiodarone the best choice for management of atrial fibrillation? Ann Card Anaesth. 2014 Jan-Mar;17(1):70-1 Authors: Malik I PMID: 24401309 [PubMed - in process] (Source: Annals of Cardiac Anaesthesia)
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Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation.
Chest
1/1/2014
We present the case of a 55-year-old male patient undergoing cryoballoon ablation complicated with pulmonary hemorrhage. The cause of this rare complication may be found in the damage of vascular venous structures near the ablation zone or, alternatively, in hemorrhagic damage of the pulmonary vein surrounding tissue (or less probably to direct injury of the lingular bronchus). The extremely low temperatures achieved in this case (which are often associated with deep balloon position inside the veins) are alarming and should alert the physician about the possibility of an excessively intrapulmonary vein deployment of the cryoablation balloon. PMID: 24394827 [PubMed - in process] (Source: Chest)
http://www.medworm.com/rss/comments.php?id=9002365
Vitamin k antagonists: beyond bleeding.
Seminars in Dialysis
1/1/2014
Authors: Krüger T, Floege J Abstract Warfarin is the most widely used oral anticoagulant in clinical use today. Indications range from prosthetic valve replacement to recurrent thromboembolic events due to antiphospholipid syndrome. In hemodialysis (HD) patients, warfarin use is even more frequent than in the nonrenal population due to increased cardiovascular comorbidities. The use of warfarin in dialysis patients with atrial fibrillation requires particular caution because side effects may outweigh the assumed benefit of reduced stroke rates. Besides increased bleeding risk, coumarins exert side effects which are not in the focus of clinical routine, yet they deserve special consideration in dialysis patients and should influence the decision of whether or not to prescribe vitam...
http://www.medworm.com/rss/comments.php?id=9003302
Should Catheter Ablation be the Preferred Approach for Treatment of Atrial Fibrillation Related Symptomatic Sinus Node Dysfunction?
Pacing and Clinical Electrophysiology : PACE
1/1/2014
(Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=10373514
Emergence of Atrial Repolarization Alternans at Late Stages of Remodeling: The “Second Factor” in Atrial Fibrillation Progression?
Journal of Cardiovascular Electrophysiology
12/31/2013 7:00:00 PM
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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Left atrial fibrosis affects left ventricular systolic function in patients with atrial fibrillation.
Turk Kardiyoloji Dernegi arsivi
12/31/2013 7:00:00 PM
Authors: Eroğlu E PMID: 24481090 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)
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The degree of left atrial structural remodeling impacts left ventricular ejection fraction in patients with atrial fibrillation.
Turk Kardiyoloji Dernegi arsivi
12/31/2013 7:00:00 PM
Conclusion: Patients with extensive LA fibrosis appear to have depressed LV function pre-ablation, suggesting that structural remodeling in the LA may also be triggering and promoting remodeling within the ventricular myocardium. PMID: 24481089 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)
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Active Ganglionated Plexi Is a Predictor of Atrial Fibrillation Recurrence After Minimally Invasive Surgical Ablation
Journal of Cardiac Surgery
12/31/2013 7:00:00 PM
ConclusionsThe number of active GP is a predictor of AF recurrence after minimally invasive surgical AF ablation. Patients with more active GP were associated with markedly higher single‐procedure success rates. doi: 10.1111/jocs.12299 (J Card Surg 2014;XX:1–7) (Source: Journal of Cardiac Surgery)
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Antivitamin k drugs in stroke prevention.
Current Vascular Pharmacology
12/31/2013 7:00:00 PM
Authors: Di Raimondo D, Tuttolomondo A, Butta C, Lucifora B, Licata G, Pinto A Abstract Among the different subtypes of ischaemic strokes, almost 20 % are of cardiac origin. Different are the causes of cardioembolic stroke, but the most common is the atrial fibrillation, a supraventricular arrhythmia. Appropriate use of antiplatelet drugs and anticoagulants after transient ischaemic attack (TIA) or ischaemic stroke depends on whether the underlying cause is cardioembolic or of presumed arterial origin. Adequate antiplatelet therapy is recommended for secondary prevention after cerebral ischaemia of presumed arterial origin, whether for patients with TIA and ischaemic stroke of cardiac origin, mainly due to atrial fibrillation. Vitamin K antagonists (VKAs) are highly effective in pr...
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68 Year Old Male: Chest Tightness – Part 2
EMS 12-Lead
12/31/2013 6:00:07 AM
This is part 2 of a multi-part series examining a 68-year-old male patient who presented with a chief complaint of "chest tightness" and an abnormal ECG. You may want to review the initial description of the patient here. We're going to save the dissection of the ECG's for the next post and continue on with his case presentation for now… You start by administering 324mg of aspirin PO, chewed well. Recognizing that the patient is in rapid atrial fibrillation at about 127 bpm and that his elevated heart-rate could be contributing to his symptoms, you start to draw up a loading-dose of diltiazem to slowly bring his rate under control. However, before you can administer the medication, you notice a change on the monitor and shoot a 12-lead.   For good measure you...
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Inappropriate Use of Antiarrhythmic Drugs in AFInappropriate Use of Antiarrhythmic Drugs in AF
Medscape Today Headlines
12/30/2013 12:00:00 PM
Clinical reality and guideline goals may part ways when it comes to atrial fibrillation treatment sequencing. Europace (Source: Medscape Today Headlines)

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Well: With A-Fib Rhythms, Higher Odds of Stroke
NYT
12/30/2013 12:06:02 AM
About three million Americans have atrial fibrillation, a heart rhythm abnormality that significantly increases the risk of stroke.     (Source: NYT)
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Personal Health: With A-Fib Rhythms, Higher Odds of Stroke
NYT Health
12/30/2013 12:01:09 AM
About three million Americans have atrial fibrillation, a heart rhythm abnormality that significantly increases the risk of stroke.     (Source: NYT Health)
http://www.medworm.com/rss/comments.php?id=7901839
Response to the Letter to the Editor titled “Atrial fibrillation in patients with acute coronary syndromes”
International Journal of Cardiology
12/30/2013
We appreciate the expressed enthusiasm about our paper. We believe that our study contributes 3 main findings. First, the overall incidence of AF occurring in the hospital following non-ST-segment elevation acute coronary syndrome (NSTE ACS) was 6%, but 44% of that occurred after coronary artery bypass graft (CABG) surgery. Second, the majority of these atrial fibrillation (AF) patients did not receive oral anticoagulation at discharge, despite almost 60% having a CHADS2 score ≥2 and almost 90% having a CHA2DS2-VASc score ≥2. Finally, both AF overall and CABG-related AF were significantly associated with greater mortality at 30days and 1year. Most prior studies evaluating AF in the setting of ACS did not distinguish between CABG-related and non-CABG AF. Because the occurrence of AF fol...

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Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: The importance of rhythm and rate control
Heart Rhythm
12/29/2013 7:00:00 PM
Conclusion: In patients with heart failure undergoing AF ablation, there is an initial short-term LVEF improvement related to baseline heart rate. However, long-term LVEF improvement is associated with rhythm outcome. (Source: Heart Rhythm)
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EP News: Clinical
Heart Rhythm
12/26/2013
Abed and colleagues (JAMA. 2013 Nov 20; 310 (19):2050-60; PMID: 24240932) evaluated the effect of weight reduction on atrial fibrillation (AF) burden and cardiac structure in a randomized controlled trial. Obese patients with symptomatic AF (150) were randomized to weight management (intervention) or general lifestyle advice (control). The primary outcomes were AF Severity Scale scores, symptom burden, and symptom severity. Secondary outcomes were AF episodes and AF duration, left atrial area, and septal thickness. The intervention group showed a significantly greater reduction in weight (14.3 and 3.6 kg, respectively; P  (Source: Heart Rhythm)
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Relaxin as novel strategy in the management of atrial fibrillation: Potential roles and future perspectives
International Journal of Cardiology
12/26/2013
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It continues to be a major burden to healthcare cost as there is no effective treatment for atrial fibrillation . The prevalence of AF has been increasing for the past few decades with the aging population . Despite being extensively studied, the mechanism of AF is still poorly understood. In recent years, we have seen increasing evidence regarding oxidative stress, inflammation, angiotensin II (Ang II), cardiac fibrosis and remodeling in AF . The current available treatment modalities have major limitations stemming from poor understanding of the disease process that is vital to the development of a novel therapeutic approach . Relaxin is a naturally occurring human peptide hormone, which was initially identified as...
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Usefulness of Right Ventricular Dysfunction to Predict New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting
The American Journal of Cardiology
12/25/2013 7:00:00 PM
In conclusion, right ventricular myocardial performance index is a novel predictor of postoperative AF in patients undergoing isolated CABG surgery and appears to be additive to established risk factors such as age and left atrial volume. (Source: The American Journal of Cardiology)
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Effect of Preoperative Obstructive Sleep Apnea on the Frequency of Atrial Fibrillation After Coronary Artery Bypass Grafting
The American Journal of Cardiology
12/25/2013 7:00:00 PM
In conclusion, OSA was found to be a strong predictor of PCAF, which in turn was found to be associated with increased length of stay. (Source: The American Journal of Cardiology)

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Impact of Gender on the Prognosis of Patients With Nonvalvular Atrial Fibrillation
The American Journal of Cardiology
12/25/2013 7:00:00 PM
Treatment guidelines for atrial fibrillation (AF) used in Western countries describe female gender as a risk factor for thromboembolic events in patients with nonvalvular AF (NVAF). The present study aimed to determine the impact of gender on prognosis of Japanese patients with NVAF. A subanalysis of 7,406 patients with NVAF (mean age 70 years) who were followed-up prospectively for 2 years was performed using data from the J-RHYTHM registry. The primary end points were thromboembolic events, major hemorrhaging, total mortality, and cardiovascular mortality. Compared with male subjects (n = 5,241), female subjects (n = 2,165) were older and displayed greater prevalences of paroxysmal AF, heart failure, and hypertension but less prevalences of diabetes, previous cerebral infarction, and...
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Impact of Increased Orifice Size and Decreased Flow Velocity of Left Atrial Appendage on Stroke in Nonvalvular Atrial Fibrillation
The American Journal of Cardiology
12/25/2013 7:00:00 PM
This study investigated whether a larger LAA orifice is related to decreased LAA flow velocity and stroke in nonvalvular AF. The dimension, morphology, and flow velocity of LAA were compared in patients with nonvalvular AF with (stroke group, n = 67, mean age 66 ± 9 years) and without ischemic stroke (no-stroke group, n = 151, mean age 56 ± 10 years). Compared with no-stroke group, the stroke group had larger LA dimension (4.7 ± 0.8 vs 4.2 ± 0.6 cm, p (Source: The American Journal of Cardiology)
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Relation of Reduced Expression of MiR-150 in Platelets to Atrial Fibrillation in Patients With Chronic Systolic Heart Failure
The American Journal of Cardiology
12/25/2013 7:00:00 PM
In conclusion, miR-150 expression levels in platelets of patients with systolic HF with AF are significantly reduced and correlated to the cell-free circulating levels of this miRNA. (Source: The American Journal of Cardiology)
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Long-term outcome and preprocedural predictors of atrial tachyarrhythmia recurrence following pulmonary vein antrum isolation-based catheter ablation in patients with non-paroxysmal atrial fibrillation.
Journal of Cardiology
12/25/2013
CONCLUSIONS: PVAI-based ablation strategies could achieve SR maintenance in almost 80% of NPAF patients after multiple procedures during long-term follow-up. The preprocedural LAV was an important predictor of the procedural outcome. PMID: 24373867 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)

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Association between the quality of life and asymptomatic episodes of paroxysmal atrial fibrillation in the J-RHYTHM II study.
Journal of Cardiology
12/25/2013
CONCLUSION: The asymptomatic AF episode frequency correlates with a reduced QoL in patients with paroxysmal AF, suggesting that there would be psychological benefits to its reduction. PMID: 24373865 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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The Role of BNP and CRP in Predicting the Development of Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Surgery.
ISRN Cardiology
12/25/2013
Conclusion. Elevated preoperative BNP serum levels are associated with the development of post-CABG AF, while CRP does not seem to be influential. PMID: 24455301 [PubMed] (Source: ISRN Cardiology)
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In the first 30 days of warfarin use, risk of stroke increases among atrial fibrillation patients
Health News from Medical News Today
12/24/2013 4:00:00 AM
Patients with atrial fibrillation - an irregular and often abnormally fast heartbeat- have nearly double the risk of suffering a stroke in the first 30 days after starting to take the anti-clotting drug warfarin compared to non-users, according to a study of over 70,000 patients.The study, published online in the European Heart Journal [1], found that the risk was particularly high in the first week after patients started to take the drug. In contrast, once the first 30 days had elapsed, the risk of a stroke was halved in patients taking warfarin compared to non-users. (Source: Health News from Medical News Today)
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Atrial fibrillation, a growing global health concern
Health News from Medical News Today
12/24/2013 3:00:00 AM
Atrial fibrillation, long considered the most common condition leading to an irregular heartbeat, is a growing and serious global health problem, according to the first study ever to estimate the condition's worldwide prevalence, death rates and societal costs.The World Health Organization data analysis, led by Sumeet Chugh, MD, associate director of the Cedars-Sinai Heart Institute, shows that 33.5 million people worldwide - or .5% of the world's population - have the condition. (Source: Health News from Medical News Today)
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Warfarin in Older Atrial Fibrillation Patients With NSTEMIWarfarin in Older Atrial Fibrillation Patients With NSTEMI
Medscape Today Headlines
12/23/2013 3:25:35 AM
What's the risk of readmission for bleeding and major cardiac events in stented NSTEMI atrial fibrillation patients? American Heart Journal (Source: Medscape Today Headlines)
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Atrial fibrillation is a 'growing global health problem,' WHO says
Health News from Medical News Today
12/23/2013 3:00:00 AM
A World Health Organization study reveals atrial fibrillation is the most common condition leading to an irregular heartbeat, and it is a serious global health problem that is growing.Atrial fibrillation and other forms of arrhythmia interfere with the electrical activity in the upper chambers, or atria, of the heart, causing an irregular heartbeat. This, in turn, disrupts the flow of blood through the heart, and can result in palpitations, lightheadness, shortness of breath, extreme fatigue and chest pain. (Source: Health News from Medical News Today)
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A Prospective Cohort Study of Patients With Transient Ischemic Attack to Identify High-Risk Clinical Characteristics [Clinical Sciences]
Stroke
12/23/2013
Conclusions— Patients with TIA with their first TIA, language disturbance, duration of symptoms ≥10 minutes, gait disturbance, atrial fibrillation, infarction on computed tomography, elevated platelets or glucose, unilateral weakness, history of carotid stenosis, and elevated diastolic blood pressure are at higher risk for an impending stroke. Patients with vertigo and no high-risk features are at low risk. The Canadian TIA Score quantifies the impending stroke risk following TIA. (Source: Stroke)
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Preadmission Oral Anticoagulant Treatment and Clinical Outcome Among Patients Hospitalized With Acute Stroke and Atrial Fibrillation: A Nationwide Study [Clinical Sciences]
Stroke
12/23/2013
Conclusions— Only a minority of hospitalized patients with acute stroke with atrial fibrillation received OAT at the time of stroke. Preadmission OAT was associated with less severe stroke and lower 30-day mortality rate in a propensity score–matched analysis. (Source: Stroke)
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Fever-induced atrial flutter associated with SCN5A mutation—A first report on successful catheter ablation in a very young child
International Journal of Cardiology
12/23/2013
SCN5A mutations are associated with a heterogeneous subset of electrical cardiac diseases including supraventricular tachycardias like atrial fibrillation and, rarely, atrial flutter . Fever-induced atrial flutter in a 3-year old boy, presented here, initially responded well to antipyretic therapy. However, during subsequent febrile episodes, the arrhythmia persisted in spite of normalization of temperature, necessitating electrical cardioversion under general anesthesia. Since SCN5a mutations are also known to cause sinus node dysfunction, prolonged PR interval and intraventricular conduction delay, preventive drugs cannot always be given. Linear ablation of the cavotricuspid isthmus may be performed, thereby precluding the development of an isthmus-dependent macro-re-entrant circuit. (So...
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Red cell distribution width as a novel, inexpensive marker for paroxysmal atrial fibrillation
International Journal of Cardiology
12/23/2013
Red cell distribution width (RDW) is a quantitative measure of variability in the size of circulating erythrocytes and has been traditionally used in the differential diagnosis of anemia . RDW has been routinely reported in complete blood count (CBC) tests and is available in most clinical settings. Recently, several studies have shown that higher RDW level is a strong independent predictor of increased morbidity and mortality in patients with acute and chronic heart failure , patients with myocardial infarction , and patients following coronary artery bypass grafting or coronary angiography . (Source: International Journal of Cardiology)

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Design and rationale of Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation: A global registry program on long-term oral antithrombotic treatment in patients with atrial fibrillation
American Heart Journal
12/22/2013 7:00:00 PM
Conclusions: Novel features of this registry program will add data from clinical practice to those from randomized trials to expand knowledge of antithrombotic treatment in patients with AF. (Source: American Heart Journal)
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Predictive value of atrial electromechanical delay for atrial fibrillation recurrence.
Cardiology Journal
12/22/2013 9:45:13 AM
CONCLUSIONS: Our results suggest that AEMD is associated with an increased risk of recurrence of AF within 1-month. These data may have implications for the identification of patients who are most likely to experience substantial benefit from cardiversion therapy for AF. PMID: 24338542 [PubMed - in process] (Source: Cardiology Journal)
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Efficacy of multi-electrode duty-cycled radiofrequency ablation in patients with paroxysmal and persistent atrial fibrillation.
Cardiology Journal
12/22/2013 9:45:13 AM
CONCLUSIONS: PVI with PVAC is a safe procedure with 48.7% efficacy in patients with paroxysmal AF. The efficacy of PVAC in patients with persistent or long-standing persistent AF is not acceptable. PMID: 24338539 [PubMed - in process] (Source: Cardiology Journal)
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How much atrial fibrillation causes symptoms of heart failure?
International Journal of Clinical Practice
12/22/2013
ConclusionsHigher AF burden is associated with higher prevalence of symptoms. The increment became significant when patients were in AF at 20–40% of visits. (Source: International Journal of Clinical Practice)
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Biomarkers in atrial fibrillation: an overview
International Journal of Clinical Practice
12/22/2013
Summary Atrial fibrillation (AF) confers a raised risk of stroke and death, and this risk of adverse events is increased by the coexistence of other cardiovascular risk factors. The pathophysiology of AF is complex, involving the role of inflammation, structural remodelling with apoptosis, inflammation or fibrosis. These changes confer a prothrombotic or hypercoagulable state in this arrhythmia. Despite being easy to use for decision‐making concerning oral anticoagulant therapy in AF, clinical risk scores used for stratification have shown modest capability in predicting thromboembolic events, and biomarkers may improve our identification of ‘high risk’ patients. Biomarkers, whether measured in the peripheral blood, urine or imaging‐based may improve our knowledge of the pathophysi...

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[Obstructive sleep apnea in neurological diseases : Specially as a risk factor for stroke.]
Der Nervenarzt
12/22/2013
Authors: Koehler U, Cassel W, Hildebrandt O, Kesper K, Kianinejad P, Nell C, Mayer G, Ohl G Abstract Neurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to re...
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Lone atrial fibrillation – an overview
International Journal of Clinical Practice
12/22/2013
Summary Atrial fibrillation (AF) sometimes develops in younger individuals without any evident cardiac or other disease. To refer to these patients who were considered to have a very favourable prognosis compared with other AF patients, the term ‘lone’ AF was introduced in 1953. However, there are numerous uncertainties associated with ‘lone’ AF, including inconsistent entity definitions, considerable variations in the reported prevalence and outcomes, etc. Indeed, increasing evidence suggests a number of often subtle cardiac alterations associated with apparently ‘lone’ AF, which may have relevant prognostic implications. Hence, ‘lone’ AF patients comprise a rather heterogeneous cohort, and may have largely variable risk profiles based on the presence (or absence) of overl...
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Patterns of Pulmonary Vein Potential Disappearance During Encircling Ipsilateral Pulmonary Vein Isolation Can Predict Recurrence of Atrial Fibrillation.
Circulation Journal
12/21/2013
Conclusions: PVP disappearance pattern during EIPVI was significantly associated with the incidence of residual PV carina conduction and AF recurrence. PMID: 24366102 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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P-Pulmonale and New-Onset Atrial Fibrillation.
Circulation Journal
12/21/2013
Authors: Aizawa Y, Sato M PMID: 24366101 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Start Warfarin, Have a Stroke? (CME/CE)
MedPage Today Cardiovascular
12/20/2013 2:00:00 PM
(MedPage Today) -- Starting warfarin for preventing stroke in patients with atrial fibrillation appeared to be associated with a transiently increased risk of ischemic stroke before the preventive effects kicked in, a large case-control study showed. (Source: MedPage Today Cardiovascular)

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New AF classification by ECG will help GPs deliver personalised treatment
ESC News and Press
12/20/2013 5:20:33 AM
AF is currently diagnosed by an ECG, often by a general practitioner (GP). But the ECG is underutilised with respect to identifying the underlying cause of AF, which would help GPs make personalised treatment decisions. GPs need to know how ECG readings correlate to the cause of AF and the Lugano meeting was convened to discuss how to start such classification.  Read more  Topics: Atrial Fibrillation (Source: ESC News and Press)
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Distinctive Patterns of Dominant Frequency Trajectory Behavior in Drug‐Refractory Persistent Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
12/20/2013
ConclusionsDF of individual VEGMs was temporally unstable, although reappearance of DF values occurred at times. Hence, targeting sites of ‘peak DF’ from a single time frame is unlikely to be a reliable ablation strategy. There appears to be a predominance of local and cyclical activity of HDFAs hinting a potentially nonrandom temporally periodic behavior that provides further mechanistic insights into the maintenance of persAF. (Source: Journal of Cardiovascular Electrophysiology)
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The Effect of Open‐Irrigated Radiofrequency Catheter Ablation of Atrial Fibrillation on Left Atrial Pressure and B‐Type Natriuretic Peptide
Pacing and Clinical Electrophysiology : PACE
12/20/2013
ConclusionsA substantial intravascular volume load during oiRFA can be absorbed with little change in LA pressure, such that LA pressure is not a reliable indicator of the fluid balance. Subsequent redistribution of the volume load imposes a risk after the procedure. Conversion to sinus rhythm may improve ability to acutely accommodate the volume load. (Source: Pacing and Clinical Electrophysiology : PACE)
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Autonomic Neural Remodeling of the Pulmonary Vein‐Left Atrium Junction in a Prolonged Right Atrial Pacing Canine Model
Pacing and Clinical Electrophysiology : PACE
12/20/2013
ConclusionAutonomic neural remodeling did exist in PV‐LA junction after prolonged atrial pacing, which may contribute to the initiation of atrial fibrillation and be significant in its treatment by radiofrequency catheter ablation. (Source: Pacing and Clinical Electrophysiology : PACE)

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Risk factors for new-onset atrial fibrillation
International Journal of Cardiology
12/20/2013
We have read with great enthusiasm the recently published article entitled “Serum potassium levels and the risk of atrial fibrillation” by Krijthe and coworkers . In that very well-designed and presented study Krijthe and coworkers tried to investigate the association of serum potassium and the risk of atrial fibrillation in a population based setting. They concluded that low serum levels of potassium were associated with a higher risk of atrial fibrillation. (Source: International Journal of Cardiology)
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WHO Data Confirm the Worldwide 'Epidemic' of AFWHO Data Confirm the Worldwide 'Epidemic' of AF
Medscape Today Headlines
12/19/2013 2:25:04 PM
A new review of global data shows that the prevalence and incidence of atrial fibrillation is increasing and that the arrhythmia is having a profound impact on patient disability and mortality. Heartwire (Source: Medscape Today Headlines)
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Management of atrial fibrillation still suboptimal in Europe
ESC News and Press
12/19/2013 10:45:23 AM
ESC presents preliminary results of Atrial Fibrillation General Registry: Statistics show that oral anticoagulant use has increased, but new oral anticoagulant (NOAC) use is still low. Authors also concluded that compliance with treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. Topics: Atrial Fibrillation (Source: ESC News and Press)

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New-Onset AF Predicts Malignant Arrhythmias in Post-MI PatientsNew-Onset AF Predicts Malignant Arrhythmias in Post-MI Patients
Medscape Today Headlines
12/19/2013 12:27:49 AM
Is atrial fibrillation the 'gateway arrhythmia' in post-MI patients? American Heart Journal (Source: Medscape Today Headlines)
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Early Doses of Warfarin Paradoxically Associated with Higher Stroke Risk (FREE)
Physician's First Watch current issue
12/19/2013
By Joe Elia Patients with atrial fibrillation seem to be at increased risk for ischemic stroke when starting warfarin prophylaxis, according to a case-control study in the European Heart Journal. … (Source: Physician's First Watch current issue)
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Atrial supply-demand balance in healthy adult pigs: coronary blood flow, oxygen extraction, and lactate production during acute atrial fibrillation
Cardiovascular Research
12/19/2013
Conclusions In healthy pigs, the LA has a lower CCR, but a higher extraction reserve compared with the LV. Although both reserves were recruited during AF, atrial lactate production increased significantly. (Source: Cardiovascular Research)
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Management of atrial fibrillation still suboptimal in Europe
EurekAlert! - Medicine and Health
12/19/2013
(European Society of Cardiology) Statistics show that oral anticoagulant use has increased, but new oral anticoagulant use is still low. Authors also concluded that compliance with treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. (Source: EurekAlert! - Medicine and Health)

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Evaluation of left atrial deformation to predict left atrial stasis in patients with non-valvular atrial fibrillation - a pilot-study
Cardiovascular Ultrasound
12/19/2013
Background: Speckle tracking-derived strain and strain rate are recently available parameters to assess left atrial (LA) deformation. We hypothesized that such new parameters could be of interest to evaluate the risk of LA stasis among patients with atrial fibrillation (AF). Methods: Single-centre study enrolling all patients with non-valvular AF lasting longer than 48 hours for whom no therapeutic anticoagulation was given in the preceding 3 weeks and who were assessed through transesophageal and transthoracic echocardiogram during a 6 month time interval. LA deformation was assessed by transthoracic echocardiogram through speckle tracking analysis, whereas LA stasis parameters were sought on transesophageal echocardiogram. Results: Among the 82 assessed patients, LA appendage thrombi or ...
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Evaluation of left atrial deformation to predict left atrial stasis in patients with non-valvular atrial fibrillation ¿ a pilot-study
Cardiovascular Ultrasound
12/19/2013
Background: Speckle tracking-derived strain and strain rate are recently available parameters to assess left atrial (LA) deformation. We hypothesized that such new parameters could be of interest to evaluate the risk of LA stasis among patients with atrial fibrillation (AF). Methods: Single-centre study enrolling all patients with non-valvular AF lasting longer than 48 hours for whom no therapeutic anticoagulation was given in the preceding 3 weeks and who were assessed through transesophageal and transthoracic echocardiogram during a 6 month time interval. LA deformation was assessed by transthoracic echocardiogram through speckle tracking analysis, whereas LA stasis parameters were sought on transesophageal echocardiogram. Results: Among the 82 assessed patients, LA appendage thrombi ...
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Thrombin generation using the calibrated automated thrombinoscope to assess reversibility of dabigatran and rivaroxaban.
Thrombosis and Haemostasis
12/19/2013
Authors: Herrmann R, Thom J, Wood A, Phillips M, Muhammad S, Baker R Abstract The new direct-acting anticoagulants such as dabigatran and rivaroxaban are usually not monitored but may be associated with haemorrhage, particularly where renal impairment occurs. They have no effective "antidotes". We studied 17 patients receiving dabigatran 150 mg twice daily for non-valvular atrial fibrillation and 15 patients receiving rivaroxaban 10 mg daily for the prevention of deep venous thrombosis after hip or knee replacement surgery. We assessed the effect of these drugs on commonly used laboratory tests and Calibrated Automated Thrombogram (CAT) using plasma samples. We also assessed effects in fresh whole blood citrated patient samples using thromboelastography on the TEG and the ROTEM. Th...
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A prospective study of estimated glomerular filtration rate and outcomes in patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project.
Chest
12/19/2013
CONCLUSION Incidence rates of IS/TE, mortality and bleeding increased with reducing eGFR, across the whole range of renal function. OAC use was associated with a lower incidence of IS/TE and mortality at 1 year, compared with non-anticoagulated individuals in all categories of renal function as measured by eGFR. The NCB balancing IS against serious bleeding was positive, in favour of OAC use amongst patients with renal impairment. PMID: 24356875 [PubMed - as supplied by publisher] (Source: Chest)
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Warfarin May Up Stroke Risk in Those with Irregular Heartbeat
MedlinePlus Health News
12/18/2013 7:00:00 PM
But the risk is temporary as blood thinner use starts, and could be overcome by other means, experts say Source: HealthDay Related MedlinePlus Pages: Atrial Fibrillation, Blood Thinners, Stroke (Source: MedlinePlus Health News)

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Simplified pulmonary vein isolation: Are we there yet?
Heart Rhythm
12/18/2013 7:00:00 PM
Since the observation by Haissaguerre et al that triggers of atrial fibrillation (AF) mapped to the pulmonary veins (PVs), circumferential PV isolation has become the cornerstone of most AF ablation strategies. As efforts have been made to improve the efficacy and safety of PV isolation, there also has been a push to simplify the circumferential ablation process in order to reduce the learning curve and expedite this time-consuming procedure. The ongoing challenge of the catheter-based ablation procedure remains: How can we best deliver a complex lesion set in a beating heart? As with all procedures, the answer lies in the interplay of the operator’s skills and the available tools. (Source: Heart Rhythm)
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Warfarin increases risk of stroke among atrial fibrillation patients in first 30 days of use
ESC News and Press
12/18/2013 12:01:15 PM
Patients with atrial fibrillation – an irregular and often abnormally fast heartbeat – have nearly double the risk of suffering a stroke in the first 30 days after starting to take the anti-clotting drug warfarin compared to non-users, according to a study of over 70,000 patients. Read more Topics: Arrhythmias, Atrial Fibrillation (Source: ESC News and Press)
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New Trial Confirms Role For Pradaxa In Venous Thromboembolism
Forbes.com Healthcare News
12/18/2013 10:19:00 AM
A new study helps support a role for  the new oral anticoagulant dabigatran (Pradaxa, Boehringer Ingelheim) in patients with venous thrombosis (VTE).  The RE-COVER II trial, published online in Circulation, confirms the finding of the earlier and highly similar RE-COVER trial, published in the New England Journal of Medicine in 2009, that dabigatran is as safe and effective as warfarin for the treatment of  deep vein thrombosis (DVT) and pulmonary embolism (PE). Dabigatran is currently approved only for the treatment of stroke prevention in patients with non-valvular atrial fibrillation. (Source: Forbes.com Healthcare News)
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Positioning of the ablation catheter in total endoscopic ablation
Interactive CardioVascular and Thoracic Surgery
12/18/2013
Minimally invasive ablation of atrial fibrillation is an option in patients not suitable for or refractory to catheter ablation. Total endoscopic ablation can be performed via a monolateral approach, whereby a left atrial box lesion is created. If the ablation is introduced from the right side, the positioning of the ablation catheter on the partly hidden left pulmonary veins is of vital importance. Using thoracoscopy in combination with multiplane transoesophageal echocardiography, the anatomical position of the ablation catheter can be established. Our experience in over 60 procedures has confirmed this to be a safe technique of total endoscopic ablation. (Source: Interactive CardioVascular and Thoracic Surgery)
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Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation.
Archives of Cardiovascular Diseases
12/18/2013
CONCLUSION: Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection. PMID: 24361056 [PubMed - as supplied by publisher] (Source: Archives of Cardiovascular Diseases)
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Prevalence of interatrial block in patients undergoing coronary bypass graft surgery
International Journal of Cardiology
12/18/2013
Interatrial block (IAB) is caused by conduction delay between the right and left atria (P-wave duration ≥120ms) and has been found to be associated with development of atrial tachyarrhythmias, most commonly atrial fibrillation (AF). It can be associated with left atrial enlargement, and it can also represent a risk factor for systemic thromboembolic events due to abnormal left atrial contraction. IAB is caused by abnormal conduction over the Bachmann's bundle, resulting in a delay of left atrial depolarization . (Source: International Journal of Cardiology)
http://www.medworm.com/rss/comments.php?id=11220311
The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20‐year registry
International Journal of Clinical Practice
12/17/2013
ConclusionsOur study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in‐hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation. (Source: International Journal of Clinical Practice)
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Novel Oral Anticoagulants in Cardiovascular Disease
Journal of Cardiovascular Pharmacology and Therapeutics
12/17/2013
Nonvalvular atrial fibrillation (AF) confers an increased risk of thromboembolism, with a 5-fold higher risk of ischemic stroke. Oral anticoagulation (OAC) has shown to be highly effective in preventing stroke and mortality compared to placebo and is also used in patients without AF for both treatment and prophylaxis of venous thromboembolism. The OAC halts the coagulation by different mechanisms. Until recently, the only option was the vitamin K antagonists (VKAs), but their inherent limitations have promoted the development of novel oral anticoagulants (NOACs), which may offer efficacious and safer alternatives. Patients should be carefully selected to receive the most suitable treatment for each one. As the VKA efficacy and safety largely rely on the time the patient remains within the ...
http://www.medworm.com/rss/comments.php?id=7859723
Letter by Morris et al Regarding Article, "Low Heart Rates Predict Incident Atrial Fibrillation in Healthy Middle-Aged Men" by Grundvold et al [Correspondence]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
(Source: Circulation: Arrhythmia and Electrophysiology)

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Response to Letter by Morris et al Regarding Article, "Low Heart Rates Predict Incident Atrial Fibrillation in Healthy Middle-Aged Men" by Grundvold et al [Correspondence]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
(Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=7859776
Atrial Tachycardia After Ablation of Persistent Atrial Fibrillation: Is It Us or Them? [Editorials]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
(Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=7859778
Unipolar Electrogram Morphology to Assess Lesion Formation During Catheter Ablation of Atrial Fibrillation: Successful Translation Into Clinical Practice [Editorials]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
(Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=7859779
Wave-Mapping as a Guide for Ablation of Atrial Fibrillation: A Daydream? [Editorials]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
(Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=7859781
Prognostic Role of Subsequent Atrial Tachycardias Occurring During Ablation of Persistent Atrial Fibrillation: A Prospective Randomized Trial [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— Catheter ablation of subsequent ATs increases freedom from AF but not AT, suggesting a contributing role of subsequent ATs in the mechanisms of persistent AF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01896570. (Source: Circulation: Arrhythmia and Electrophysiology)

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Adenosine-Induced Pulmonary Vein Ectopy as a Predictor of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— Adenosine-induced PV ectopy is a predictor of recurrent AF after PV isolation and may be a marker of increased susceptibility to autonomic triggers of AF. (Source: Circulation: Arrhythmia and Electrophysiology)
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Intracardiac Echocardiography for Detection of Thrombus in the Left Atrial Appendage: Comparison With Transesophageal Echocardiography in Patients Undergoing Ablation for Atrial Fibrillation: The Action-Ice I Study [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— ICE can be used safely and effectively for the evaluation of LAA in patients undergoing atrial fibrillation ablation. ICE imaging from pulmonary artery is accurate for LAA visualization. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01371279. (Source: Circulation: Arrhythmia and Electrophysiology)
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Complications of Catheter Ablation of Atrial Fibrillation: A Systematic Review [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— Catheter ablation of atrial fibrillation has a low incidence of periprocedural complications. The acute complication rate has decreased significantly in recent years. This may reflect improved catheter technology and experience. The use of different strategies across centers worldwide seems to be safe with no established relationship between procedural variables and complication rate. (Source: Circulation: Arrhythmia and Electrophysiology)
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Catheter Ablation of Atrial Fibrillation in Hypertrophic Cardiomyopathy: Long-Term Outcomes and Mechanisms of Arrhythmia Recurrence [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— PV isolation in patients with hypertrophic cardiomyopathy is feasible and safe, although is not effective in preventing late (≥1 year) AF recurrences in 50% of patients. Non-PV triggers seem to be responsible of late recurrences, which supports the appropriateness of a more extensive ablation beyond PV isolation to improve the long-term arrhythmia-free survival. (Source: Circulation: Arrhythmia and Electrophysiology)
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Unipolar Signal Modification as a Guide for Lesion Creation During Radiofrequency Application in the Left Atrium: Prospective Study in Humans in the Setting of Paroxysmal Atrial Fibrillation Catheter Ablation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— Unipolar signal modification is a useful end point for radiofrequency energy delivery in patients with paroxysmal atrial fibrillation who undergo PVI and leads to a substantial midterm sinus rhythm maintenance rate. (Source: Circulation: Arrhythmia and Electrophysiology)

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Pulmonary Vein Isolation Using a Pace-Capture-Guided Versus an Adenosine-Guided Approach: Effect on Dormant Conduction and Long-Term Freedom From Recurrent Atrial Fibrillation--A Prospective Study [Original Articles]
Circulation: Arrhythmia and Electrophysiology
12/17/2013
Conclusions— The use of high-output pacing post-PV isolation results in a significant reduction in the incidence of dormant conduction with a comparable long-term freedom from recurrent atrial fibrillation (versus adenosine-guided ablation). The use of these approaches requires evaluation in a long-term prospective randomized study. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980 (Source: Circulation: Arrhythmia and Electrophysiology)
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World Health Organization study: Atrial fibrillation is a growing global health concern
EurekAlert! - Medicine and Health
12/17/2013
(Cedars-Sinai Medical Center) Atrial fibrillation, long considered the most common condition leading to an irregular heartbeat, is a growing and serious global health problem, according to the first study ever to estimate the condition's worldwide prevalence, death rates and societal costs. (Source: EurekAlert! - Medicine and Health)
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Red cell distribution width in patients with atrial fibrillation
Journal of Internal Medicine
12/17/2013
This article is protected by copyright. All rights reserved. (Source: Journal of Internal Medicine)

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A Rising Tide: The Global Epidemic of Atrial Fibrillation.
Circulation
12/17/2013
Authors: Alonso A, Bengtson LG Abstract In his seminal lecture to the Massachusetts Medical Society in 1997, Dr. Eugene Braunwald pointed to atrial fibrillation (AF) as an emerging epidemic of cardiovascular disease.(1) At that time, information on the burden-prevalence, incidence, and associated outcomes-of AF in the general population was limited to a few epidemiologic studies, most of them conducted in the United States and Western Europe. Since then, dozens of publications have contributed to provide a clearer picture of the real impact of AF. These publications confirmed Dr. Braunwald's prediction, demonstrating that AF is the most common sustained arrhythmia in clinical practice and a major public health concern. In the last couple of years, two systematic reviews of the lite...
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Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study.
Circulation
12/17/2013
CONCLUSIONS: These findings provide evidence of progressive increases in overall burden, incidence, prevalence and AF-associated mortality between 1990-2010. Systematic, global surveillance of AF is required to better direct prevention and treatment strategies. PMID: 24345399 [PubMed - as supplied by publisher] (Source: Circulation)
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Effect of Percutaneous Closure of Patent Foramen Ovale on Post-Procedural Arrhythmias
Journal of the American College of Cardiology: Cardiovascular Interventions
12/16/2013 6:21:27 PM
Atrial arrhythmias after percutaneous patent foramen ovale (PFO) closure, including atrial fibrillation (AF), has been consistently reported in different series suggesting a causal link between mechanical closure of PFO and the new onset of post-procedural arrhythmias (1,2,3). We have systematically assessed the effect of percutaneous PFO closure upon the development of post-procedural arrhythmias in 221 consecutive patients (144 women; mean age 48 ± 13 years) undergoing percutaneous PFO closure. At clinical evaluation, no patient had symptoms indicative or suggestive of arrhythmias. Indications for closure were the presence of significant (grade >1) basal or Valsalva-induced right-to-left atrial shunt (RLS) at contrast transthoracic echocardiography (TTE) associated with cryptogenic stro...
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'Preferred' management of atrial fibrillation in Europe
Europace
12/16/2013
(Source: Europace)

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Atrial flutter with 1 : 1 atrioventricular conduction after administration of vernakalant for atrial fibrillation
Europace
12/16/2013
(Source: Europace)
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Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF)
Europace
12/16/2013
Conclusion The management of AF patients in 2012 has adapted to recent evidence and guideline recommendations. Oral anticoagulant therapy with VKA (majority) or NOACs is given to over 80% of eligible patients, including those at risk for bleeding. Rate is often adequately controlled, and rhythm control therapy is widely used. (Source: Europace)
http://www.medworm.com/rss/comments.php?id=7855143
A prospective evaluation of haemodynamics, functional status, and quality of life after radiofrequency catheter ablation of long-standing persistent atrial fibrillation
Europace
12/16/2013
Conclusion Ablation of long-standing persistent atrial fibrillation was associated with significant recovery of haemodynamics and exercise capacity that projected onto the long-term improvement in quality of life. (Source: Europace)
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Lone atrial fibrillation as a positive predictor of left atrial volume reduction following ablation of atrial fibrillation
Europace
12/16/2013
Conclusion Based on the subgroup of patients with lone AF, PVI leads to a significant LAVR 4 months after the procedure, especially in patients with clinical success in terms of AF freedom. Comorbidities such as arterial hypertension may prevent this reverse atrial remodelling, despite AF freedom. Clinical implications need to be further elucidated. (Source: Europace)
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Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation: a matched group comparison
Europace
12/16/2013
Conclusion In present matched study comparing a surgical with transcatheter PVI treatment strategy in symptomatic AF patients failed on AADs, but without prior ablations, a surgical PVI strategy was more effective to prevent recurrence of atrial arrhythmias, than a transcatheter PVI treatment strategy. However, complications were more frequent with surgical PVI. (Source: Europace)

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Early mortality in prophylactic implantable cardioverter-defibrillator recipients: development and validation of a clinical risk score
Europace
12/16/2013
Conclusion A simple risk score based on age, LVEF, eGFR, and atrial fibrillation can identify patients at low, intermediate, and high risk for early mortality after ICD implantation. This may be helpful in the risk assessment of ICD candidates. (Source: Europace)
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Should catheter atrial fibrillation ablation be considered as a 'high bleeding risk' intervention?
Europace
12/16/2013
(Source: Europace)
http://www.medworm.com/rss/comments.php?id=7855169
Role of imaging in assessment of atrial fibrosis in patients with atrial fibrillation: state-of-the-art review
European Journal of Echocardiography
12/16/2013
Atrial fibrillation (AF) is the most common arrhythmia in the world. Despite the large number of studies focused on the causes and mechanisms of AF, it remains a clinical challenge. Atrial electrical and structural remodelling caused by AF is responsible for the perpetuation of the arrhythmia. However, a validated noninvasive method for assessment of atrial fibrosis in clinical practice is lacking. In this review, we aim to present an update about the origins and mechanisms of atrial remodelling, particularly focusing on atrial fibrosis, and compare imaging techniques that can detect atrial changes and greatly contribute to the clinical management of patients with AF. (Source: European Journal of Echocardiography)
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Aorto-right atrial fistula: a rare complication of trans-septal puncture and catheter ablation for atrial fibrillation
European Journal of Echocardiography
12/16/2013
(Source: European Journal of Echocardiography)

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Mechanisms With Clinical Implications for Atrial Fibrillation-Associated Remodeling: Cathepsin K Expression, Regulation, and Therapeutic Target and Biomarker [Arrhythmia and Electrophysiology]
JAHA:Journal of the American Heart Association
12/16/2013
Conclusions These data indicated that increased plasma CatK levels are linked with the presence of AF. Angiotensin type 1 receptor antagonist appears to be effective in alleviating atrial fibrosis in a rabbit AF model, partly reducing angiotensin type 1 receptor-p38mitogen-activated protein kinase-dependent and -independent CatK activation, thus preventing AF. (Source: JAHA:Journal of the American Heart Association)
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Airflow Obstruction, Lung Function, and Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study.
Circulation
12/16/2013
CONCLUSIONS: In this large population-based study with a long term follow-up, reduced FEV1 and obstructive respiratory disease were inversely - associated with a higher AF incidence after adjusting for measured confounders. PMID: 24344084 [PubMed - as supplied by publisher] (Source: Circulation)
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Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation
International Journal of Cardiology
12/16/2013
Abstract: Background: Left atrium (LA) dilation and P-wave duration are linked to the amount of endurance training and are risk factors for atrial fibrillation (AF). The aim of this study was to evaluate the impact of LA anatomical and electrical remodeling on its conduit and pump function measured by two-dimensional speckle tracking echocardiography (STE).Method: Amateur male runners >30years were recruited. Study participants (n=95) were stratified in 3 groups according to lifetime training hours: low (4500h, n=30).Results: No differences were found, between the groups, in terms of age, blood pressure, and diastolic function. LA maximal volume (30±5, 33±5 vs. 37±6ml/m2, p (Source: International Journal of Cardiology)
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Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome
International Journal of Cardiology
12/16/2013
Thrombosis prevention in atrial fibrillation is a very common problem for cardiologists. Low molecular weight heparin bridging therapy (LMWH-BT) has been considered in patients at high risk of thromboembolism during the start or temporary interruption of oral anticoagulation therapy . Several cases of treatment failure of LMWH-BT have been reported . A 70-year-old man, with a history of arterial hypertension, recurrent atrial fibrillation and mild aortic valve stenosis in oral anticoagulant therapy , came to our observation for inferior STEMI (A) complicated by total BAV (B). In urgency was inserted PM temporary and revascularized with double DES for thrombotic occlusion of the proximal right coronary artery. The current therapy with LMWH was standardized according to body weight, beta-blo...
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Hybrid Surgical and Catheter Treatment for Atrial Fibrillation.
ISRN Cardiology
12/16/2013
Authors: Kaneko T, Aranki SF Abstract Advances in surgery for atrial fibrillation from cut and sew technique to thoracoscopy and new energy source have enabled minimally invasive approach which avoids median sternotomy and cardiopulmonary bypass. However, minimally invasive approach is unable to match the outcome of classic surgical technique due to difficulty in creating some of linear ablation lines. Hybrid procedure using catheter mapping and ablation in addition to minimally invasive surgical ablation has gained interest to combine the advantages of both procedures. No large study has been conducted to date comparing this new technique to other existing treatments. The aim of this paper is to review the data on hybrid procedure for atrial fibrillation and assess its early outco...

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Doppler flow signals in small amount pericardial effusion after radiofrequency ablation
International Journal of Cardiology
12/16/2013
A 59-year-old man underwent radiofrequency ablation for chronic atrial fibrillation. The angiogram was normal. The left and right atriums is significantly dilated, no thrombi was detected in the atriums and atrial appendage by transesophageal echocardiography. Post-ablation, sinus rhythm was return. He was started on amiodarone. (Source: International Journal of Cardiology)
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Atrial fibrillation from the pathologist’s perspective
Cardiovascular Pathology
12/15/2013 7:00:00 PM
Abstract: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia encountered in clinical practice, is associated with increased morbidity and mortality. Electrophysiologically, it is characterized by a high rate of asynchronous atrial cell depolarization causing a loss of atrial contractile function and irregular ventricular rates. For a long time, AF was considered as a pure functional disorder without any structural background. Only in recent years, have new mapping and imaging techniques identified atrial locations, which are very often involved in the initiation and maintenance of this supraventricular arrhythmia (i.e. the distal portion of the pulmonary veins and the surrounding atrial myocardium). Morphological analysis of these myocardial sites has demonstrated signi...
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Comparison of the Frequency of Atrial Fibrillation in Young Obese Versus Young Nonobese Men Undergoing Examination for Fitness for Military Service
The American Journal of Cardiology
12/15/2013 7:00:00 PM
The association between body mass index (BMI) in young adulthood and long-term risk of atrial fibrillation (AF) has not yet been examined for men. We conducted a population-based 36-year cohort study to examine the BMI-associated risk of AF in 12,850 young men who had BMI measured at their examination of fitness for military service. AF was identified from the Danish National Registry of Patients, covering all Danish hospitals since 1977. We began follow-up on the twenty-second birthday of each subject and continued until the occurrence of AF, emigration, death, or December 31, 2012. We used Cox regression to compute hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for education and height. The cohort contributed a total of 375,888 person-years of follow-up and the median...
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Unanswered Questions in Patients With Concurrent Atrial Fibrillation and Acute Coronary Syndrome
The American Journal of Cardiology
12/15/2013 7:00:00 PM
In conclusion, until the results of additional ongoing or planned randomized trials are known, clinicians must continue to rely on expert opinion and their own clinical judgment when treating these patients. (Source: The American Journal of Cardiology)
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Surgical Treatment of Atrial Fibrillation: Today’s Questions and Answers
Seminars in Thoracic and Cardiovascular Surgery
12/14/2013 8:15:41 AM
Although atrial fibrillation is common in cardiac surgery patients, the Cox maze IV procedure is underutilized; in contemporary practice, most cardiac surgery patients with atrial fibrillation do not receive concomitant surgical ablation. Available evidence suggests that a biatrial, energy-assisted Cox maze IV procedure restores normal sinus rhythm in two-thirds to three-quarters of patients without increasing operative risk. The best results are obtained by adherence to the correct lesion set and careful attention to perioperative management of heart rhythm and anticoagulation. To date, we have no randomized clinical trials confirming that surgical ablation improves clinical outcomes beyond restoration of sinus rhythm; however, available evidence does suggest that concomitant surgical abl...

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Should We Treat Nonsleepy Patients with Obstructive Sleep Apnea and Atrial Fibrillation with CPAP?
Journal of Clinical Sleep Medicine : JCSM
12/14/2013 7:15:03 AM
(Source: Journal of Clinical Sleep Medicine : JCSM)
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Atrial fibrillation in athletes and the interplay between exercise and health
European Heart Journal
12/14/2013
(Source: European Heart Journal)
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High-Risk Afib Needs More Aggressive Tx (CME/CE)
MedPage Today Cardiovascular
12/13/2013 10:02:09 AM
(MedPage Today) -- Even though patients with both atrial fibrillation and atherothrombotic disease had a high long-term risk of adverse cardiovascular outcomes, use of anticoagulants remained relatively low, an international registry showed. (Source: MedPage Today Cardiovascular)

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Impact of a 4q25 Genetic Variant in Atrial Flutter and on the Risk of Atrial Fibrillation After Cavotricuspid Isthmus Ablation
Journal of Cardiovascular Electrophysiology
12/13/2013
ConclusionsOur study demonstrates that Afl, whether occurring in isolation or along with AF, is associated with the rs2200733 AF risk allele. Genetic carrier status of rs2200733 failed to predict an increased risk of incident or recurrent AF following catheter ablation for Afl. These findings suggest that the causal mechanism associated with rs2200733 is germane to both AF and Afl. (Source: Journal of Cardiovascular Electrophysiology)
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The Impact of Age on the Epidemiology of Atrial Fibrillation Hospitalizations
The American Journal of Medicine
12/13/2013
Abstract: Background: Given that 4 million individuals in the United States have atrial fibrillation, understanding the epidemiology of this disease is crucial. We sought to identify and characterize the impact of age on national atrial fibrillation hospitalization patterns.Methods: The study sample was drawn from the 2009-2010 Nationwide Inpatient Sample. Patients hospitalized with a principal International Classification of Diseases, 9th Revision discharge diagnosis of atrial fibrillation were included. Patients were categorized as “older” (≥65 years) or “younger” ( (Source: The American Journal of Medicine)
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Irregular Heartbeat Tied to Depression
MedlinePlus Health News
12/12/2013 5:37:52 PM
People with an irregular heartbeat may also be at increased risk of being depressed, suggests a new study from Germany.Source: Reuters Health Related MedlinePlus Pages: Atrial Fibrillation, Depression (Source: MedlinePlus Health News)
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FDA Panel Gives Support To Novel Stroke Prevention Device From Boston Scientific
Forbes.com Healthcare News
12/12/2013 11:04:00 AM
The FDA's Circulatory System Devices Panel yesterday gave a vote of confidence to Boston Scientific's Watchman left atrial appendage closure device for the prevention of stroke in atrial fibrillation patients. By a large majority the panel agreed that the device was effective, that it was safe, and that the benefits outweighed the risks. In each case the vote was 13-1. (Source: Forbes.com Healthcare News)
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Oral Anticoagulation Therapy for Elderly Patients With Atrial Fibrillation: Utility of Bleeding Risk Covariates to Better Understand and Moderate Risks
Clinical and Applied Thrombosis/Hemostasis
12/12/2013
Elderly individuals are prone to nonvalvular atrial fibrillation (AF) with associated risks of arterial thromboembolic disease. Despite definitive guidelines, oral anticoagulant therapy (OAC) is notoriously underutilized in patients with AF. Physicians cite excessive bleeding risk as one reason they omit OAC for their older patients with AF. Improved understanding of the pathophysiology of age-related bleeding may improve risk–benefit assessments for warfarin and newer antithrombotic agents. We reviewed the literature to identify age-related pathophysiological elements that can exacerbate the likelihood of bleeding. In the context of the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcoh...
http://www.medworm.com/rss/comments.php?id=7846551
The Effects of Vitamin D Deficiency on Atrial Fibrillation
Clinical and Applied Thrombosis/Hemostasis
12/12/2013
Conclusion: As a result, our study revealed a relationship between vitamin D deficiency and nonvalvular AF. (Source: Clinical and Applied Thrombosis/Hemostasis)
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Are Geriatric Syndromes Associated with Reluctance to Initiate Oral Anticoagulation Therapy in Elderly Adults with Nonvalvular Atrial Fibrillation?
Journal of the American Geriatrics Society
12/12/2013
(Source: Journal of the American Geriatrics Society)

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Evaluation of patients' attitudes towards stroke prevention and bleeding risk in atrial fibrillation.
Thrombosis and Haemostasis
12/12/2013
In conclusion, there was a substantial amount of inter-patient variability, and often extreme differences in opinion regarding tolerance of bleeding risk in the context of stroke prevention in atrial fibrillation. These findings highlight the importance of considering patient preferences when deciding on SPAF therapy. PMID: 24337399 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
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Experimental evaluation of the cardiac rhythm originating in myocardial sleeves of pulmonary veins using a monophasic action potential.
Physiological Research
12/12/2013
Authors: Kittnar O, Yang SG, Mlček M Abstract Spontaneous depolarization similar to that from the sinus node was documented from the myocardial sleeves of pulmonary veins (PV) after isolation procedures. It was then hypothesized that sinus node-like tissue is present in the PVs of humans. Based on a number of features, the myocardium of myocardial sleeves (MS) is highly arrhythmogenic. Membrane potentials originating from MS are invariably recordable at the PVs ostia in patients with atrial fibrillation (AF) and delayed conduction around the PVs ostia may play a role in re-entry process responsible for the initiation and maintenance of AF. Diagnostic and therapeutic evidence of premature atrial beats induced in MS of PVs and resulting in launch of AF was detected by 3D electroanat...
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Watchman Afib Device Wins FDA Panel Nod
MedPage Today Cardiovascular
12/11/2013 7:43:00 PM
(MedPage Today) -- GAITHERSBURG, Md. -- A panel of FDA advisers gave strong backing to an implantable device that's an alternative to blood-thinners for stroke prevention in patients with atrial fibrillation. (Source: MedPage Today Cardiovascular)
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Associations between atrial fibrillation and early outcomes of patients with heart failure and reduced or preserved ejection fraction
American Heart Journal
12/11/2013 7:00:00 PM
Conclusions: Atrial fibrillation was associated with higher 30-day mortality among patients with heart failure with preserved EF but not reduced EF. The association of atrial fibrillation with 30-day readmission was modest and did not differ by heart failure type. (Source: American Heart Journal)
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NOACs Cut Brain Bleed Risk in Afib (CME/CE)
MedPage Today Primary Care
12/11/2013 8:00:00 AM
(MedPage Today) -- The new oral anticoagulants consistently reduced the risk of intracranial hemorrhage when used for stroke prevention in patients with nonvalvular atrial fibrillation, a meta-analysis showed. (Source: MedPage Today Primary Care)

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National Survey of Patients With AF in the Acute Medical UnitNational Survey of Patients With AF in the Acute Medical Unit
Medscape Today Headlines
12/11/2013 12:27:14 AM
Acute medical units represent the first point of assessment and care for many patients with atrial fibrillation. How do they stack up according to patients? British Journal of Cardiology (Source: Medscape Today Headlines)
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Safety of percutaneous left atrial appendage closure with the amplatzer cardiac plug in patients with atrial fibrillation and contraindications to anticoagulation
Catheterization and Cardiovascular Interventions
12/11/2013
Conclusion: Percutaneous LAA closure with the ACP in patients with contraindications to oral anticoagulation is safe. The stroke and bleeding risk after percutaneous LAA closure is lower than predicted by conventional risk scores. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
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Boston Scientific May Face A Tough FDA Panel
Forbes.com Healthcare News
12/10/2013 4:56:00 PM
On Wednesday the FDA's Circulatory System Devices Panel will once again review Boston Scientific's Watchman left atrial appendage closure device for the prevention of stroke in atrial fibrillation patients (click here for the meeting materials). The panel will be the latest chapter in the long and contentious story of the Watchman. In 2010 the FDA issued a complete response letter and earlier this year a scandal broke out when the American College of Cardiology cancelled a prestigious late-breaking clinical trial presentation of the PREVAIL trial after the company broke an embargo by giving trial results to investors. (Source: Forbes.com Healthcare News)
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Watchman Afib Device Gets Second Chance
MedPage Today Cardiovascular
12/10/2013 1:43:00 PM
(MedPage Today) -- The Watchman transcatheter left atrial appendage closure device will be considered again by an FDA advisory committee for the prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation. (Source: MedPage Today Cardiovascular)
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Results of percutaneous closure of patent foramen ovale with the GORE ® Septal Occluder
Catheterization and Cardiovascular Interventions
12/10/2013
Conclusion. PFO closure with the GSO is accompanied by a high technical success rate and closure rates similar to other currently used devices. The incidence of atrial fibrillation was higher than reported with most other devices. This may be a chance finding but warrants further investigation in larger trials. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
http://www.medworm.com/rss/comments.php?id=7836711
Characterization of a novel multifunctional resveratrol derivative for the treatment of atrial fibrillation
British Journal of Pharmacology
12/10/2013
Conclusion and ImplicationsC1 behaved as a promising multifunctional small molecule targeting a number of key pathways involved in AF. (Source: British Journal of Pharmacology)
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Conjugate upward gaze paralysis with unilateral ptosis caused by a unilateral midbrain infarction
Journal of Neurology, Neurosurgery and Psychiatry
12/10/2013
A 73-year-old woman with atrial fibrillation presented with a sudden right hemiparesis, with diplopia and left ptosis, and was admitted at an Emergency Unit. The neurological examination found fluctuations on consciousness level, predominant crural right hemiparesis and right central facial paralysis without sensitive abnormalities. The first ophthalmological evaluation showed normal pupillary reflexes, total left ptosis and paresis of adduction of the left eye, with conjugated horizontal palsy for right gaze and conjugated vertical palsy for upward and downward gaze on saccadic and smooth pursuit eye movements. The convergence showed paresis of left eye, with reactive pupils, and oculocephalic test was normal. A head CT had no acute ischaemic signs, and after 4 days, she was discharg...

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A novel PITX2c loss-of-function mutation associated with familial atrial fibrillation.
European Journal of Medical Genetics
12/10/2013
Authors: Wang J, Zhang DF, Sun YM, Yang YQ Abstract Atrial fibrillation (AF) represents the most prevalent form of sustained cardiac arrhythmia and contributes substantially to cardiovascular morbidity and mortality. Aggregating evidence demonstrates that genetic risk factors play an important role in the pathogenesis of AF. However, AF is a genetically heterogeneous disease and the genetic defects responsible for AF in an overwhelming majority of patients remain unclear. In the present study, the whole coding region and splice junction sites of the PITX2c gene, which encodes a paired-like homeobox transcription factor essential for normal cardiovascular development, were sequenced in 160 unrelated patients with lone AF, and a novel heterozygous mutation, c.349C > T equivalent...
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Anticoagulation therapy: Edoxaban noninferior to warfarin in patients with AF
Nature Reviews Cardiology
12/10/2013
Nature Reviews Cardiology 11, 66 (2014). doi:10.1038/nrcardio.2013.206 Author: Alexandra Roberts Two different dose regimens of the direct oral factor Xa inhibitor edoxaban have been shown to be noninferior to warfarin for stroke prevention in patients with atrial fibrillation (AF). These findings from the ENGAGE AF-TIMI 48 trial were presented at the 2013 AHA Scientific Sessions (Source: Nature Reviews Cardiology)
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Pre-Existing Dementia in Octagenerians with Acute Ischemic Stroke
Neurobiology of Aging
12/9/2013 10:01:15 PM
To investigate the prevalance of pre-existing dementia and vascular risk factors in hospitalized octaganerians with acute ischemic stroke. Study subjects were selected from neurology inpatient records of Haseki Research and Education Hospital and included inpatients over 80 years old with acute ischemic stroke between January 2010 and July 2013. Their medical records were reviewed, and the rates of hypertension, diabetes mellitus, atrial fibrillation and dementia were calculated. (Source: Neurobiology of Aging)
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Atrial Fibrillation Predicts Cognitive Impairment in Patients With Ischemic Stroke
Neurobiology of Aging
12/9/2013 10:01:11 PM
Atrial fibrillation (AF) is considered as a risk factor for cognitive impairment. This retrospective chart review study was conducted in a patient stroke rehabilitation ward of a university-affiliated referral hospital. The participants were 707 patients admitted for a standard rehabilitation course after an ischemic stroke. Cognitive status was assessed by the Mini-Mental State Examination (MMSE), and scores lower than 24 points were considered as suggestive of cognitive impairment. (Source: Neurobiology of Aging)
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Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation A Randomized Clinical Trial
Journal of the American College of Cardiology: Cardiovascular Interventions
12/9/2013 6:21:02 PM
ConclusionsAddition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. (Circumferential Versus Ganglionated Plexi Ablation for Atrial Fibrillation [AF]; NCT00671905) (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Ganglionated Plexus Ablation in Patients Undergoing Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Here We Go Again ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
12/9/2013 6:21:02 PM
The role of the pulmonary veins (PVs) in initiating (1,22) and maintaining (3,44) paroxysms of atrial fibrillation (AF) has been well documented. The fact that the arrhythmia can be eliminated in ∼90% of patients undergoing antral PV isolation (5) also speaks to the critical role of the thoracic veins in patients with paroxysmal AF. However, these outcomes are attained at the expense of repeat procedures, most often for PV reconnection. Although these results are encouraging and can be realized with a low risk of complications at experienced centers, the potential for late recurrence years after the ablation procedure is sobering (6). In an effort to improve outcomes, several adjunctive targets have been promulgated, including complex, fractionated atrial electrograms (CFAEs) (7), left a...
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Unveiling the Remodeled Atrium: Lessons from the Early Recurrence of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
12/9/2013
(Source: Journal of Cardiovascular Electrophysiology)
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Impact of Structural Heart Disease on the Acute Complication Rate in Atrial Fibrillation Ablation
Journal of Cardiovascular Electrophysiology
12/9/2013
ConclusionIn general, CA of AF has a low number of severe complications. In our prospective registry HHD emerged as an independent predictor of severe, nonfatal complications during AF ablation but other SHD including CAD and CM did not. The influence of HHD on the complication rate should be considered in patient selection. (Source: Journal of Cardiovascular Electrophysiology)
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Role of Arrhythmogenic Superior Vena Cava on Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
12/9/2013
ConclusionsIn a subset of patients, SVC plays a role in AF not only as an initiator/trigger but also as a driver/perpetuator.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Efficacy and Safety of Dabigatran Compared with Warfarin in Relation to Baseline Renal Function in Patients with Atrial Fibrillation: A RE-LY Trial Analysis.
Circulation
12/9/2013
CONCLUSIONS: The efficacy of both dosages of dabigatran was consistent with the overall trial irrespective of renal function. However, with the CKD-EPI and MDRD equations both dabigatran doses displayed significantly lower rates of major bleeding in patients with GFR ≥80 ml/min. CLINICAL TRIAL REGISTRATION INFORMATION: www.clinicaltrials.gov. Identifier: NCT00262600. PMID: 24323795 [PubMed - as supplied by publisher] (Source: Circulation)

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Serum sRANKL/OPG predict recurrence after radiofrequency catheter ablation of lone atrial fibrillation
International Journal of Cardiology
12/9/2013
Conclusions: Baseline serum high sRANKL level and sRANKL/OPG ratio are associated with AF recurrence after primary ablation procedure in lone AF patients, and may be used in the prediction of AF recurrence in these patients. (Source: International Journal of Cardiology)
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Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry
International Journal of Cardiology
12/9/2013
Abstract: Background: Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events. The long-term prognostic implications of AF in patients with atherothrombosis are unknown.Methods: We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry, an international, prospective cohort of patients with established atherosclerotic arterial disease (CAD, CVD, PAD) or at least 3 risk factors (RFO).Results: AF status and 4year follow-up data were available on 44,518 patients. The prevalence of AF at baseline was 10.3% (n=4582). Overall, patients with AF had approximately a 2-fold increase in the composite of CV death, MI, or stroke compared with patients without AF after adjustment for age, gender, prior ...
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Does the amount of atrial mass reduction improve clinical outcomes after radiofrequency catheter ablation for long-standing persistent atrial fibrillation? Comparison between linear ablation and defragmentation
International Journal of Cardiology
12/9/2013
Conclusion: Conduction block through linear lines+PVI was an efficient ablation strategy for L-PeAF, whereas the AMR amount did not influence clinical outcomes. (Source: International Journal of Cardiology)
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Sequencing deeper to find the genetic mechanism of atrial fibrillation
Heart Rhythm
12/8/2013 7:00:00 PM
The principle of inheritance as originally described by Gregor Mendel through his pea experiments in the 1860s laid the foundation for modern genome-wide association studies (GWAS). Although Mendelian genetics allowed the identification of the first genetic diseases such as cystic fibrosis and Duchene muscular dystrophy, “Mendelian” diseases are rare. Many common diseases, such as atrial fibrillation, are inheritable, but have multifaceted genetic components that cannot be determined using Mendelian genetics. (Source: Heart Rhythm)
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Tissue velocity imaging of the left atrium predicts response to flecainide in patients with acute atrial fibrillation
Heart Rhythm
12/8/2013 7:00:00 PM
Conclusions: Electro-echocardiographic atrial TVI measurement is a promising noninvasive tool for predicting outcome of pharmacological cardioversion. A short AFCL-TVI and a low AFV-TVI are related to failure of cardioversion of AF using flecainide. (Source: Heart Rhythm)
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Uric Acid Levels in Obstructive Sleep Apnea Patients with Atrial Fibrillation
Archives of Medical Research
12/8/2013 7:00:00 PM
The objective of this observational study was to determine whether there is an association between atrial fibrillation (AF) and uric acid and to identify the risk markers for AF in obstructive sleep apnea (OSA).Methods: Consecutive patients with newly diagnosed OSA were screened at baseline. The final study population consisted of 516 patients. One hundred and eight patients had AF. Demographic, clinical, laboratory, and echocardiographic characteristics were carefully recorded. Logistic regression was used for the multivariate analysis of independent risk factors.Results: Uric acid, triglyceride, high-density lipoprotein, C-reactive protein (CRP), left atrial diameter, interventricular septum thickness, apnea hypopnea index, and Epworth sleepiness scale were significantly higher in OSA pa...
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Renal function and outcomes in anticoagulated patients with non-valvular atrial fibrillation: the AMADEUS trial
European Heart Journal
12/7/2013
Conclusion Renal impairment (CrCl <60 mL/min) doubles the risk of stroke and increased the risk of major bleeding by almost 60% in anticoagulated patients with AF. Renal impairment was additive to stroke risk prediction scores based on a significant NRI, but no significant improvement in discrimination ability (based on c-indexes) for CHA2DS2VASc or CHADS2 was observed. (Source: European Heart Journal)
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New Oral Anticoagulants and the Cancer Patient.
The Oncologist
12/6/2013
Authors: Short NJ, Connors JM Abstract Indications for anticoagulation are common in patients with malignancy. Cancer patients have an increased risk of developing venous thromboembolic events or may have other indications for anticoagulation, such as atrial fibrillation. New oral anticoagulants (NOACs) are now available that offer increased options for anticoagulation beyond the traditional vitamin K antagonists and low molecular weight heparins that have long been the cornerstone of treatment. This review will focus on the three NOACs that are currently approved for use in the U.S.-the direct thrombin inhibitor, dabigatran, and the factor Xa inhibitors, apixaban and rivaroxaban. Oncologists are likely to encounter an increasing number of patients taking these agents at the time o...
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Are the Site and Mode of Termination Matters of Prime Importance in Catheter Ablation of Persistent Atrial Fibrillation?
Circulation Journal
12/6/2013
Authors: Kim YH PMID: 24317111 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Left ventricular geometry and outcomes in patients with atrial fibrillation: The AFFIRM Trial
International Journal of Cardiology
12/6/2013
Conclusion: An easily obtained echocardiographic index of LVH (IVS thickness) may enhance risk stratification of patients with AF, and raise the possibility that LVH regression should be a therapeutic target in this population. (Source: International Journal of Cardiology)
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Atrial natriuretic peptide as a predictor of atrial fibrillation in a male population study. The Study of Men Born in 1913 and 1923
International Journal of Cardiology
12/6/2013
Conclusions: In this population-based longitudinal study, we found that elevated ANP levels at baseline predicted atrial fibrillation during a follow-up time of 16years. (Source: International Journal of Cardiology)
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Don't move during ablation of atrial fibrillation!
International Journal of Cardiology
12/6/2013
Conclusions: Keeping patients motionless may be important to reduce the procedural duration of AF ablation. (Source: International Journal of Cardiology)

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Eastern promises: Additive role of metabolic syndrome for thromboembolic risk stratification in Taiwanese atrial fibrillation patients
Heart Rhythm
12/5/2013 7:00:00 PM
The key to prevention of stroke and other thromboembolic (TE) events in atrial fibrillation (AF) patients is effective risk stratification. Several schemes have been developed that use a combination of factors found to be associated with higher occurrence of TE events. Among the various risk stratification schemes, the CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes, and prior history of stroke) scoring system is the most popular. Although the simplicity of this scoring system has resulted in its wide adoption, a major criticism has been its inability to consistently identify a truly low-risk group of AF patients. To address this deficit, the CHA2DS2-VASc scoring system was developed. This scheme uses all components of the CHADS2 system but with greater emphasis o...
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Large Study Finds Favorable Risk-Benefit Profile For The New Anticoagulants
Forbes.com Healthcare News
12/5/2013 2:44:00 PM
A very large new meta-analysis finds a favorable risk-benefit for the new oral anticoagulant drugs in the setting of atrial fibrillation. The findings, published online in the Lancet, were remarkably consistent for all four of the new agents which have been fighting to replace warfarin, which was the only oral anticoagulant available for decades until the arrival of the new agents. Although warfarin is inexpensive, it has numerous interactions with other drugs and foods and requires regular monitoring and dose adjustments. The new agents can be taken once or twice a day and do not require dose changes. (Source: Forbes.com Healthcare News)
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The Shadow Within: A Colossal Left Atrium
Echocardiography
12/5/2013
Mini‐Abstract A 32‐year‐old male with rheumatic heart disease presented with atrial fibrillation and severe mitral regurgitation. His chest radiograph showed cardiomegaly and the distinctive shadow within shadow appearance of a distended left atrium (LA); echocardiogram revealed an LA dimension of 15.2 × 12.8 cm and cardiac magnetic resonance imaging disclosed a calculated LA volume of 1950 mL, representing one of the largest reported LA sizes in the current literature. (Source: Echocardiography)
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Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms.
Thrombosis and Haemostasis
12/5/2013
The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex. PMID: 24305974 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)

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Can Personalized Medicine And An Adaptive Trial Design Salvage This Hard-Luck Drug?
Forbes.com Healthcare News
12/4/2013 5:37:00 PM
Arca Biopharma today announced that it had received FDA clearance to start a phase 2B/3 trial of its novel beta-blocker, Gencaro (bucindolol) for the prevention of atrial fibrillation in patients with heart failure. The GENETIC-AF trial has all the hallmarks of the modern era: the drug will only be tested in patients with a genetic variation that the company believes may predict a positive response to the drug. And the trial will be one of the first to utilize the much-discussed "adaptive" trial design, starting as a phase 2B study and then possibly expanding to a phase 3 study after an interim analysis of the trial data. (Source: Forbes.com Healthcare News)
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Premature Atrial Contraction Count Improves AF Risk ModelPremature Atrial Contraction Count Improves AF Risk Model
Medscape Today Headlines
12/4/2013 5:32:25 PM
Knowing a patient's premature atrial-contraction counts may help predict future atrial fibrillation, a study reports; an editorial suggests that perhaps more focus should be on earlier detection of existing AF. Heartwire (Source: Medscape Today Headlines)
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New Drugs for Atrial Fibrillation Represent Choices for Clinicians,...
PRWeb: Medical Pharmaceuticals
12/4/2013 4:15:18 PM
Symporia Bioscience Analysis of Novel Oral Anticoagulants reveals the changing landscape for AF at the therapeutic and product levels.(PRWeb December 04, 2013)Read the full story at http://www.prweb.com/releases/2013/12/prweb11384170.htm (Source: PRWeb: Medical Pharmaceuticals)
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Correction
Journal of the American College of Cardiology
12/4/2013 9:18:06 AM
Nakatani Y, Nishida K, Sakabe M, Kataoka N, Sakamoto T, Yamaguchi Y, Iwamoto J, Mizumaki K, Fujiki A, Inoue H. Tranilast Prevents Atrial Remodeling and Development of Atrial Fibrillation in a Canine Model of Atrial Tachycardia and Left Ventricular Dysfunction. J Am Coll Cardiol 2013;61:582–8. (Source: Journal of the American College of Cardiology)
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Mechanisms of persistent atrial fibrillation
Current Opinion in Cardiology
12/4/2013 6:20:27 AM
Purpose of review: Atrial fibrillation is the most common sustained arrhythmia, but its mechanisms are poorly understood. In particular, little is known about the factors that contribute to the establishment of persistent or permanent atrial fibrillation. This review addresses possible common signaling pathways that might promote both structural and electrical remodeling of the atria, thus contributing to atrial fibrillation perpetuation. Recent findings: Sustained atrial fibrillation may trigger an inflammatory response leading to activation of myofibroblasts and to the release of cytokines such as transforming growth factor-β and platelet-derived growth factor, as well as profibrotic proteins such as galectin-3. Activation of signaling cascades involving such proteins is critical for th...

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Screening for undiagnosed atrial fibrillation in the community
Current Opinion in Cardiology
12/4/2013 6:20:27 AM
Purpose of review: Recent years have seen significant advances in knowledge about the prevalence of ‘silent’ atrial fibrillation and the morbidity associated with this condition. Data are emerging on improved strategies for screening, and new technologies for detecting atrial fibrillation are becoming available, making a review of this field timely. Recent findings: Studies suggest that, when screening is performed, undiagnosed atrial fibrillation is present in around 1% of the screened population, rising to 1.4% for those aged at least 65 years. The prevalence of silent atrial fibrillation is even higher in patients with additional risk factors (e.g. those aged 75 years, patients with heart failure). Prolonged monitoring of patients with hypertension and an implanted cardiac device sh...
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Prevention of thromboembolism in the patient with acute coronary syndrome and atrial fibrillation: the clinical dilemma of triple therapy
Current Opinion in Cardiology
12/4/2013 6:20:26 AM
Purpose of review: Atrial fibrillation in patients with acute coronary syndrome (ACS) is associated with a high thromboembolic event rate. Combined oral anticoagulant (OAC) and antiplatelet therapy (APT) are often used to reduce thromboembolic risk, recurrent coronary ischemic events, and stent thrombosis, despite the high bleeding risk. This review is timely with the recent introduction of novel OACs (NOACs), more potent antiplatelet agents, and second-generation coronary stents with a lower risk of late stent thrombosis, and considers strategies and new opportunities to reduce both thrombotic events and bleeding. Recent findings: The benefits of NOACs in patients with atrial fibrillation have been shown in recent studies. New evidence indicates that single rather than dual APT may be ade...
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Atrial fibrillation in patient with concealed Wolff-Parkinson-White syndrome.
Polish Heart Journal
12/4/2013 6:19:50 AM
We present a case of 33-year-old woman suffered from palpitations and syncope. ECG was normal at the rest and showed irregular tachycardia with wide QRS complex (HR > 300/min) during the effort. The patient was admitted to our department in order to perform detailed diagnostics and therapy. Based on electrophysiological study we found and ablated numerous concealed accessory pathways. During 1 year observation patient stay assymptomatic. PMID: 24297723 [PubMed - in process] (Source: Polish Heart Journal)
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[Does a high percentage of right ventricular pacing influence the incidence of paroxysmal atrial fibrillation in myotonic dystrophy type 1 patients?].
Polish Heart Journal
12/4/2013 6:19:50 AM
CONCLUSIONS: In a 12-month follow-up comparison, we showed a statistically significant increase in paroxysmal AF episodesin MD1 patients with a high percentage of right ventricular pacing and a lower percentage of atrial stimulation. PMID: 24297712 [PubMed - in process] (Source: Polish Heart Journal)
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Factors influencing post-coronary artery bypass grafting atrial fibrillation episodes.
Polish Heart Journal
12/4/2013 6:19:50 AM
Authors: Mariscalco G, Musumeci F, Banach M PMID: 24297708 [PubMed - in process] (Source: Polish Heart Journal)
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Submit your abstract. Join the elite.
ESC News and Press
12/4/2013 4:43:13 AM
Submit an abstract to ESC Congress 2014, the world's largest and most influential cardiovascular event of the year. Deadline is 14 February. You can also: Register | Book your hotel Topics: Acute Coronary Syndromes (ACS), Arrhythmias, Atherosclerosis, Atrial Fibrillation, Basic Science, Cardiac Tumours, Cardiovascular Disease Prevention - Risk Assessment and Management, Cardiovascular Nursing, Cardiovascular Surgery, Chronic Ischaemic Heart Disease (IHD), Clinical pharmacology, Computers in Cardiology, Congenital Heart Disease, Diabetic heart disease, Diseases of the Aorta and Trauma to the Aorta and Heart, Echocardiography (Non-invasive imaging), Genetics, Heart Failure (HF), Hypertension, Infective Endocarditis, Invasive Imaging: Cardiac Cathete...
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Specific Heart Contractions Could Predict Atrial Fibrillation
UCSF Medical Center
12/4/2013
A commonly used heart monitor may be a simple tool for predicting the risk of atrial fibrillation, the most frequently diagnosed type of irregular heart rhythm, according to researchers at UC San Francisco. (Source: UCSF Medical Center)
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Atrial fibrillation.
Nursing Standard
12/4/2013
Authors: Skinner A Abstract Atrial fibrillation (AF) is a supraventricular arrhythmia. AF is common, occurs mostly in older people, and is often associated with cardiovascular conditions. PMID: 24299388 [PubMed - in process] (Source: Nursing Standard)

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New Oral Anticoagulants Top Warfarin for Afib (CME/CE)
MedPage Today Cardiovascular
12/3/2013 7:43:00 PM
(MedPage Today) -- As a whole, the new oral anticoagulants improve outcomes versus warfarin in patients with nonvalvular atrial fibrillation, at the expense of more gastrointestinal bleeding, a meta-analysis showed. (Source: MedPage Today Cardiovascular)
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Documentation of atrial fibrillation prior to first‐ever ischemic stroke
Acta Neurologica Scandinavica
12/3/2013 11:00:59 AM
ConclusionComprehensive approach for AF screening allows detecting AF in one‐third of patients admitted with first‐ever ischemic stroke. Patients with high cardiovascular risk are more likely to have non‐permanent AF. (Source: Acta Neurologica Scandinavica)
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Atrial Fibrillation in Myocardial Infarction PatientsAtrial Fibrillation in Myocardial Infarction Patients
Medscape Today Headlines
12/3/2013 12:28:18 AM
Find out how timing of AF onset impacts outcomes for patients with myocardial infarction. American Heart Journal (Source: Medscape Today Headlines)
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Ectopy and expectations: can we predict atrial fibrillation, and should we try?
Annals of Internal Medicine
12/3/2013
Authors: Kramer DB, Zimetbaum PJ PMID: 24297197 [PubMed - in process] (Source: Annals of Internal Medicine)
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Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study.
Annals of Internal Medicine
12/3/2013
CONCLUSION: The addition of PAC count to a validated AF risk algorithm provides superior AF risk discrimination and significantly improves risk reclassification. Further study is needed to determine whether PAC modification can prospectively reduce AF risk. PRIMARY FUNDING SOURCE: American Heart Association, Joseph Drown Foundation, and National Institutes of Health. PMID: 24297188 [PubMed - in process] (Source: Annals of Internal Medicine)

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Correction
Journal of the American College of Cardiology: Cardiovascular Interventions
12/2/2013 6:20:50 PM
Nakatani Y, Nishida K, Sakabe M, Kataoka N, Sakamoto T, Yamaguchi Y, Iwamoto J, Mizumaki K, Fujiki A, Inoue H. Tranilast Prevents Atrial Remodeling and Development of Atrial Fibrillation in a Canine Model of Atrial Tachycardia and Left Ventricular Dysfunction. J Am Coll Cardiol 2013;61:582–8. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
http://www.medworm.com/rss/comments.php?id=7807064
Prevalence of Peripheral Artery Disease by Abnormal Ankle-Brachial Index in Atrial Fibrillation Implications for Risk and Therapy
Journal of the American College of Cardiology: Cardiovascular Interventions
12/2/2013 6:20:49 PM
Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia encountered in clinical practice and is associated with a 5-fold increased risk for stroke (1). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS 2 or CHA 2 DS 2 -VASc Scores in Anticoagulated Patients With Atrial Fibrillation
Journal of the American College of Cardiology: Cardiovascular Interventions
12/2/2013 6:20:48 PM
ConclusionsIn anticoagulated AF patients, a validated specific bleeding risk score, HAS-BLED, should be used for assessing major bleeding. The practice of using CHADS2 and CHA2DS2-VASc as a measure of high bleeding risk should be discouraged, given its inferior predictive performance compared with the HAS-BLED score. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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The Incidence, Pattern, and Prognostic Value of Left Ventricular Myocardial Scar by Late Gadolinium Enhancement in Patients With Atrial Fibrillation
Journal of the American College of Cardiology: Cardiovascular Interventions
12/2/2013 6:20:48 PM
ConclusionsIn patients with AF, LV LGE is a frequent finding and is a powerful predictor of mortality. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Left Ventricular Scar in Atrial Fibrillation Cause or Effect? ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
12/2/2013 6:20:48 PM
Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased risk for stroke, heart failure, and all-cause mortality (1,2,3). The mortality rate of patients with AF is about double that of patients in normal sinus rhythm, and data from the Framingham Heart Study show an AF-associated mortality risk even after adjusting for preexisting cardiovascular conditions (3). Although some of the mortality risk, such as stroke-related death (4) and worsening heart failure, could be traced back to AF, the fact remains that in most cases, AF is viewed merely an association (5,6,7,8). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Simple Technique Eyed for Diagnosing Irregular Heart Beat
MedlinePlus Health News
12/2/2013 5:00:00 PM
Common heart monitor can predict atrial fibrillation, study says Source: HealthDay Related MedlinePlus Page: Atrial Fibrillation (Source: MedlinePlus Health News)
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Effect of oral vitamin C on atrial fibrillation developing after isolated coronary artery bypass grafting surgery: a prospective randomized clinical trial.
Cardiology Journal
12/2/2013
CONCLUSIONS: Oral vitamin C can be safely used to decrease the incidence of postoperative AF in patients undergoing elective isolated on-pump CABG surgery. PMID: 24293167 [PubMed - as supplied by publisher] (Source: Cardiology Journal)
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Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation.
Cardiology Journal
12/2/2013
Conclusions: Highest markers for myocardial injury were observed in cryoballoon group. It is possible that a longer delivery energy duration and others factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown. PMID: 24293166 [PubMed - as supplied by publisher] (Source: Cardiology Journal)
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Short-term amiodarone therapy after reversion of persistent atrial fibrillation reduces recurrences at 18 months.
Cardiology Journal
12/2/2013
CONCLUSIONS: In patients regaining sinus rhythm after the first episode of persistent AF, a 3-month amiodarone treatment after reversion is a reasonable option for rhythm control. PMID: 24293165 [PubMed - as supplied by publisher] (Source: Cardiology Journal)
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Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation — Could it refine clinical risk stratification in AF?
International Journal of Cardiology
12/2/2013
Conclusions: Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF. It deserves a prospective trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants. (Source: International Journal of Cardiology)

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Safety and Utility of Noninvasive Ventilation During Deep Sedation for Catheter Ablation of Atrial Fibrillation
Journal of Cardiothoracic and Vascular Anesthesia
12/2/2013
We read with interest the article by Elkassabany et al, entitled “Anesthetic management of patients undergoing pulmonary vein isolation for treatment of atrial fibrillation using high-frequency jet ventilation.” We wish to share our experience in the context of using noninvasive ventilation (NIV) during deep sedation to render the procedure safer and more comfortable for patients undergoing a long procedure that requires motionlessness. This retrospective study was conducted in a single high-volume electrophysiology procedure center, and 41 consecutive catheter ablation for paroxysmal/persistent atrial fibrillation procedures performed with deep sedation using NIV were evaluated. Sedation procedures were performed according to SIAARTI guidelines. During the procedure, routine monitorin...
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Genetic diversity of the KCNE1 gene and susceptibility to postoperative atrial fibrillation
American Heart Journal
12/2/2013
Conclusion: This study confirmed the association of the 112G>A polymorphism and postoperative AF in a cohort of patients undergoing cardiac surgery. (Source: American Heart Journal)
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Left Atrial Size and Function: Role in Prognosis
Journal of the American College of Cardiology
12/1/2013 7:00:00 PM
The author examines the ability of left atrial size and function to predict cardiovascular outcomes. Data are sufficient to recommend evaluation of left atrial volume in certain populations, and although analysis of atrial reservoir, conduit, and booster pump function trails in that regard, the gap is rapidly closing. In this state-of-the-art paper, the author reviews the methods used to assess left atrial size and function and discusses their role in predicting cardiovascular events in general and referral populations and in patients with atrial fibrillation, cardiomyopathy, ischemic heart disease, and valvular heart disease. (Source: Journal of the American College of Cardiology)
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A Twist in the Heart
Heart, Lung and Circulation
12/1/2013 7:00:00 PM
A 69 year-old obese female with poorly controlled ventricular rates in atrial fibrillation (AF) underwent single chamber pacemaker implantation followed by an atrioventricular node ablation one month later. The chest X-ray performed after the ablation showed the header of pulse generator facing medially (arrow) with satisfactory right ventricular, mid-septal lead positioning (A). During a coronary angiogram for angina six months later, the right anterior fluoroscopic view of the pacing lead showed a double twist within the right atrium (arrow) (B). In addition, the pulse generator had flipped horizontally (arrow) (C). The patient denied ‘twiddling’ with the device. Fortunately, pacemaker lead function remained normal. (Source: Heart, Lung and Circulation)

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The dominant morphology of fractionated atrial electrograms has greater temporal stability in persistent as compared with paroxysmal atrial fibrillation
Computers in Biology and Medicine
12/1/2013
In this study, an algorithm was devised to extract morphologic components according to frequency, and its usefulness for distinguishing CFAE was shown.Method: CFAE of length 16s were obtained at two sites each from the four pulmonary vein ostia (PV), and from anterior and posterior left atrial free wall (FW), in nine paroxysmal and 10 longstanding persistent AF patients. The DF was computed for each of two 8s CFAE segments in each 16s recording. Each CFAE segment was then transformed into a set of basis vectors, which represent electrogram morphology at each frequency. The dominant morphology (DM) is defined as the ensemble average of sequential signal segments, with the segment length equal to the period at the DF. The DMs of the two 8s pairs were correlated. Normalized correlation coeffi...
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Atrial fibrillation: relieving symptoms and managing risk.
Clinical Medicine
12/1/2013
Authors: Haywood G, Davies E PMID: 24298111 [PubMed - in process] (Source: Clinical Medicine)
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Successful repair of a mitral valve aneurysm with cleft of anterior mitral leaflet in an adult.
The Annals of Thoracic Surgery
12/1/2013
Authors: Ohira S, Doi K, Yamano T, Yaku H Abstract A 40-year-old woman was admitted with severe mitral regurgitation (MR) and atrial fibrillation. Preoperative 3-dimensional transesophageal echocardiography demonstrated severe MR with an unruptured mitral valve aneurysm and a cleft. The stiff cleft edge was removed and closed directly, and plication of the aneurysm was added. After the implantation of a semirigid full ring, there was no residual MR. An adult patient with MR involving an unruptured mitral valve aneurysm with a cleft not associated with infection or a congenital anomaly is extremely rare. The 3-dimensional transesophageal echocardiography modality is useful for mitral valve repair because it provides precise anatomic information preoperatively. PMID: 24296198 [...
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Combined Use of Warfarin and Oral P2Y12 Inhibitors in Patients With Atrial Fibrillation and Acute Coronary Syndrome
Clinical Cardiology
12/1/2013
ConclusionsAmong Medicare beneficiaries with AF and ACS, combination therapy with warfarin and P2Y12 inhibitor was uncommon during the 90‐day ascertainment period, and more than one‐quarter of patients had no claims for warfarin or P2Y12 inhibitors. Rates of all‐cause readmission and mortality within 1 year of hospitalization for ACS were high. (Source: Clinical Cardiology)

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Inefficacy of a Highly‐Selective T‐Type Calcium Channel Blocker in Preventing Atrial Fibrillation Related Remodeling
Journal of Cardiovascular Electrophysiology
12/1/2013
ConclusionsICaT‐blockade with the highly‐selective compound AZ9112 failed to prevent rate‐related atrial remodeling. Thus, prevention of atrial electrophysiological remodeling by mibefradil cannot be attributed exclusively to ICaT blockade. These results indicate that ICaT inhibition is not likely to be a useful approach for AF therapy.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Cutaneous indurated plaque on the abdomen associated with diabetes mellitus.
Australian Family Physician
12/1/2013
Authors: Salazar-Nievas M, Crespo-Lora V, Rubio-López J, Arias-Santiago S Abstract Case study A woman, 74 years of age, presented to the emergency department with a lesion on the lower abdominal wall that had started a month earlier and was not associated with any other symptoms. Her family physician had treated it with emollient creams. Relevant past medical history included congestive heart failure, hypertension, hypertensive heart disease, pulmonary hypertension, mitral regurgitation, chronic atrial fibrillation, rosacea and diabetes mellitus that was being treated with oral hypoglycaemics (metformin). Physical examination revealed an area of skin on the lower abdominal wall that was ill-defined and indurated, with whitish papules and a 'cobblestone' appearance (Figure 1). ...
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Management of Postoperative Atrial Fibrillation and Subsequent Outcomes in Contemporary Patients Undergoing Cardiac Surgery: Insights From the Society of Thoracic Surgeons CAPS‐Care Atrial Fibrillation Registry
Clinical Cardiology
12/1/2013
ConclusionsPostoperative AF is common following CABG, and such patients continue to have higher rates of postoperative complications. Postoperative AF is significantly associated with increased length of stay following surgery. (Source: Clinical Cardiology)
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Cryoballoon pulmonary vein isolation prior to percutaneous atrial septal defect closure: a case report.
Turk Kardiyoloji Dernegi arsivi
12/1/2013
We report the case of a 61-year-old female who was admitted to our department with progressive dyspnea and palpitation. Transthoracic echocardiography and transesophageal echocardiography showed a small atrial septal defect (ASD, 8x7 mm). Paroxysmal atrial fibrillation (AF) was detected in Holter monitoring. As repair of ASD does not significantly reduce the risk of arrhythmias, cryoablation of AF was performed prior to ASD closure. On cardiac examination at one year, this combined intervention improved right ventricular function and prevented AF episodes. PMID: 24351948 [PubMed - in process] (Source: Turk Kardiyoloji Dernegi arsivi)

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The Pulmonary Veins of the Pig as an Anatomical Model for the Development of a New Treatment for Atrial Fibrillation
Anatomia, Histologia, Embryologia: Journal of Veterinary Medicine Series C
12/1/2013
Summary The layout of the porcine atriopulmonary junction and immediately adjacent structures was investigated by gross anatomical and vascular corrosion casting studies to meet the need for more in‐depth anatomical insights when using the pig as an animal model in the development of innovative approaches for surgical cardiac ablation in man. The veins from the right cranial and middle lung lobes drain through a common ostium in the left atrium, whereas a second ostium receives the blood returning from all other lung lobes, although limited variation to this pattern was observed. Surrounding anatomical structures that are most vulnerable to ablation damage as reported in man are located at a safer distance from the pulmonary veins in pigs, yet a certain locations, comparable risks are to...
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Does pulmonary artery venting decrease the incidence of postoperative atrial fibrillation after conventional aortocoronary bypass surgery?
The Heart Surgery Forum
12/1/2013
Conclusions: Pulmonary arterial venting may be used as an alternative to aortic root venting during on-pump coronary bypass surgery, especially in patients at high risk of postoperative atrial fibrillation. PMID: 24370797 [PubMed - in process] (Source: The Heart Surgery Forum)
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Intermittent Atrial Tachycardia Promotes Repolarization Alternans and Conduction Slowing During Rapid Rates, and increases Susceptibility to Atrial Fibrillation in a Free‐behaving Sheep Model
Journal of Cardiovascular Electrophysiology
12/1/2013
ConclusionThis study suggests that weeks of intermittent right atrial tachycardia result in a gradual electrical remodeling favorable for wavebreaks and reentry that may facilitate fibrillation.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Catheter Ablation of Atrial Fibrillation and Risk of Asymptomatic Cerebral Embolism
Pacing and Clinical Electrophysiology : PACE
12/1/2013
Recent studies have suggested that a significant minority of patients undergoing atrial fibrillation catheter ablation (AFCA) develop evidence of acute, asymptomatic cerebral emboli (ACE) detected by brain magnetic resonance imaging. Although the prognostic significance of ACE associated with AFCA remains unclear, given the heightened risk of dementia associated with asymptomatic chronic infarcts on brain imaging, it is imperative to understand the pathogenesis of ACE and identify methods to mitigate the risk of emboli associated with AF ablation. In this paper, we review the incidence of ACE associated with AFCA and discuss patient‐ and procedure‐specific markers of risk for asymptomatic embolism. We also review the data to support strategies, which have been proposed to reduce the in...

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Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion
Cardiovascular Therapeutics
12/1/2013
ConclusionAdvanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)
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Patient perspective on the management of atrial fibrillation in five European countries
BMC Cardiovascular Disorders
11/30/2013 9:18:05 PM
Conclusions: In the context of Europe-wide guidelines for management of AF, most patients with AF were satisfied with their care, but for a greater proportion of patients, some aspects are unsatisfactory. Patient-centred surveys, such as the EUPS-AF, are crucial for understanding the factors that contribute to patient satisfaction and compliance with long-term treatment for chronic conditions. (Source: BMC Cardiovascular Disorders)
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Balancing thromboembolic risk against vitamin K antagonist-related bleeding and accelerated calcification: is fondaparinux the Holy Grail for end-stage renal disease patients with atrial fibrillation?
Nephrology Dialysis Transplantation
11/29/2013
(Source: Nephrology Dialysis Transplantation)
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A 5-Year Review of Atrial Fibrillation in Military Aircrew
Aviation, Space, and Environmental Medicine
11/28/2013 9:15:32 AM
(Source: Aviation, Space, and Environmental Medicine)

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Unanswered questions and research priorities to optimise stroke prevention in atrial fibrillation with the new oral anticoagulants.
Thrombosis and Haemostasis
11/28/2013
Authors: Hankey GJ Abstract This review article discusses the following, as yet unanswered, questions and research priorities to optimise patient management and stroke prevention in atrial fibrillation with the new direct oral anticoagulants (NOACs): 1. In patients prescribed a NOAC, can the anticoagulant effects or plasma concentrations of the NOACs be measured rapidly and reliably and, if so, can "cut-off points" between which anticoagulation is therapeutic (i.e. the "therapeutic range") be defined? 2. In patients who are taking a NOAC and bleeding (e.g. intracerebral haemorrhage), can the anticoagulant effects of the direct NOACs be reversed rapidly and, if so, can NOAC-associated bleeding and complications be minimised and patient outcome improved? 3. In patients taking a NOAC ...
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Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?
Journal of Cardiothoracic Surgery
11/28/2013
Background: Epicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation. Methods: We included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablat...
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Correction
Journal of the American College of Cardiology
11/27/2013 12:18:05 PM
Medi C, Evered L, Silbert B, Teh A, Halloran K, Morton J, Kistler P, Kalman J. Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation. J Am Coll Cardiol 2013;62:531–9. (Source: Journal of the American College of Cardiology)
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Outlook Better When Warfarin Restarted After Major Bleed (CME/CE)
MedPage Today Cardiovascular
11/27/2013 10:43:00 AM
(MedPage Today) -- Among patients with atrial fibrillation who stopped taking warfarin because of a major gastrointestinal bleed, restarting anticoagulation was associated with improved outcomes, a retrospective study showed. (Source: MedPage Today Cardiovascular)
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Antiarrhythmic Effect of Ranolazine in Combination with Class III Drugs in an Experimental Whole‐Heart Model of Atrial Fibrillation
Cardiovascular Therapeutics
11/27/2013
ConclusionIn this study, ranolazine on top of class III antiarrhythmic therapy had a beneficial effect. The increase in interatrial conduction time and marked atrial aPRR suppressed AF. These results shed further light on a potential therapeutic benefit of ranolazine on top of conventional antiarrhythmic therapy for rhythm control in AF. (Source: Cardiovascular Therapeutics)

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Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia
Europace
11/26/2013
Conclusion The provision of catheter-based AF ablation services in Australia has increased exponentially over the past decade. Its annual growth rate exceeded that of PCIs and all cardiovascular procedures. Given the increasing epidemic of AF, these data have critical implications for public health policy assessing the adequacy of infrastructure, training, and funding for AF ablation services. (Source: Europace)
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Relationship between left atrial tissue structural remodelling detected using late gadolinium enhancement MRI and left ventricular hypertrophy in patients with atrial fibrillation
Europace
11/26/2013
Conclusion Patients with LVH tend to have a significantly greater degree of LA-SRM, when compared with patients without LVH. Moreover, LA-SRM is a predictor for procedural success in patients undergoing AF ablation procedure. (Source: Europace)

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Inappropriate use of antiarrhythmic drugs in paroxysmal and persistent atrial fibrillation in a large contemporary international survey: insights from RealiseAF
Europace
11/26/2013
Conclusion The use of AADs for persistent or paroxysmal AF in this large contemporary international survey showed some deviations from international guidelines. The highest discordance came with the use of amiodarone in first line. Clearly, there is a large discrepancy between published guidelines and current practice. (Source: Europace)
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A survey of German centres performing invasive electrophysiology: structure, procedures, and training positions
Europace
11/26/2013
Conclusion The results indicate a high number of electrophysiology centres and procedures in Germany. Atrial fibrillation was the most common arrhythmia invasively treated. An increasing demand for catheter ablation is likely, but training opportunities are limited. Women are clearly underrepresented. A co-operation of higher and lower volume electrophysiology centres may be necessary for training purposes. (Source: Europace)
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Prevalence and electrophysiological characteristics of typical atrial flutter in patients with atrial fibrillation and chronic obstructive pulmonary disease
Europace
11/26/2013
Conclusion In COPD patients with AF, conduction time of RA was prolonged and typical AFL was commonly observed. (Source: Europace)
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Cilostazol decreases total atrial conduction time in patients with peripheral artery disease.
Perfusion
11/26/2013
CONCLUSION: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF). PMID: 24280344 [PubMed - as supplied by publisher] (Source: Perfusion)

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Risk factors: Insights from the REGARDS study
Nature Reviews Cardiology
11/26/2013
Nature Reviews Cardiology 11, 3 (2014). doi:10.1038/nrcardio.2013.182 Author: Alexandra Roberts Two analyses from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study have shed new light on the relevance of potential risk factors for cardiac events. Soliman et al. report that atrial fibrillation (AF) is associated with an increased risk of (Source: Nature Reviews Cardiology)
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The importance of avoiding unnecessary right ventricular pacing in clinical practice.
World Journal of Cardiology
11/26/2013
Authors: Akerström F, Arias MA, Pachón M, Jiménez-López J, Puchol A, Juliá-Calvo J Abstract Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with long-term pacing of the apex of the right ventricle (RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function (LVEF) are at pa...
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Correction
Journal of the American College of Cardiology: Cardiovascular Interventions
11/25/2013 6:22:16 PM
Medi C, Evered L, Silbert B, Teh A, Halloran K, Morton J, Kistler P, Kalman J. Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation. J Am Coll Cardiol 2013;62:531–9. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Meta-Analyses of Statin Trials Clear Benefit for Primary Prevention in the Elderly ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
11/25/2013 6:22:14 PM
Many statin meta-analyses have been published, at least 250 according to my just-completed, informal search of PubMed. The endpoint of interest for many of these is incident cancer of a specific type or site (e.g., melanoma, lung, bladder, esophagus, liver, breast, or prostate), but many other diverse conditions have also been reported, including atrial fibrillation, dementia, osteoporosis, and macular degeneration. The broad scope of these studies is a consequence of the widespread use of statins and their multiple biologic effects due to inhibition of the 3-hydroxy-3-methylglutaryl CoA reductase enzyme. Most of these studies have inherent limitations: they use observational datasets of varying quality and not clinical trial data, endpoint definitions are often not uniform, sample siz...
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Weight Loss Decreases Atrial Fibrillation Burden, SeverityWeight Loss Decreases Atrial Fibrillation Burden, Severity
Medscape Cardiology Headlines
11/25/2013 3:09:27 PM
Along with intensive risk factor management, weight reduction results in reduced AF symptoms and in beneficial cardiac remodelling. Medscape Medical News (Source: Medscape Cardiology Headlines)
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Distinctive Patterns of Dominant Frequency Trajectory Behavior in Drug‐Refractory Persistent Atrial Fibrillation: Preliminary Characterization of Spatiotemporal Instability
Journal of Cardiovascular Electrophysiology
11/25/2013
ConclusionsDF of individual VEGMs was temporally unstable, although reappearance of DF values occurred at times. Hence, targeting sites of ‘peak DF’ from a single time frame is unlikely to be a reliable ablation strategy. There appears to be a predominance of local and cyclical activity of HDFAs hinting a potentially non‐random temporally periodic behavior that provides further mechanistic insights into the maintenance of persAF.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Evolving Antithrombotic Strategies in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: Results From a Survey Among US Cardiologists
Clinical Cardiology
11/25/2013
ConclusionsThe survey highlights an interest in the new strategy of dropping aspirin, but the lack of concrete evidence triggers undesired diversity in clinical approaches. High‐quality data on the efficacy and safety of such interventions are needed to further consolidate these approaches. (Source: Clinical Cardiology)
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Prolonged Ablation on Critical Segments of Pulmonary Vein Ostia in Paroxysmal Atrial Fibrillation: A Prospective Randomized Controlled Study
Pacing and Clinical Electrophysiology : PACE
11/25/2013
ConclusionsProlonged radiofrequency application on critical segments of LA‐PV connection is a safe and effective ablative strategy that significantly reduces acute PV reconnection and AF recurrence rates after a single ablation procedure for paroxysmal AF. (Source: Pacing and Clinical Electrophysiology : PACE)
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Effect of Sleep Apnea and Continuous Positive Airway Pressure on Cardiac Structure and Recurrence of Atrial Fibrillation [Imaging]
JAHA:Journal of the American Heart Association
11/25/2013
Conclusions Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI. (Source: JAHA:Journal of the American Heart Association)

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Impact of Atrial Fibrillation on Stroke-Related Healthcare Costs [Hypertension]
JAHA:Journal of the American Heart Association
11/25/2013
Conclusion Stroke-related care for IS, HS, and TIA is costly, especially among individuals with AF. Reducing the risk of AF-related stroke is important from both clinical and economic standpoints. (Source: JAHA:Journal of the American Heart Association)
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Early Adoption of Dabigatran and Its Dosing in US Patients With Atrial Fibrillation: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [Health Services and Outcomes Research]
JAHA:Journal of the American Heart Association
11/25/2013
Conclusions Patients receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients appeared to drive switching from warfarin, whereas clinical characteristics influenced de novo start of dabigatran. These data suggest cautious early uptake of dabigatran, and more careful attention to dosing adjustments is warranted. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT01165710. (Source: JAHA:Journal of the American Heart Association)
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Platelet Activation after Radiofrequency Ablation in Atrial Fibrillation: Is There Any Clinical Implication?
Circulation
11/25/2013
Authors: Violi F, Pignatelli P Abstract Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population and in patients undergoing cardiac surgery(1). AF is a self-perpetuating arrhythmia which is facilitated by structural and functional changes elicited by atrial high rate activity. Shortening of atrial effective refractory period is the earliest functional change that characterizes atrial remodeling(2). As prevalence of AF increases with advancing age, its social impact is becoming very relevant because of the associated high risk of cardiovascular events and increased morbidity and mortality. AF is complicated by stroke of thrombo-embolic origin, which is thought to stem from thrombus formation, generated in the left atrial appendage with ensuing embolis...
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Effect of Remote Ischemic Preconditioning on Platelet Activation and Reactivity Induced by Ablation for Atrial Fibrillation.
Circulation
11/25/2013
CONCLUSIONS: Our data show that remote IPC before RF catheter ablation for paroxysmal AF significantly reduces the increased platelet activation and reactivity associated with the procedure. PMID: 24277055 [PubMed - as supplied by publisher] (Source: Circulation)
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Factor Xa Inhibitors Versus Vitamin K Antagonists for Preventing Cerebral or Systemic Embolism in Patients With Atrial Fibrillation [Cochrane Corner]
Stroke
11/25/2013
(Source: Stroke)

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Evaluation of Patients for Paroxysmal Atrial Fibrillation After Ischemic Stroke [Illustrative Teaching Case]
Stroke
11/25/2013
(Source: Stroke)
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Spectrum of Transient Visual Symptoms in a Transient Ischemic Attack Cohort [Clinical Sciences]
Stroke
11/25/2013
Conclusions— Approximately 20% of patients with TVS had a major source of embolism detected, requiring urgent management. Atrial fibrillation was particularly frequent in patients with transient homonymous lateral hemianopia. (Source: Stroke)
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Improved Detection of Silent Atrial Fibrillation Using 72-Hour Holter ECG in Patients With Ischemic Stroke: A Prospective Multicenter Cohort Study [Clinical Sciences]
Stroke
11/25/2013
Conclusions— In unselected survivors of stroke or TIA, 72-hour ECG monitoring is feasible and improves the detection rate of silent paroxysmal AF. (Source: Stroke)
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Effect of Sleep Apnea and Continuous Positive Airway Pressure on Cardiac Structure and Recurrence of Atrial Fibrillation [Arrhythmia and Electrophysiology]
JAHA:Journal of the American Heart Association
11/25/2013
Conclusions Patients with SA have an increased blood pressure, pulmonary artery pressure, right ventricular volume, left atrial size, and left ventricular mass. Therapy with continuous positive airway pressure is associated with lower blood pressure, atrial size, and ventricular mass, and a lower risk of AF recurrence after PVI. (Source: JAHA:Journal of the American Heart Association)
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Impact of Atrial Fibrillation on Stroke-Related Healthcare Costs [Stroke]
JAHA:Journal of the American Heart Association
11/25/2013
Conclusion Stroke-related care for IS, HS, and TIA is costly, especially among individuals with AF. Reducing the risk of AF-related stroke is important from both clinical and economic standpoints. (Source: JAHA:Journal of the American Heart Association)
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Effects of olanzapine on the PR and QT intervals in patients with schizophrenia
Schizophrenia Research
11/25/2013
Prolongation of the PR interval is associated with increased risks of atrial fibrillation, pacemaker implantation, and all-cause mortality (). To date, we have reported that olanzapine (OLZ) has a greater QT prolongation effect compared to aripiprazole (), and that a female is a risk factor for the QT prolongation caused by OLZ (). Meanwhile, although there are several reports on first-degree heart block being attributed to OLZ (), it is unknown precisely what effect OLZ treatment has on the electrocardiogram PR interval. (Source: Schizophrenia Research)
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Adherence and Persistence in the Use of Warfarin After Hospital Discharge Among Patients With Heart Failure and Atrial Fibrillation
Journal of Cardiac Failure
11/25/2013
Conclusions: One-third of eligible patients with heart failure and atrial fibrillation were not prescribed warfarin at discharge from a heart failure hospitalization, and few started therapy as outpatients. In contrast, most patients who were prescribed warfarin at discharge filled the prescription within 90 days and remained on therapy at 1 year. (Source: Journal of Cardiac Failure)

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Sudden drops in blood pressure linked to irregular heartbeat
Health News - UPI.com
11/24/2013 8:43:53 PM
BALTIMORE, Nov. 24 (UPI) -- U.S. researchers say they identified a possible link between a history of sudden drops in blood pressure and atrial fibrillation, or an irregular heartbeat. (Source: Health News - UPI.com)
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Assessment of Dabigatran Utilization and Prescribing Patterns for Atrial Fibrillation in a Physician Group Practice Setting
The American Journal of Cardiology
11/24/2013 7:00:00 PM
For years, warfarin and aspirin have been standard therapies for prophylaxis of stroke in atrial fibrillation. In late 2010, dabigatran, an oral direct thrombin inhibitor, became available for use in nonvalvular atrial fibrillation. We sought to evaluate utilization and prescribing patterns of dabigatran in a physician group practice setting. We retrospectively collected prescription data from October 2010 to December 2011 including indication of use, dose, renal function, drug interactions, history of warfarin therapy, and risk assessment scores (CHADS2 and HAS-BLED). Off-label use (history of valve disease or no diagnosis of atrial fibrillation) occurred in 20% (n = 34) of 174 patients. Renal function assessed by Cockcroft-Gault equation identified 1 case of contraindicated use and the ...
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Prevalence of and Risk Factors for Silent Ischemic Stroke in Patients With Atrial Fibrillation as Determined by Brain Magnetic Resonance Imaging
The American Journal of Cardiology
11/24/2013 7:00:00 PM
Varied silent ischemic stroke (SS) prevalence occurs in patients with atrial fibrillation (AF). Stroke history is worth 2 points in the CHADS2 scoring system. An unknown proportion of patients with AF with a CHADS2 score of 0 or 1 have been undertreated for stroke prevention. We investigated SS risk factors using magnetic resonance imaging and estimated SS impact on clinical outcomes in patients with AF. We analyzed a total of 1,200 patients (400 with AF and 800 with sinus rhythm) who had brain magnetic resonance imaging performed for routine health checkups. Clinical outcomes including symptomatic stroke, dementia, and cognitive disorder were also evaluated in patients with AF (follow-up duration: 66.7 ± 35.9 months; range 10 to 162). SS was observed in 113 patients with AF (28.3%), whi...
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Restarting Anticoagulation and Outcomes After Major Gastrointestinal Bleeding in Atrial Fibrillation
The American Journal of Cardiology
11/24/2013 7:00:00 PM
Data regarding the outcomes of restarting anticoagulation in patients who develop gastrointestinal bleeding (GIB) while anticoagulated are sparse. We hypothesized that restarting anticoagulation in these patients is associated with better outcomes. This is a retrospective cohort study that enrolled subjects who developed GIB while on anticoagulation from 2005 to 2010. Atrial fibrillation was defined by history and electrocardiography on presentation. GIB was defined as a decrease in hemoglobin by 2 g, visible bleeding, or positive endoscopic evaluation. Time-to-event adjusted analyses were performed to find an association of restarting warfarin and recurrent GIB, arterial thromboembolism, and mortality. Stratified analysis by duration of interruption of warfarin was also performed. Overal...
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Prognostic Usefulness of Left Ventricular Hypertrophy by Electrocardiography in Patients With Atrial Fibrillation (from the Randomized Evaluation of Long-Term Anticoagulant Therapy Study)
The American Journal of Cardiology
11/24/2013 7:00:00 PM
It is unknown whether left ventricular hypertrophy (LVH) diagnosis by electrocardiography improves risk stratification in patients with atrial fibrillation (AF). We investigated the prognostic impact of LVH diagnosis by electrocardiography in a large sample of anticoagulated patients with AF included in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) Study. We defined electrographic LVH (ECG-LVH) by strain pattern or Cornell voltage (R wave in aVL plus S wave in V3) >2.0 mV (women) or >2.4 mV (men). LVH prevalence was 22.7%. During a median follow-up of 2.0 years, 303 patients developed a stroke, 778 died (497 from cardiovascular causes), and 140 developed a myocardial infarction. LVH was associated with a greater risk of stroke (1.99% vs 1.32% per year, hazard ratio...

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Assessment of clinical factors associated with a successful catheter ablation outcome in younger patients with atrial fibrillation.
Journal of Cardiology
11/24/2013
CONCLUSION: In symptomatic younger AF patients, a low BMI was an independent clinical factor for unsuccessful AF ablation outcomes. PMID: 24284233 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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Age, left atrial dimension and arterial stiffness after external cardioversion of atrial fibrillation. A vascular component in arrhythmia maintenance? Results from a preliminary study.
Aging Clinical and Experimental Research
11/24/2013
CONCLUSIONS: In patients with AF, immediately after ECV, arterial stiffness is associated with age and AF length, and could represent an important factor for left atrium remodeling and, therefore, for AF maintenance. PMID: 24272230 [PubMed - as supplied by publisher] (Source: Aging Clinical and Experimental Research)
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Outpatient Management of Oral Anticoagulation in Atrial Fibrillation
Critical Care Nursing Clinics of North America
11/23/2013 6:19:58 AM
This article presents an overview of the outpatient management of oral anticoagulation for the prevention of stroke and systemic embolism in the setting of atrial fibrillation. Results of recent clinical trials demonstrating the efficacy and safety of 3 of the new target-specific oral anticoagulants are reviewed. Discussion includes determining patient candidates for the newer agents and consideration for choice of agent. Advantages and disadvantages to using these newer agents are presented, as are dosing adjustments for renal and hepatic impairment. (Source: Critical Care Nursing Clinics of North America)
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Prognostic difference between paroxysmal and non-paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy.
Journal of Cardiology
11/23/2013
CONCLUSIONS: AF is a common supraventricular arrhythmia in HCM and has an adverse influence on the prognosis. In addition, each type of AF had a different clinical impact, with paroxysmal AF being a significant independent determinant of an adverse outcome, including sudden death. PMID: 24280311 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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High Frequency Source Ablation Effective in Treating Atrial Fibrillation
MedlinePlus Health News
11/22/2013 5:02:26 PM
Source: American Heart Association Related MedlinePlus Page: Atrial Fibrillation (Source: MedlinePlus Health News)

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Symptomatic Pulmonary Embolus After Joint Arthroplasty: Stratification of Risk Factors.
Clinical Orthopaedics and Related Research
11/22/2013
CONCLUSIONS: Patients who are obese, undergo knee procedures, have an elevated Charlson Comorbidity Index, chronic obstructive pulmonary disease, atrial fibrillation, anemia, depression, or postoperative deep vein thrombosis are at greater risk of having a postoperative PE develop. These risk factors should be considered when deciding on postoperative anticoagulation prophylaxis. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence. PMID: 24264881 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)
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Maze procedure in patients with left ventricular dysfunction
International Journal of Cardiology
11/22/2013
This study aimed to evaluate the clinical impacts of the Maze procedure in patients with atrial fibrillation and left ventricular (LV) dysfunction.Methods: Between January 1999 and March 2011, a total of 139 patients (mean age 52.7±12.3years, 54 females) with valvular atrial fibrillation (AF) and an LV ejection fraction (EF) of 40% or less underwent open heart surgery with (n=77) or without (n=62) a concomitant Maze procedure. We compared adverse outcomes (death and composite of death, thromboembolic events and congestive heart failure [CHF]) during a median follow-up period of 66.0months (inter-quartile range, 27.5–106.9months).Results: Adverse events occurred in 41 patients, including 36 deaths, seven thromboembolic events and eight hospitalizations due to CHF. After adjustment for ba...
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Diagnosis and Treatment of Obstructive Sleep Apnea Is Key to Achieving Optimal Results After Catheter Ablation of Atrial Fibrillation
Journal of the American College of Cardiology
11/21/2013 7:00:00 PM
Fein et al. report that obstructive sleep apnea (OSA) adversely affects the results of ablation for paroxysmal or persistent atrial fibrillation (AF) except in those who reported using continuous positive airway pressure. Clearly, the study advances our understanding of the role that OSA may play in AF and its management. (Source: Journal of the American College of Cardiology)
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Reply: Diagnosis and Treatment of Obstructive Sleep Apnea Is Key to Achieving Optimal Results After Catheter Ablation of Atrial Fibrillation
Journal of the American College of Cardiology
11/21/2013 7:00:00 PM
The association between obstructive sleep apnea (OSA) and cardiovascular morbidity is well established . In particular, OSA has been shown to potentiate atrial fibrillation (AF) substrate in both animal and human studies . Our study not only demonstrated that OSA adversely affects the results of AF ablation, but also highlighted the beneficial effect of OSA treatment on AF ablation outcome in this patient population . (Source: Journal of the American College of Cardiology)

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Left atrial appendage occlusion in octogenarians: Short‐term and one‐year follow‐up
Catheterization and Cardiovascular Interventions
11/21/2013
Conclusions: LAA closure is a safe and efficacious method of stroke prevention in the very elderly with atrial fibrillation. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
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Increased risk of atrial fibrillation among elderly Norwegian men with a history of long‐term endurance sport practice
Scandinavian Journal of Medicine and Science in Sports
11/21/2013
This study suggests that elderly men with a history of long‐term endurance sport practice have an increased risk of AF compared with elderly men in the general population. (Source: Scandinavian Journal of Medicine and Science in Sports)
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Should oral anticoagulants be restarted after warfarin-associated cerebral haemorrhage in patients with atrial fibrillation?
Thrombosis and Haemostasis
11/21/2013
Authors: Paciaroni M, Agnelli G Abstract Intracranial haemorrhage (ICH), which affects up to 1% of patients on oral anticoagulation per year, is the most feared and devastating complication of this treatment. After such an event, it is unclear whether anticoagulant therapy should be resumed. Such a decision hinges upon the assessment of the competing risks of haematoma growth or recurrent ICH and thromboembolic events. ICH location and the risk for ischaemic cerebrovascular event seem to be the key factors that lead to risk/benefit balance of restarting anticoagulation after ICH. Patients with lobar haemorrhage or cerebral amyloid angiopathy remain at higher risk for anticoagulant-related ICH recurrence than thromboembolic events and, therefore would be best managed without anticoa...
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Rationale and design of REVEAL AF: A prospective study of previously undiagnosed atrial fibrillation as documented by an insertable cardiac monitor in high-risk patients
American Heart Journal
11/21/2013
Conclusions: REVEAL AF will determine the incidence rate of AF lasting ≥6 minutes in patients who are at high risk for having AF. Secondary outcomes include observations regarding physician actions in response to detected AF and determination of risk markers for AF development. (Source: American Heart Journal)
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Genetic variation in the β1-adrenergic receptor is associated with the risk of atrial fibrillation after cardiac surgery
American Heart Journal
11/21/2013
Conclusion: The Gly389 variant in the β1-adrenoreceptor is associated with PoAF, and this association appears to be modulated by β-blocker therapy. Future studies of the association of other adrenergic pathway genes with PoAF will be of interest. (Source: American Heart Journal)

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AHA: Choosing an Anticoagulant Just Got Tougher
MedPage Today Cardiovascular
11/20/2013 8:13:00 PM
DALLAS (MedPage Today) -- With a possible fourth new oral anticoagulant nipping at the heels of warfarin, how should physicians choose among the options for stroke prevention in atrial fibrillation? Leading cardiologists offered their approach. (Source: MedPage Today Cardiovascular)
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AHA: Smart Pacing Cuts Afib Risk (CME/CE)
MedPage Today Cardiovascular
11/20/2013 5:55:36 PM
DALLAS (MedPage Today) -- A pacemaker set to pace only when and where needed improved patient outcomes, particularly the risk of permanent atrial fibrillation, a trial showed. (Source: MedPage Today Cardiovascular)
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AHA: Mixed Results for Substrate Ablation for Afib
MedPage Today Cardiovascular
11/20/2013 3:31:11 PM
DALLAS (MedPage Today) -- Ablating the atrial chamber substrate for prevention of paroxysmal atrial fibrillation appears to be noninferior to the standard method of ablating suspected triggers in the pulmonary veins, researchers reported here. (Source: MedPage Today Cardiovascular)
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AHA: Another Anticoagulant Bests Warfarin in Afib (CME/CE)
MedPage Today Cardiovascular
11/20/2013 11:13:00 AM
(MedPage Today) -- The novel oral factor Xa inhibitor edoxaban prevented stroke as well as warfarin but did so with lower risk in nonvalvular atrial fibrillation, a randomized trial showed. (Source: MedPage Today Cardiovascular)
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Novel Anticoagulant Bests Warfarin in Afib (CME/CE)
MedPage Today Cardiovascular
11/20/2013 10:05:15 AM
(MedPage Today) -- The novel oral factor Xa inhibitor edoxaban prevented stroke as well as warfarin but did so with lower risk in nonvalvular atrial fibrillation, a randomized trial showed. (Source: MedPage Today Cardiovascular)

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Sudden Steep Drop in Blood Pressure on Standing from Lying Down May Predict Atrial Fibrillation Years Later - 11/20/13
Johns Hopkins Medicine News
11/20/2013 7:00:00 AM
Results of a Johns Hopkins-led study have identified a possible link between a history of sudden drops in blood pressure and the most common form of irregular heartbeat. (Source: Johns Hopkins Medicine News)
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A Novel Method for Real‐Time Atrial Fibrillation Detection in Electrocardiograms Using Multiple Parameters
Annals of Noninvasive Electrocardiology
11/20/2013
ConclusionsOur proposed method has prospects as a practical tool enabling clinical diagnosis, treatment, and monitoring of AF. (Source: Annals of Noninvasive Electrocardiology)
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N-terminal pro-B-type natriuretic peptide as a predictor of incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis: the effects of age, sex and ethnicity
Heart
11/20/2013
Conclusions NT proBNP is a robust predictor of incident AF; its prognostic value is more significant in younger patients and women compared with older patients and men. NT proBNP was also as strongly predictive in black patients, Hispanics and Asian/Chinese as in white patients despite a lower incidence of arrhythmia. (Source: Heart)
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Complete atrioventricular block does not reduce long-term mortality in patients with permanent atrial fibrillation treated with cardiac resynchronization therapy
European Journal of Heart Failure
11/20/2013
Conclusions AVJ block did not improve survival for patients in AF treated with CRT. Basal NYHA functional class IV, poor renal function, and LVEF were the independent predictors of mortality. (Source: European Journal of Heart Failure)
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Increased level of resistin predicts development of atrial fibrillation.
Journal of Cardiology
11/20/2013
CONCLUSION: The elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group. PMID: 24268420 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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AHA: Mixed Data for Warfarin Dosing By Genotype (CME/CE)
MedPage Today Cardiovascular
11/19/2013 5:13:02 PM
DALLAS (MedPage Today) -- For patients requiring anticoagulation for atrial fibrillation, venous thromboembolism, or some other indication, genotype-guided dosing of warfarin and similar drugs might have some benefit, three trials showed. (Source: MedPage Today Cardiovascular)
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Edoxaban versus Warfarin in Patients with Atrial Fibrillation
New England Journal of Medicine
11/19/2013 11:45:15 AM
New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print. (Source: New England Journal of Medicine)
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Weight Loss Cuts AFib Events (CME/CE)
MedPage Today Cardiovascular
11/19/2013 9:42:29 AM
(MedPage Today) -- Patients were able to significantly reduce the impact of atrial fibrillation symptoms if they also were able to lose weight, researchers reported. (Source: MedPage Today Cardiovascular)

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Practical Considerations for Using Novel Oral Anticoagulants in Patients With Atrial Fibrillation
Clinical Cardiology
11/19/2013
Abstract Novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, represent new options for preventing stroke in patients with atrial fibrillation, as shown by the results from large, randomized phase III trials. Because of their greater specificity, rapid onset of action, and predictable pharmacokinetics, the novel oral anticoagulants (dabigatran, rivaroxaban, and apixaban) address several limitations of warfarin or other vitamin K antagonists in day‐to‐day clinical practice. However, a range of practical questions relating to the novel oral anticoagulants has emerged, including topics such as patient selection, treatment of patients with renal impairment, risk of myocardial infarction, drug interactions, switching between anticoagulants, and management of bleeding,...
http://www.medworm.com/rss/comments.php?id=7772696
Cost-Effectiveness of Oral Anticoagulants for Treatment of Atrial Fibrillation [Original Articles]
Circulation: Cardiovascular Quality and Outcomes
11/19/2013
Conclusions— While at a standard cost-effectiveness threshold of $100 000 per quality-adjusted life year, apixaban seems to be the optimal anticoagulation strategy; this finding is sensitive to assumptions about its efficacy and cost. In sensitivity analysis, warfarin seems to be the optimal choice in an equal number of simulations. As a result, although all the novel oral anticoagulants produce greater quality-adjusted life expectancy than warfarin, they may not represent good value for money. (Source: Circulation: Cardiovascular Quality and Outcomes)
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Postoperative Atrial Fibrillation and Cardiac Surgery.
Circulation Journal
11/19/2013
Authors: Chua SK, Shyu KG, Lo HM PMID: 24257102 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Edoxaban Effective in Preventing Stroke, Reducing Bleeding and Cardiovascular Death in Patients With Atrial Fibrillation
BWH News
11/18/2013 7:00:00 PM
New study demonstrates that high- and low-dose edoxaban were at least as effective in preventing stroke or systemic embolism (blood clot), while significantly reducing bleeding and cardiovascular death, compared to warfarin. (Source: BWH News)
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Association between reduced kidney function and clinical outcomes after ischaemic stroke with atrial fibrillation
European Journal of Neurology
11/18/2013 4:17:09 PM
ConclusionsReduced eGFR was independently associated with increased risk of death in patients with ischaemic stroke and AF. The association between reduced eGFR and risk of stroke recurrence needs to be explored in larger studies. (Source: European Journal of Neurology)
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Late Breaking Clinical Trial Results Show Significant Delay in Atrial Fibrillation Disease Progression with Medtronic-Exclusive Pacing Features
HSMN NewsFeed
11/18/2013 10:59:38 AM
MINERVA Trial at AHA Meeting Shows Medtronic Pacemakers Reduce the Progression of Permanent AF by 61 Percent MINNEAPOLIS and DALLAS - Nov.18, 2013 --(Healthcare Sales & Marketing Network)-- New research shows that Medtronic, Inc. (MDT) pacemakers with e... Devices, CardiologyMedtronic, SureScan, pacemaker, atrial fibrillation, bradycardia (Source: HSMN NewsFeed)
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Weight Loss Can Combat Irregular Heart Beat, Study Says
MedlinePlus Health News
11/18/2013 6:00:00 AM
Atrial fibrillation is a potentially fatal condition affecting more and more people Source: HealthDay Related MedlinePlus Pages: Atrial Fibrillation, Body Weight, Weight Control (Source: MedlinePlus Health News)

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Preoperative cardiac evaluation and management of patients undergoing elective non-cardiac surgery.
Med J Aust
11/18/2013
Authors: Scott IA, Shohag HA, Kam PC, Jelinek MV, Khadem GM Abstract Perioperative cardiac complications are a common cause of death and major morbidity in patients undergoing non-cardiac surgery. Preoperative evaluation and medical optimisation can improve outcomes, although the evidence base is limited. Evidence of effectiveness is strongest for prophylactic use of β-blockers in high-risk patients and aspirin in patients with coronary artery disease. Particular challenges arise among patients with heart failure or valvular heart disease or those receiving antithrombotic therapy for coronary artery stents or atrial fibrillation. Close liaison between general practitioners, surgeons, anaesthetists and cardiologists is needed for optimising preoperative management and subsequent cl...
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Cellular and Molecular Mechanisms of Atrial Arrhythmogenesis in Patients With Paroxysmal Atrial Fibrillation.
Circulation
11/18/2013
CONCLUSIONS: Increased diastolic sarcoplasmic reticulum Ca(2+) leak and related delayed after-depolarizations/triggered activity promote cellular arrhythmogenesis in pAF patients. Biochemical, functional, and modeling studies point to a combination of increased sarcoplasmic reticulum Ca(2+) load related to phospholamban hyperphosphorylation and ryanodine receptor dysregulation as underlying mechanisms. PMID: 24249718 [PubMed - as supplied by publisher] (Source: Circulation)
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Relation between soluble ST2, growth differentiation factor–15, and high-sensitivity troponin I and incident atrial fibrillation
American Heart Journal
11/18/2013
Conclusion: In a community-based cohort, circulating hsTnI concentrations were associated with incident AF. None of the novel biomarkers evaluated improved AF risk discrimination or reclassification beyond standard clinical AF risk factors and biomarkers. (Source: American Heart Journal)
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Relation of hypothyroidism and incident atrial fibrillation (from the Framingham heart study)
American Heart Journal
11/18/2013
Background: Hyperthyroidism has a well-described association with atrial fibrillation (AF). However, the relation of hypothyroidism to AF has had limited investigation. Hypothyroidism is associated with cardiovascular risk factors, subclinical cardiovascular disease, and overt cardiovascular disease, all of which predispose to AF. We investigated 10-year incidence of AF in a community-dwelling cohort.Methods: Among 6,653 Framingham heart Study participants, 5,069 participants, 52% female, with mean age of 57 ± 12 years, were eligible after excluding those with missing thyroid-stimulating hormone (TSH), TSH 19.9 μU/L, or prevalent AF. Thyroid-stimulating hormone was categorized by range (≥0.45 to (Source: American Heart Journal)
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Acute epigastric and low back pain during amiodarone infusion; is it the drug or the vehicle to blame?
Heart and Lung
11/18/2013
Abstract: Amiodarone is a Class III antiarrhythmic agent used for cardioversion and prevention of recurrences of atrial fibrillation. However, its use is limited due to its side-effects resulting from the drug's long-term administration. We have described acute epigastric pain following treatment with intravenous amiodarone for atrial fibrillation in a previous report. Hereby, we describe a second patient who suffered acute epigastric pain, as well as one who suffered acute low back pain. Intravenous amiodarone has been related to a series of minor and major adverse reactions, indicating other constituents of the intravenous solution as the possible cause, possibly polysorbate-80. A possible correlation between acute epigastric and low back pain after intravenous amiodarone loading is unpr...

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King of Hearts for Ace of Spades: Apical Hypertrophic Cardiomyopathy
The American Journal of Medicine
11/18/2013
Despite recurring hospitalizations and evaluations, the correct diagnosis can remain elusive. This point was highlighted when a 56-year-old man presented with chest pain, headache, and syncope. He had a long history of atypical chest pain, recurrent syncope, paroxysmal atrial fibrillation, and nonsustained ventricular tachycardia. His chest pain was nonexertional, sharp, and localized to the substernum; it was not associated with dyspnea. He described the headache as frontal and sharp in nature without focal neurological symptoms, nausea, or vomiting. Syncope, which occurred upon standing, was preceded by a brief period of lightheadedness. (Source: The American Journal of Medicine)
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Phased RF ablation in persistent atrial fibrillation
Heart Rhythm
11/18/2013
Conclusions: Catheter ablation of persistent/long-standing persistent AF with the phased RF ablation system is effective with greater reduction of AF compared with MM. More intense anticoagulation strategies, careful attention to catheter placement relative to the pulmonary vein ostia, and elimination of electrode interaction are expected to reduce the risk of stroke, pulmonary vein stenosis, and asymptomatic cerebral emboli. (Source: Heart Rhythm)
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The left and right atria finally express themselves
Heart Rhythm
11/18/2013
Much of the effort in revealing genetic factors underlying cardiac diseases, including atrial fibrillation (AF), has involved studying the variation in coding sequences of genes—the part of the genome that encodes the structure of proteins. This work has largely involved the identification of disease-causing mutations, but disease expression in patients with the same mutation can be variable or the mutation can exhibit what geneticists term incomplete penetrance. It is now known that single nucleotide polymorphisms (SNPs) can act as regulatory elements to alter the abundance of a gene transcript. A good example was discovered recently in long QT syndrome type 1. An SNP in the 3′ untranslated region of the KCNQ1 gene governs whether the associated coding region is read or not; if the mu...
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Safety and feasibility of transseptal puncture for atrial fibrillation ablation in patients with atrial septal defect closure devices
Heart Rhythm
11/18/2013
AF is often found in association with an ASD. There are an increasing number of patients undergoing transcatheter closure of an ASD who subsequently develop AF in clinical practice. Catheter ablation has emerged as an effective treatment strategy for drug-refractory symptomatic AF. While transseptal access to the left atrium (LA) is a prerequisite for AF ablation, it may prove difficult in the presence of an ASD closure device. Anticipating technical difficulties and potential complications may discourage operators from considering catheter ablation of AF in this particular patient population. Herein, we describe our experience with TSP in patients with prior implantation of an ASD closure device. (Source: Heart Rhythm)

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Additive effect of the metabolic syndrome score to the conventional CHADS2 score for the thromboembolic risk stratification of patients with atrial fibrillation
Heart Rhythm
11/17/2013 7:00:00 PM
Conclusions: We, for the first time, demonstrated that metabolic syndrome components were associated with thromboembolic risk in Taiwanese patients with AF. In addition to the conventional CHADS2 scheme, the calculation of the CHADS2-MS score provides additional information on stroke risk assessment. (Source: Heart Rhythm)
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Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury
Heart Rhythm
11/17/2013 7:00:00 PM
Background: Cryoballoon ablation has been associated with a significant incidence of phrenic nerve injury (PNI).Objective: The purpose of this study was to evaluate whether recordings of diaphragmatic compound motor action potentials (CMAP) on a modified lead I during cryoballoon ablation can predict PNI.Methods: Cryoballoon ablation was performed in 109 patients with atrial fibrillation (AF). During ablation of the right-sided pulmonary veins, the phrenic nerve was paced from the superior vena cava. The right and left arm electrodes from a 12-lead ECG were positioned 5 cm above the xiphoid process and 16 cm along the right costal margin. The amplitude of CMAP was recorded on lead I during ablation.Results: Cryoballoon was applied 424 times in 211 right-sided veins. PNI occurred in 7 (6.4%...
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Targeted sequencing in candidate genes for atrial fibrillation: The Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Targeted Sequencing Study
Heart Rhythm
11/17/2013 7:00:00 PM
Conclusions: We identified 1 common single-nucleotide polymorphism and 1 gene region that were significantly associated with AF. Future sequencing efforts with larger sample sizes and more comprehensive genome coverage are anticipated to identify additional AF-related variants. (Source: Heart Rhythm)
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Weight reduction decreases atrial fibrillation and symptom severity
EurekAlert! - Medicine and Health
11/17/2013
(The JAMA Network Journals) Hany S. Abed, B.Pharm., M.B.B.S., of the University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia and colleagues evaluated the effect of a structured weight reduction program on atrial fibrillation symptoms. (Source: EurekAlert! - Medicine and Health)
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In Workup for New-Onset AF, What and What Not to Order?
Consultant Live
11/15/2013 7:00:00 AM
In evaluating a patient with new-onset atrial fibrillation for cardiac or embolic risk, there are several essential elements in a thorough workup. See if you know which of the tests here you can forgo. (Source: Consultant Live)

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Low Mortality and Low Rate of Perceived and Documented Arrhythmias after Cox Maze III Surgery for Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
11/15/2013
ConclusionCut‐and‐sew Cox maze III surgery provided long‐lasting high efficacy, also in patients with nonparoxysmal AF of long duration and/or concomitant surgery, and was associated with low rates of subsequent adverse events. (Source: Pacing and Clinical Electrophysiology : PACE)
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Novel Oral Anticoagulants and Atrial Fibrillation: Efficacy and Safety Considerations
Drug Development Research
11/15/2013
Abstract For almost six decades, vitamin K antagonists (e.g., warfarin) were the only available oral drugs for the prevention of thromboembolism in patients with atrial fibrillation. Recently, novel oral anticoagulants that target thrombin (dabigatran) or activated factor X (rivaroxaban and apixaban) have successfully completed clinical development and received approval for stroke prevention in atrial fibrillation. Novel oral anticoagulants have been shown to be noninferior, or in some cases superior to warfarin in both safety and efficacy aspects. Their advanced pharmacological properties result to rapid, consistent anticoagulation at fixed dosing without need for laboratory monitoring. As with any antithrombotic therapy, novel oral anticoagulants should be used with caution, for t...
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Clinical Research needs investigator initiated trials: AFNET-EAST has enrolled 1000 patients
ESC News and Press
11/14/2013 10:05:29 AM
The pan-European clinical trial “Early treatment of atrial fibrillation for stroke prevention trial (EAST)“ compares two different treatment strategies in atrial fibrillation and exemplifies the added value of independent investigator initiated trials for clinical progress. Many questions which are important for medical care, such as the relevance of early rhythm control therapy, will not be addressed by commercial trials.  Read more Topics: Arrhythmias, Atrial Fibrillation (Source: ESC News and Press)
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Electromechanical Effects of 1,25‐Dihydroxyvitamin D with Antiatrial Fibrillation Activities
Journal of Cardiovascular Electrophysiology
11/14/2013
Conclusion1,25[OH]2D has direct electromechanical effects on the LA and can prevent or terminate AF. (Source: Journal of Cardiovascular Electrophysiology)
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Esophago‐pericardial Fistula Complicating Atrial Fibrillation Ablation Using a Novel‐Irrigated Radiofrequency Multipolar Ablation Catheter
Journal of Cardiovascular Electrophysiology
11/14/2013
(Source: Journal of Cardiovascular Electrophysiology)
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Unveiling the Remodelled Atrium: Lessons From the Early Recurrence of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
11/14/2013
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Impact of Structural Heart Disease on the Acute Complication Rate in Atrial Fibrillation Ablation: Results from the German Ablation Registry
Journal of Cardiovascular Electrophysiology
11/14/2013
ConclusionIn general, CA of AF has a low number of severe complications. In our prospective registry HHD emerged as an independent predictor of severe, non‐fatal complications during AF ablation but other structural heart diseases including CAD and CM did not. The influence of HHD on the complication rate should be considered in patient selection.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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Impact of a 4q25 Genetic Variant in Atrial Flutter and the Risk of Atrial Fibrillation after Cavotricuspid Isthmus Ablation
Journal of Cardiovascular Electrophysiology
11/14/2013
ConclusionsOur study demonstrates that Afl, whether occurring in isolation or along with AF, is associated with the rs2200733 AF risk allele. Genetic carrier status of rs2200733 failed to predict an increased risk of incident or recurrent AF following catheter ablation for Afl. These findings suggest that the causal mechanism associated with rs2200733 is germane to both AF and Afl.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Evaluation of Time Course and Predicting Factors of Progression of Paroxysmal or Persistent Atrial Fibrillation to Permanent Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
11/14/2013
ConclusionsProgression to permanent AF is a slow process. Aging, LA size, VVI pacing, lack of AA therapy, and a persistent form of AF independently increased the progression to permanent AF. (Source: Pacing and Clinical Electrophysiology : PACE)
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Highlights from the literature
Emergency Medicine Journal
11/14/2013
Good news for coffee drinkers For a long time there has been a presumed association between caffeine exposure and cardiovascular disease, particularly arrhythmias. However, increasingly, the evidence seems not to support such a relationship. A systematic review and meta-analysis has revealed not only that caffeine exposure does not seem to be related to an increased risk of atrial fibrillation, but that in low doses it may even be a protective factor (Heart 2013;99:1383–9). Power of the internet Physicians in six European countries took part in a study on the impact of internet training on antibiotic prescribing in patients with lower respiratory tract infections based upon point of care testing of C-reactive protein levels (Lancet 2013;382:1175–82). The authors use their resul...
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The Efficacy and Safety of Oral Anticoagulants in Warfarin-Suitable Patients With Nonvalvular Atrial Fibrillation: Systematic Review and Meta-Analysis
Clinical and Applied Thrombosis/Hemostasis
11/14/2013
The novel oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban have been recently indicated for stroke prevention in patients with atrial fibrillation (AF) . Due to a lack of direct head-to-head trials comparing the NOACs, the current systematic review and network meta-analysis (NMA) were conducted to assess their relative efficacy and safety. Three phase III randomized controlled trials enrolling 50 578 patients were included. Results of the NMA show a clear trend favoring NOACs over warfarin with regard to the key outcomes of stroke/systemic embolism and all-cause mortality, with apixaban also showing a favorable response for major bleeding and total discontinuations. Although there were few significant differences among the NOACS with regard to efficacy outcomes, apixa...

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The Association of Interleukin 6-634C/G Polymorphism With Left Atrial Thrombus and Severe Spontaneous Echocontrast in Patients With Atrial Fibrillation
Clinical and Applied Thrombosis/Hemostasis
11/14/2013
Atrial fibrillation (AF) not only is an independent risk factor for death but also confers significant risk of morbidity from stroke associated with left atrial thrombus. The association of interleukin 6 (IL-6) polymorphism with thrombus in AF has not been investigated before. We carried out a case–control study in Han Chinese. The IL-6 –634C/G genotypes of 31 patients with thrombus and 45 patients without thrombus were detected by polymerase chain reaction and restriction fragment length polymorphism. The frequencies of the IL-6 genotypes (CC, CG, and GG) were 29.03%, 54.54%, and 16.13% for the patients with thrombus, and 55.56%, 40.00%, and 4.44% for the patients without thrombus, respectively (P = .0391). Compared with the CC genotype, the G allele carriers (CG + GG) had a 2...
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Risk scoring and thromboprophylactic treatment of patients with atrial fibrillation with and without access to primary healthcare data: Experience from the Stockholm health care system
International Journal of Cardiology
11/14/2013
Conclusions: Registry CHA2DS2VASc scores were underestimated without co-morbidity data from primary care. Many individuals with scores 0 and 1 were treated with warfarin, despite poor documentation of clinical benefit. In contrast, warfarin appears to be underused and ASA overused among high risk atrial fibrillation patients. Lack of diagnoses from primary care underestimated CHA2DS2VASc scores and may thereby have overestimated treatment benefits in low-risk patients in earlier studies. (Source: International Journal of Cardiology)
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Also beware of inaccuracies in the estimation of renal function
American Heart Journal
11/14/2013
What the authors referred to as the “potential for prolongation of action and dose accumulation [of the new anticoagulants]” was exemplified by a 74-year-old significantly overweight (body weight 146 kg) patient with gastrointestinal bleeding and worsening congestive cardiac failure who had been taking dabigatran for atrial fibrillation thromboprophylaxis. Despite an estimated glomerular filtration rate (GFR) of >90 mL/min, her plasma dabigatran levels starting 24 hours after discontinuation of the drug were 247, 317, 157, and 10.6 ng/mL, at 24, 36, 48, and 96 hours, signifying high levels for at least 5 days after its discontinuation. One potential explanation for delayed excretion of dabigatran is that the GFR of >90 mL/min was an overestimate, given the recent observation that both ...
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Meta-Analysis of Gender Differences in Residual Stroke Risk and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants
The American Journal of Cardiology
11/14/2013
In conclusion, women with AF treated with warfarin have a greater residual risk of CVA/SE and an equivalent major bleeding risk, whereas those treated with NOAC agents deemed superior to warfarin are at equivalent residual risk of CVA/SE and less major bleeding risk compared with men. These results suggest an increased net clinical benefit of NOAC agents compared with warfarin in treating women with AF. (Source: The American Journal of Cardiology)
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AUtomated Risk Assessment for Stroke in Atrial Fibrillation (AURAS-AF) - an automated software system to promote anticoagulation and reduce stroke risk: study protocol for a cluster randomised controlled trial
Trials
11/13/2013
DiscussionAURAS-AF will investigate whether a simple intervention, using electronic primary care records, can improve OAC uptake in a high risk group for stroke. Given previous concerns about safety, especially surrounding inappropriate prescribing, we will also examine whether electronic reminders safely impact care in this clinical area.Trial registration: ISRCTN 55722437 (Source: Trials)

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New oral anticoagulants: An emergency department overview
Emergency Medicine Australasia
11/13/2013
Abstract As of September 2013, three new oral anticoagulants (NOACs) are now available for clinical use on the Pharmaceutical Benefits Scheme in Australia. All three are for stroke prevention in atrial fibrillation, and one will also be available for the treatment of deep venous thrombosis and pulmonary embolism. All have been evaluated in large, multicentre randomised clinical trials. These drugs show at least equivalent efficacy to the current standard of care, the vitamin K antagonist warfarin. Major bleeding rates are overall comparable with warfarin, but there is an important reduction in intracranial bleeding of approximately 50% with all NOAC agents. The NOACs are administered in a simple, fixed dose regimen. There are a few clinically important interactions with other medications o...
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Use of novel oral anticoagulants for patients with atrial fibrillation: Systematic review and clinical implications
Heart and Lung
11/13/2013
Abstract: Atrial fibrillation (AF), a common arrhythmia, increases the risk of ischemic stroke. Stroke and bleeding scores for patients with AF can help to stratify risk and determine the need for antithrombotic therapy, for which warfarin has been the gold standard. Although highly effective, warfarin has several limitations that can lead to its underuse. Data from randomized, Phase III clinical trials of the novel oral anticoagulants, dabigatran, a direct thrombin inhibitor, and rivaroxaban and apixaban, both factor Xa inhibitors, indicate these drugs are at least noninferior to warfarin for the prevention of stroke and systemic embolism. They are easier to administer, and have an equivalent or lower risk of bleeding versus warfarin. A better understanding of the risks and benefits of th...
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Novel Oral Anticoagulants: A New Practical GuideNovel Oral Anticoagulants: A New Practical Guide
Medscape Today Headlines
11/12/2013 1:18:07 PM
Guidance on the management of nonvalvular atrial fibrillation, from the European Heart Rhythm Association. theheart.org on Medscape (Source: Medscape Today Headlines)
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"Cardiovascular diseases should be higher on the political agenda" said Tonio Borg, the EU commissioner for health.
ESC News and Press
11/12/2013 11:40:16 AM
Cardiovascular disease is the number one killer in the EU, but it is not yet given enough importance on the political agenda, according to Tonio Borg, who has scheduled an EU summit on chronic diseases at the beginning of next year.He spoke at the launch of the Cardiovascular Health Week, an initiative by the MEP Heart Group. Read the article. Topics: Acute Coronary Syndromes (ACS), Arrhythmias, Atherosclerosis, Atrial Fibrillation, Basic Science, Cardiac Tumours, Cardiovascular Disease Prevention - Risk Assessment and Management, Cardiovascular Nursing, Cardiovascular Surgery, Chronic Ischaemic Heart Disease (IHD), Clinical pharmacology, Computers in Cardiology, Congenital Heart Disease, Diabetic heart disease, Diseases of the Aorta and Trauma to th...
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Atrial Fibrillation (AFib) Myths and Facts
WebMD Health
11/12/2013 11:22:25 AM
If you or someone you know has been diagnosed with AFib, it’s important to separate the myths from the facts. Here’s what you need to know. (Source: WebMD Health)

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Ca 2+ Leak in Atrial Fibrillation Junctophilin-2 Stabilizes Ryanodine Receptor ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:16 PM
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, poses a formidable challenge to modern-day medicine. AF affects as many as 5 million Americans (1), and responses to therapy are highly variable among patients. Some therapies are fraught with substantial risk of proarrhythmia. As our population ages, the incidence of this rhythm disturbance, which can be associated with markedly increased morbidity and mortality, will continue to increase. Although strides have been made in elucidating underlying mechanisms, key molecular events remain elusive (2). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Rare Insight Into the Rapid Evolution of a Coronary Aneurysm and Fistula
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:16 PM
A 79-year-old man with controlled systemic hypertension, aortic aneurysm, and remote myocardial infarction presented with chest pains. Coronary angiography (A, Online Video 1) demonstrated a dominant left circumflex artery, occluded marginal branches, and minor ectasia (arrows). He was managed with medication. The patient re-presented 3 weeks later with symptomatic new atrial fibrillation and lateral ST-segment depression on electrocardiography. Repeat angiography (B,Online Video 2) demonstrated unchanged left anterior descending disease but some progression in his proximal circumflex ectasia. His medications were adjusted. The patient presented again 2 weeks later, with further chest pain and more pronounced inferolateral ST-segment depression than previously. Angiography (C, Online V...
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First-in-Man Randomized Clinical Trial of Renal Denervation for Atrial Arrhythmia Raises Concern
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:16 PM
Pokushalov et al. (1) reported the first-in-man randomized clinical trial (NCT01117025) comparing the effects of pulmonary vein isolation with (intervention) or without (control) renal denervation in patients with refractory atrial fibrillation and treatment-resistant hypertension. We were struck by several inconsistencies in this trial. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Reply First-in-Humans Randomized Clinical Trial of Renal Denervation for Atrial Arrhythmia Raises Concern
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:16 PM
We appreciate the interest that Dr. Staessen and colleagues have expressed regarding our recently published study (1). We have addressed each of the issues.1.The original protocol identified office systolic blood pressure (BP) at 2 years, not recurrence of atrial fibrillation (AF) at 1 year, as the primary endpoint that should have informed the sample size calculations. The number of patients actually randomized was 27, 1 more than required according to last version of the protocol at the registry Website, and 82% less than first planned for (N = 150). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Prevalence of Silent Cerebral Ischemia in Paroxysmal and Persistent Atrial Fibrillation and Correlation With Cognitive Function
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:15 PM
ObjectivesThe aim of this study was to compare the prevalence of silent cerebral ischemia (SCI) and cognitive performance in patients with paroxysmal and persistent atrial fibrillation (AF) and controls in sinus rhythm.BackgroundLarge registries have reported a similar risk for symptomatic stroke in both paroxysmal and persistent AF. The relationship among paroxysmal and persistent AF, SCI, and cognitive impairment has remained uncharted.MethodsTwo hundred seventy subjects were enrolled: 180 patients with AF (50% paroxysmal and 50% persistent) and 90 controls. All subjects underwent clinical assessment, neurological examination, cerebral magnetic resonance, and the Repeatable Battery for the Assessment of Neuropsychological Status.ResultsAt least 1 area of SCI was present in 80 patients...
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Atrial Fibrillation, Silent Cerebral Ischemia, and Cognitive Function ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:15 PM
In this issue of the Journal, Gaita et al. (1) report findings from 270 patients, of whom 180 had atrial fibrillation and 90 with similar demographic and clinical characteristics did not have atrial fibrillation. All were free of clinical stroke at the time of the study, and all underwent brain magnetic resonance imaging (MRI). Silent cerebral ischemia (SCI) was defined as a focal, sharply demarcated area on MRI of hyperintensity on T2-weighted fluid-attenuated inversion recovery or isointensity on T1-weighted imaging. The numbers of SCI lesions, and the areas of the brain in which they were observed, were determined. A standardized measure of cognitive function was also obtained. Gaita et al. found a substantially higher prevalence of SCI in those with atrial fibrillation compared wi...
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Mutation E169K in Junctophilin-2 Causes Atrial Fibrillation Due to Impaired RyR2 Stabilization
Journal of the American College of Cardiology: Cardiovascular Interventions
11/11/2013 6:21:15 PM
ConclusionsOur data suggest a novel mechanism by which reduced JPH2-mediated stabilization of RyR2 due to loss-of-function mutation or reduced JPH2/RyR2 ratios can promote SR Ca2+ leak and atrial arrhythmias, representing a potential novel therapeutic target for AF. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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The Relationship between Paroxysmal Atrial Fibrillation and Coronary Artery Spasm
Pacing and Clinical Electrophysiology : PACE
11/11/2013
ConclusionsParoxysmal AF patients have high positive rates of drug‐provoked coronary artery spasm. Patients with paroxysmal AF may coincidentally exhibit coronary artery spasm (Source: Pacing and Clinical Electrophysiology : PACE)
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The Effect of Anxiety and Depression on Symptoms Attributed to Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
11/11/2013
ConclusionsOur results extend previous studies demonstrating that anxiety and depression are associated with worsened AFSS. Antiarrhythmic drug therapy or catheter ablation reduces AFSS but does not affect depression and anxiety symptoms. To achieve more comprehensive AF symptom relief, treatment of both AF and psychological comorbidities may be beneficial. (Source: Pacing and Clinical Electrophysiology : PACE)

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High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke
Neurology
11/11/2013
(Source: Neurology)
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Comparison of Transesophageal Echocardiography Versus Computed Tomography for Detection of Left Atrial Appendage Filling Defect (Thrombus)
The American Journal of Cardiology
11/11/2013
Patients with atrial fibrillation, who are referred for radiofrequency pulmonary vein antral isolation, frequently undergo transesophageal echocardiography (TEE) to detect and/or exclude left atrial or left atrial appendage (LAA) thrombus and cardiac computed tomographic angiography (CCTA) to define and/or evaluate left atrial and pulmonary venous anatomy. Previous studies have reported CCTA to have high sensitivity and negative predictive value (NPV) for detecting thrombus in the LAA. Previous studies determining an optimal LAA/ascending aorta (AA) Hounsfield unit (HU) density ratio for detection of LAA thrombus have been small, with limited numbers of thrombi. We thus sought to determine both the optimal cutoff for LAA HU density and LAA/AA HU density ratio in detecting LAA thrombus comp...
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An N-terminal pro-atrial natriuretic peptide (NT-proANP) ‘aggregation-prone’ segment involved in isolated atrial amyloidosis
FEBS Letters
11/11/2013
Highlights: Abstract: Isolated atrial amyloidosis (IAA) is a common localized form of amyloid deposition within the atria of the aging heart. The main constituents of amyloid fibrils are atrial natriuretic peptide (ANP) and the N-terminal part of its precursor form (NT-proANP). An ‘aggregation-prone’ heptapeptide (114KLRALLT120) was located within the NT-proANP sequence. This peptide self-assembles into amyloid-like fibrils in vitro, as electron microscopy, X-ray fiber diffraction, ATR FT-IR spectroscopy and Congo red staining studies reveal. Consequently, remedies/drugs designed to inhibit the aggregation tendency of this ‘aggregation-prone’ segment of NT-proANP may assist in prevention/treatment of IAA, congestive heart failure (CHF) or atrial fibrillation (AF). (Source: FEBS Let...
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Usefulness of Pharmacologic Conversion of Atrial Fibrillation During Dofetilide Loading Without the Need for Electrical Cardioversion to Predict Durable Response to Therapy
The American Journal of Cardiology
11/11/2013
In conclusion, PC during in-hospital dofetilide loading is an important predictor of durable response even in long-standing persistent patients, which has important public health implications for choice of therapy. (Source: The American Journal of Cardiology)
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Overtreatment and Undertreatment With Anticoagulation in Relation to Cardioversion of Atrial Fibrillation (the RHYTHM-AF Study)
The American Journal of Cardiology
11/11/2013
In conclusion, ECV was frequently performed under appropriate antithrombotic therapy for most high-risk patients with atrial fibrillation, whereas PCV was frequently performed without appropriate antithrombotic therapy. To enhance pericardioversion stroke prevention, cardioversion algorithms should focus less on the type of conversion and more on stroke risk factors and atrial fibrillation duration. (Source: The American Journal of Cardiology)

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Meta-Analysis Comparing Carvedilol Versus Metoprolol for the Prevention of Postoperative Atrial Fibrillation Following Coronary Artery Bypass Grafting
The American Journal of Cardiology
11/11/2013
In conclusion, compared with metoprolol, carvedilol significantly reduces the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. (Source: The American Journal of Cardiology)
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Successful closure of residual leak following lariat procedure in a patient with high risk of stroke and hemorrhage
Catheterization and Cardiovascular Interventions
11/9/2013
Percutaneous left atrial appendage suture ligation with the LARIAT® device (Sentre HEART, Redwood City, CA) was successfully performed on an 84‐year‐old woman with non‐valvular atrial fibrillation who developed intracranial hemorrhage on warfarin. However, a large gap developed at follow‐up precluding warfarin cessation. To the best of our knowledge, this case report represents the first description of the use of a Gore® Helex® Septal Occluder (W. L. Gore and Associates, Newark, Delaware) as a novel approach to close a gap following percutaneous LAA suture ligation. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)
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[Atrial fibrillation after coronary artery bypass graft].
Polish Heart Journal
11/8/2013 6:19:09 AM
Authors: Michta K, Pietrzyk E, Wożakowska-Kapłon B PMID: 24197592 [PubMed - in process] (Source: Polish Heart Journal)

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Relation of Low Vitamin D to Nonvalvular Persistent Atrial Fibrillation in Chinese Patients
Annals of Noninvasive Electrocardiology
11/8/2013
ConclusionsLow vitamin D levels are associated with AF. It may be involved in its development. (Source: Annals of Noninvasive Electrocardiology)
http://www.medworm.com/rss/comments.php?id=7742378
Left Atrial Laceration With Epicardial Ligation Device.
Annals of Thoracic and Cardiovascular Surgery
11/8/2013
Authors: Keating VP, Kolibash CP, Khandheria BK, Bajwa T, Sra J, Kress DC Abstract Many new devices and techniques are being developed to attempt a reduction in embolic stroke risk for patients with atrial fibrillation who are either unable or unwilling to maintain long-term anticoagulation. One of these new devices (LARIAT(®), SentreHEART Inc., Redwood City, California, USA) employs delivery of an epicardial suture to ligate the left atrial appendage after percutaneous pericardial and transseptal access. This series presents three clinical cases that demonstrate a serious and recurrent complication of left atrial laceration and cardiac tamponade shortly following delivery of an epicardial suture ligation to the left atrial appendage. Three clinical cases are described in detail w...
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Apixaban vs Warfarin in Patients With Atrial FibrillationApixaban vs Warfarin in Patients With Atrial Fibrillation
Medscape Today Headlines
11/7/2013 3:05:23 AM
Are the rates of stroke/systemic embolism and major bleeding lower among patients assigned to apixaban -- irrespective of prior vitamin K antagonist use? American Heart Journal (Source: Medscape Today Headlines)
http://www.medworm.com/rss/comments.php?id=7739989
Biomarker Can Predict Events in Afib Patients (CME/CE)
MedPage Today State Required CME
11/6/2013 1:43:03 PM
(MedPage Today) -- Beta-trace protein, a biomarker that has been associated with both kidney damage and an increased cardiovascular risk, may help identify high-risk atrial fibrillation patients, researchers found. (Source: MedPage Today State Required CME)
http://www.medworm.com/rss/comments.php?id=7739051
Real‐Time Contact Force Sensing for Pulmonary Vein Isolation in the Setting of Paroxysmal Atrial Fibrillation: Procedural and 1‐Year Results
Journal of Cardiovascular Electrophysiology
11/6/2013
ConclusionOur findings suggest a potential benefit of real‐time CF sensing technology, in reducing AF recurrence during the first year after PVI. (Source: Journal of Cardiovascular Electrophysiology)

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AF Linked with Increased Risk of Heart Attack
Medical Headlines From Ivanhoe.com
11/6/2013
(Ivanhoe Newswire) –Atrial fibrillation (AF), an irregular heartbeat, was associated with a nearly two-fold relative increase in the risk of myocardial infarction (MI), especially in women and blacks, according to a recent study at Wake Forest School of Medicine. (Source: Medical Headlines From Ivanhoe.com)
http://www.medworm.com/rss/comments.php?id=7740628
The adequacy of anticoagulation with IV unfractionated heparin
International Journal of Surgery
11/5/2013 10:18:40 PM
Aim: Heparin is commonly prescribed as an IV unfractionated infusion for venous thromboembolism, patients with mechanical cardiac valves and atrial fibrillation. Our aim was to determine the proportion of time that the APTT was within therapeutic range. (Source: International Journal of Surgery)
http://www.medworm.com/rss/comments.php?id=7736748
A survey of the management of post-operative atrial fibrillation in cardiac centres across the UK
International Journal of Surgery
11/5/2013 10:18:39 PM
Aim: European guidelines have been written on the management of post-op atrial fibrillation (AF). We sought to determine the variability in practice of post-op AF management in cardiac surgical centres across the UK. (Source: International Journal of Surgery)
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An audit investigating the loading of amiodarone in patients developing atrial fibrillation post cardiac surgery
International Journal of Surgery
11/5/2013 10:18:39 PM
This study evaluates adherence to these guidelines in our cardiac unit. (Source: International Journal of Surgery)

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Ablation of paroxysmal and persistent atrial fibrillation with multielectrode phased radiofrequency duty-cycled catheters: long-term results from a large cohort of patients
Journal of Cardiovascular Medicine
11/5/2013 12:19:46 PM
ConclusionThe ablation of symptomatic PAF and CAF with multielectrode phased radiofrequency/duty-cycled ablation catheters shows long-term safety and effectiveness with relatively short procedure times. (Source: Journal of Cardiovascular Medicine)
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Physical activity and atrial fibrillation
Heart
11/5/2013
Atrial fibrillation is primarily a problem of older age and the risk factors for atrial fibrillation in older age are well described: older age, male sex, valve disease, heart failure, systolic blood pressure and Body Mass Index.1 But a significant minority of atrial fibrillation presents in younger patients without obvious morbidities or risk factors: lone atrial fibrillation. This may have a more benign prognosis to atrial fibrillation in older adults.2 A persistent puzzle about the causes of lone atrial fibrillation has been the relationship between physical activity and the onset of lone atrial fibrillation. Could being more physically active also have adverse consequences? Plausible mechanisms have been advanced for an increased risk of atrial fibrillation in endurance athletes: incre...
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Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309 540 men and women
Heart
11/5/2013
Conclusions This population based study supports the hypothesis that the risk of drug treated lone AF increases with declining resting heart rate in both sexes, and with increasing levels of self-reported physical activity in men. (Source: Heart)
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Ceruloplasmin dysfunction: a key factor in the pathophysiology of atrial fibrillation?
Journal of Internal Medicine
11/5/2013
This article is protected by copyright. All rights reserved. (Source: Journal of Internal Medicine)

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Atrial fibrillation: Catheter ablation is better than drugs to treat persistent AF
Nature Reviews Cardiology
11/5/2013
Nature Reviews Cardiology 10, 680 (2013). doi:10.1038/nrcardio.2013.170 Author: Megan Cully Ablation therapy could be an effective treatment for patients with persistent atrial fibrillation (AF). In a randomized, controlled trial comparing catheter ablation with antiarrhythmic drug therapy, patients who underwent catheter ablation had fewer episodes of AF or atrial flutter lasting >24 h than patients treated (Source: Nature Reviews Cardiology)
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Efficacy, Safety, and Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction
Journal of the American College of Cardiology: Cardiovascular Interventions
11/4/2013 6:20:51 PM
ConclusionsOur results suggest that AF can be effectively and safely treated with a composite of repeat procedures and pharmaceuticals in patients with HFPEF. However, the current study was a single-arm analysis; therefore, larger randomized control studies are needed to verify the benefit of AF ablation in this cohort. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Treating AF: Reducing Stroke Risk With AblationTreating AF: Reducing Stroke Risk With Ablation
Medscape Today Headlines
11/4/2013 5:29:10 PM
Drs. Ileana Piña and Hugh Calkins discuss recent findings suggesting that treating atrial fibrillation with catheter ablation can reduce the risk for stroke. Medscape Cardiology (Source: Medscape Today Headlines)
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Heart-Rhythm Disorder Tied to Higher Risk of Heart Attack
MedlinePlus Health News
11/4/2013 4:00:00 PM
People with atrial fibrillation had nearly doubled odds of a later heart attackSource: HealthDay Related MedlinePlus Pages: Atrial Fibrillation, Heart Attack (Source: MedlinePlus Health News)
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Afib May Spark MI (CME/CE)
MedPage Today State Required CME
11/4/2013 3:00:00 PM
(MedPage Today) -- Although myocardial infarction is a known risk factor for the development of atrial fibrillation, the relationship might work the other way around, too, researchers found. (Source: MedPage Today State Required CME)

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Update on the management of atrial fibrillation.
Med J Aust
11/4/2013
Authors: Amerena JV, Walters TE, Mirzaee S, Kalman JM Abstract Atrial fibrillation (AF) is a common arrhythmia, with a prevalence that increases markedly with increasing age. Presence of AF has implications for management of future stroke risk. If the patient's pulse is irregular, an electrocardiogram should be ordered. Key management decisions are whether to adopt a rhythm control or a rate control strategy and whether to initiate anticoagulation. The primary aim of a rhythm control strategy is improved symptom control. AF ablation may be considered in younger patients (aged < 65 years) with paroxysmal or early persistent AF. AF increases the risk of stroke, and anticoagulation should be considered on the basis of stroke risk - clearly indicated with a CHADS 2 score (congesti...
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Evaluation and care of a patient with new-onset atrial fibrillation.
cmaj
11/4/2013
Authors: Moayedi Y, Abdel-Qadir HM, Dorian P PMID: 24190989 [PubMed - as supplied by publisher] (Source: cmaj)
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Relation of atrial fibrillation (AF) and change of lipoproteins: male patients with AF exhibited severe pro-inflammatory and pro-atherogenic properties in lipoproteins.
Clinical Biochemistry
11/4/2013
CONCLUSION: Lipoprotein properties were severely impaired in the AF group with increased extent of oxidation and inflammation. The modified lipoprotein properties with impaired antioxidant functions can be used as a putative biomarker for prognostic detection for the relatively young onset AF. PMID: 24201066 [PubMed - as supplied by publisher] (Source: Clinical Biochemistry)
http://www.medworm.com/rss/comments.php?id=7756435
Apixaban in patients with atrial fibrillation and prior coronary artery disease: Insights from the ARISTOTLE trial
International Journal of Cardiology
11/4/2013
Conclusions: In patients with AF, apixaban more often prevented stroke or systemic embolism and death and caused less bleeding than warfarin, regardless of the presence of prior CAD. Given the common occurrence of AF and CAD and the higher rates of cardiovascular events and death, our results indicate that apixaban may be a better treatment option than warfarin for these high-risk patients. (Source: International Journal of Cardiology)
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Should surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium?
The Journal of Thoracic and Cardiovascular Surgery
11/4/2013
Conclusions: The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-ablation, left atrial size should not be a discouragement when evaluating surgical candidates with atrial fibrillation. (Source: The Journal of Thoracic and Cardiovascular Surgery)
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Directed acyclic graphs helped to identify confounding in the association of disability and electrocardiographic findings: results from the KORA-Age study
Journal of Clinical Epidemiology
11/4/2013
Abstract: Objectives: To examine the association between electrocardiographic (ECG) findings and disability status in older adults.Study Design and Setting: KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older.Results: A total of 534 (51.5%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P  (Source: Journal of Clinical Epidemiology)
http://www.medworm.com/rss/comments.php?id=7899147
The CURE-AF trial: A prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery
Heart Rhythm
11/4/2013
Background: Ablation technology has been introduced to replace the surgical incisions of the Cox-Maze procedure in order to simplify the operation. However, the efficacy of these ablation devices has not been prospectively evaluated.Objective: The purpose of this study was to examine the efficacy and safety of irrigated unipolar and bipolar radiofrequency ablation for the treatment of persistent and long-standing persistent atrial fibrillation (AF) during concomitant cardiac surgical procedures.Methods: Between May 2007 and July 2011, 150 consecutive patients were enrolled at 15 U.S. centers. Patients were followed for 6 to 9 months, at which time a 24-hour Holter recording and echocardiogram were obtained. Recurrent AF was defined as any atrial tachyarrhythmia (ATA) lasting over 30 second...

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Effect of carvedilol on reduction in heart rate in patients with chronic atrial fibrillation.
Clin Med Res
11/3/2013 3:45:03 AM
CONCLUSIONS: We observed that carvedilol certainly reduced HR in patients with chronic AF. We believe that the effect of carvedilol on the reduction in HR can contribute to the management of AF patients treated with rate-control strategy. PMID: 24171057 [PubMed] (Source: Clin Med Res)
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Impact of Atrial Fibrillation Termination Site and Termination Mode in Catheter Ablation on Arrhythmia Recurrence.
Circulation Journal
11/1/2013 11:00:00 PM
Conclusions: The site and mode of AF termination during the index ablation procedure predict ATa recurrence following multiple catheter ablation procedures for PsAF. PMID: 24189505 [PubMed - as supplied by publisher] (Source: Circulation Journal)
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Subclinical Hyperthyroidism and Cardiovascular Risk: Recommendations for Treatment
Cardiology in Review
11/1/2013
Subclinical hyperthyroidism (SHy), the mildest form of hyperthyroidism, is diagnosed in patients having a persistently low or undetectable serum concentration of thyroid-stimulating hormone (TSH) with normal free T4 and T3 concentrations. Although overt hyperthyroidism is associated with an increased risk of adverse cardiovascular outcomes, the cardiovascular risk of SHy is controversial. Multiple studies have demonstrated an increased risk of atrial fibrillation, especially in older individuals with TSH levels (Source: Cardiology in Review)
http://www.medworm.com/rss/comments.php?id=7762497
Novel anticoagulants for stroke prevention in atrial fibrillation: safety issues in the elderly.
Pharmacological Reviews
10/31/2013 11:00:00 PM
Authors: Strunets A, Mirza M, Sra J, Jahangir A Abstract Vitamin K antagonists (VKAs) are the most widely used anticoagulants for stroke prevention in patients with atrial fibrillation (AF). Recently, the US FDA approved three novel anticoagulants that work through inhibition of coagulation cascade independent of Vitamin K-dependent enzymatic reactions and, therefore, should have less food-drug interactions. Since AF is a disease of the aging heart, it is important to assess safety and efficacy of these new anticoagulants in elderly patients. We reviewed age-related changes in pharmacokinetics and pharmacodynamics observed with senescence and the effects of these changes on novel anticoagulants, known and anticipated drug and food interactions, and challenges related to bleeding co...

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Cardiac Critical Care After Transcatheter Aortic Valve Replacement
Cardiology Clinics
10/31/2013 11:00:00 PM
Transcatheter aortic valve replacement (TAVR) is a new therapy for severe aortic stenosis now available in the United States. Initial patients eligible for TAVR are defined by high operative risk, with advanced age and multiple comorbidities. Following TAVR, patients experience acute hemodynamic changes and several possible complications, including hypotension, vascular injury, anemia, stroke, new-onset atrial fibrillation, conduction disturbances and kidney injury, requiring an acute phase of intensive care. Alongside improvements in TAVR technology and technique, improvements in care after TAVR may contribute to improved outcomes. This review presents an approach to post-TAVR critical care and identifies directions for future research. (Source: Cardiology Clinics)
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Common Carotid Artery Occlusion With Retrograde Flow in the Internal Carotid Artery: A Case Report
Journal of Diagnostic Medical Sonography
10/31/2013 11:00:00 PM
In most cases of common carotid artery (CCA) occlusion, the internal carotid artery (ICA) is also occluded. This case presents a patient with a patent ICA distal to a thrombotic CCA occlusion, likely secondary to cardiac embolization related to chronic atrial fibrillation, with retrograde filling of the extracranial ICA via intracranial collateral flows. (Source: Journal of Diagnostic Medical Sonography)
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Thyrotropin-secreting pituitary tumor presenting with congestive heart failure and good response to dopaminergic agonist cabergoline.
J Formos Med Assoc
10/31/2013 11:00:00 PM
Authors: Kao YH, Chang TJ, Huang TS Abstract Hyperthyroidism is an important inducing factor in patients with atrial fibrillation, and may trigger heart failure. Thyrotropin (thyroid stimulating hormone, TSH)-secreting pituitary tumors are rare causes of hyperthyroidism. Here, we report a 66-year-old man with a pituitary TSH-secreting tumor who presented with hyperthyroidism and congestive heart failure. Endonasal trans-sphenoidal pituitary adenomectomy was performed. After the operation, the symptoms of hyperthyroidism and congestive heart failure were relieved, associated with normalization of thyroid function tests. Unfortunately, hand tremor and progressively elevated free T4 and TSH concentrations recurred 5 months after surgery. A dopaminergic agonist, cabergoline was adminis...
http://www.medworm.com/rss/comments.php?id=7739919
Contemporary Management of Atrial Fibrillation
The Journal for Nurse Practitioners
10/31/2013 11:00:00 PM
This article reviews the latest American College of Cardiology Foundation/American Heart Association guideline on the management of atrial fibrillation. Emphasis is placed on the changing landscape of pharmacological agents. Use of guideline-directed medical therapy will ultimately improve patients’ quality of life and prevent stroke and premature death. (Source: The Journal for Nurse Practitioners)

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Atrial fibrillation and coronary artery disease: Resembling twins?
Journal of Cardiology
10/31/2013 11:00:00 PM
Authors: Akao M PMID: 24189242 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)
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On the Preprocessing of Atrial Electrograms in Atrial Fibrillation: Understanding Botteron's Approach
Pacing and Clinical Electrophysiology : PACE
10/31/2013 11:00:00 PM
ConclusionsBotteron preprocessing succeeds in estimating the dominant atrial rate in most EGMs during AF. However, this approach presents some limitations and improved methods are required. (Source: Pacing and Clinical Electrophysiology : PACE)
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A Novel Biomarker‐Based Approach for the Detection of Asymptomatic Brain Injury during Catheter Ablation of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/31/2013 11:00:00 PM
ConclusionSerial assessment of serum protein S100B may improve detection of asymptomatic acute brain injury in patients undergoing radiofrequency catheter ablation of AF. In our study, the incidence of these events was 1.7% when evaluated only by DW‐MRI but the incidence increased to 5% after employing the more sensitive biomarker‐based approach.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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The Epidemiology of Cardiovascular Diseases in Sub-Saharan Africa: The Global Burden of Diseases, Injuries and Risk Factors 2010 Study
Progress in Cardiovascular Diseases
10/31/2013 11:00:00 PM
Abstract: The epidemiology of cardiovascular diseases in sub-Saharan Africa is unique among world regions, with about half of cardiovascular diseases (CVDs) due to causes other than atherosclerosis. CVD epidemiology data are sparse and of uneven quality in sub-Saharan Africa. Using the available data, the Global Burden of Diseases, Risk Factors, and Injuries (GBD) 2010 Study estimated CVD mortality and burden of disease in sub-Saharan Africa in 1990 and 2010. The leading CVD cause of death and disability in 2010 in sub-Saharan Africa was stroke; the largest relative increases in CVD burden between 1990 and 2010 were in atrial fibrillation and peripheral arterial disease. CVD deaths constituted only 8.8% of all deaths and 3.5% of all disability-adjusted life years (DALYs) in sub-Sahara Afri...
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An Explanation of Recommendation Differences: Illustrations from Recent Atrial Fibrillation Guidelines
Pacing and Clinical Electrophysiology : PACE
10/31/2013 11:00:00 PM
This article reviews major AF guidelines from around the world and discusses aspects which have nothing to do with the scientific evidence base in order to help the practicing physician understand and make better use of differing guideline recommendations. (Source: Pacing and Clinical Electrophysiology : PACE)
http://www.medworm.com/rss/comments.php?id=7795476
P‐Wave Abnormality Predicts Recurrence of Atrial Fibrillation after Electrical Cardioversion: A Prospective Study
Annals of Noninvasive Electrocardiology
10/31/2013 11:00:00 PM
ConclusionA prolonged P‐wave duration measured by 12‐lead ECG predicts recurrent AF within 1 month after ECV. (Source: Annals of Noninvasive Electrocardiology)
http://www.medworm.com/rss/comments.php?id=7833811
High Plasma Human Atrial Natriuretic Peptide and Reduced Transthoracic Left Atrial Appendage Wall‐Motion Velocity Are Noninvasive Surrogate Markers for Assessing Thrombogenesis in Patients with Paroxysmal Atrial Fibrillation
Echocardiography
10/31/2013 11:00:00 PM
ConclusionHigher plasma HANP and lower LAA wall‐motion velocity may be noninvasive surrogate markers for assessing left atrial thrombogenesis during sinus rhythm in paroxysmal AF patients. (Source: Echocardiography)
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Usefulness of P‐Wave Signal Averaging to Predict Atrial Fibrillation Recurrences after Electrical Cardioversion
Annals of Noninvasive Electrocardiology
10/31/2013 11:00:00 PM
ConclusionIn this unselected “real‐life” group of patients submitted to ECV for persistent AF, none of the SAPW parameters, including total filtered P‐wave duration, was able to predict AF recurrences. (Source: Annals of Noninvasive Electrocardiology)
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The Current and Future Role of the Novel Oral Anticoagulants—Indications Beyond Atrial Fibrillation
Heart, Lung and Circulation
10/31/2013 11:00:00 PM
Abstract: The direct thrombin inhibitors and Factor-Xa inhibitors are novel oral anticoagulants which are gaining rapid acceptance not only as alternatives to warfarin, but also as recommended first line agents for use as stroke prophylaxis in patients with non-valvular atrial fibrillation.There are, however, other patient settings in which anticoagulation is either indicated or has a potential role. Warfarin is still the predominant anticoagulant used for the treatment and prevention of venous thromboembolic events including deep vein thrombosis and pulmonary embolism as well as in patients with mechanical prosthetic heart valves. In this article, we review the current evidence for the use of dabigatran, rivaroxaban, apixaban and edoxaban in these settings. A summary of suggested regimens...
http://www.medworm.com/rss/comments.php?id=7949926
Outcomes of Urgent Warfarin Reversal with Frozen Plasma Versus Prothrombin Complex Concentrate in the Emergency Department: Hickey M, Gatien M, Taljaard M, et al. Circulation 2013;128:360–4.
The Journal of Emergency Medicine
10/31/2013 5:16:04 AM
Warfarin administration is a widely used form of anticoagulation for a variety of underlying prothrombotic conditions, including heart failure with low ejection fraction, atrial fibrillation, venous thromboembolism, and prosthetic heart valves. This retrospective cohort study out of two Ottawa-based tertiary care emergency departments (EDs) seeks to determine the optimal form of warfarin reversal, comparing the adverse events associated with fresh frozen plasma (FFP) administration to those of the prothrombin complex concentrate Octaplex (Octapharma, Lachen, Switzerland). (Source: The Journal of Emergency Medicine)

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Atrioesophageal Fistula during Cryoballoon Ablation for Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/30/2013 11:00:00 PM
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Do Atrial differences in Endothelial Damage, Leukocyte and Platelet Activation, or Tissue Factor Activity Contribute to Chamber‐Specific Thrombogenic Status in Patients with Atrial Fibrillation?
Journal of Cardiovascular Electrophysiology
10/30/2013 11:00:00 PM
ConclusionsOur data show no evidence for increased thrombogenic status in the left atrium that would account for its greater propensity for thrombus formation in patients with AF.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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A new era of stroke prevention in atrial fibrillation: comparing a new generation of oral anticoagulants with warfarin
International Archives of Medicine
10/30/2013 11:00:00 PM
Traditionally, warfarin has been used to prevent stroke in patients with atrial fibrillation (AF), but data from large, multinational, prospective, randomized studies suggest that novel oral anticoagulants (NOACs) may be suitable alternatives. These include the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban. These data showed that dabigatran 150 mg twice daily was more effective at preventing stroke than warfarin, with similar rates of major bleeding, while rivaroxaban 20 mg once daily was noninferior to warfarin, with no difference in major bleeding rates. In addition, apixaban 5 mg twice daily was shown to be superior to warfarin for preventing stroke, with lower bleeding rates. Currently, edoxaban is still in clinical trials. NOACs ...
http://www.medworm.com/rss/comments.php?id=7724427
Grants & fellowships: Don't miss your chance
ESC News and Press
10/30/2013 12:32:17 PM
The ESC offers a large range of grants and fellowships. Have a look and choose the one that fits you in General Cardiology,  Basic Science, Electrophysiology, Interventional Cardiology and Arrhythmias and Cardiac Pacing and for Nurses and Allied professionals. Choose yours quickly as some of them close soon! Topics: Arrhythmias, Atrial Fibrillation, Basic Science, Cardiovascular Nursing, Percutaneous Cardiovascular Intervention (PCI) (Source: ESC News and Press)

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http://www.medworm.com/rss/comments.php?id=7730344
Grants & fellowships: A few days left to apply.
ESC News and Press
10/30/2013 12:32:17 PM
The ESC offers a large range of grants and fellowships. Have a look and choose the one that fits you in General Cardiology,  Basic Science, Electrophysiology, Interventional Cardiology and Arrhythmias and Cardiac Pacing and for Nurses and Allied professionals. Choose yours quickly as some of them close soon! Topics: Arrhythmias, Atrial Fibrillation, Basic Science, Cardiovascular Nursing, Percutaneous Cardiovascular Intervention (PCI) (Source: ESC News and Press)
http://www.medworm.com/rss/comments.php?id=7866029
Grants & Fellowships: still time to apply before January deadlines!
ESC News and Press
10/30/2013 12:32:17 PM
The ESC offers a large range of grants and fellowships. Have a look and choose the one that fits you in General Cardiology,  Basic Science, Electrophysiology, Interventional Cardiology and Arrhythmias and Cardiac Pacing and for Nurses and Allied professionals. Choose yours quickly as some of them close soon! Topics: Arrhythmias, Atrial Fibrillation, Basic Science, Cardiovascular Nursing, Percutaneous Cardiovascular Intervention (PCI) (Source: ESC News and Press)
http://www.medworm.com/rss/comments.php?id=7871071
U-shaped relationship between tissue docosahexaenoic acid and atrial fibrillation following cardiac surgery
European Journal of Clinical Nutrition
10/29/2013 11:00:00 PM
Authors: R G Metcalf, G V Skuladottir, O S Indridason, T R Sullivan, L Bjorgvinsdottir, P Sanders, D O Arnar, R A Gibson, R Heidarsdottir, L G Cleland, R Palsson, A L Farquharson, G D Young & M J James (Source: European Journal of Clinical Nutrition)
http://www.medworm.com/rss/comments.php?id=7720528
Abstract 315: Correlation Between Endothelial Dysfunction and Left Atrial Diameter in Hypertensive Patients With Persistent Atrial Fibrillation [Poster Session I]
Hypertension
10/29/2013 11:00:00 PM
Conclusion: A strong negative correlation between left atrial diameter and endothelial-dependent FMD was found in hypertensive patients with persistent AF. (Source: Hypertension)
http://www.medworm.com/rss/comments.php?id=7732132
Abstract 364: Maternal History of Hypertension and Incident Atrial Fibrillation According to Blood Pressure Category in a General Urban Population: The Suita Study [Poster Session II]
Hypertension
10/29/2013 11:00:00 PM
Conclusions: A maternal history of hypertension is a predictor of incident AF. For persons with a maternal history of hypertension, BP control would be under normal BP for AF prevention. (Source: Hypertension)

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Predictors of obstructive coronary artery disease in otherwise ‘healthy’ individuals with ST-segment depression during paroxysms of atrial fibrillation
International Journal of Cardiology
10/29/2013 11:00:00 PM
Ischemic ST-segment depression only during paroxysms of atrial fibrillation (AF), while the ECG appears unremarkable or non-specific during sinus rhythm, is not uncommon. This presentation is usually considered as a positive stress-test equivalent. However, we and other investigators have recently shown that in subjects without a history of cardiac disease, the presence of transient ischemic ECG changes during a paroxysm of AF, is not strongly associated with occult obstructive coronary artery disease (CAD). The present study aimed to investigate whether certain clinical factors or biochemical variables could predict the presence of underlying severe CAD in otherwise healthy individuals, who present with transient ischemic-type ST-depression only during AF, and have no evidence of profound...
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Impact of Atrial Fibrillation in Patients With ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention (from the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] Trial)
The American Journal of Cardiology
10/29/2013 11:00:00 PM
Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with ST-segment elevation myocardial infarctions. Three-year ischemic and bleeding end points were compared between patients with and without new-onset AF after PCI. Of the 3,602 patients included in the HORIZ...
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Initial impedance decrease as an indicator of good catheter contact: Insights from radiofrequency ablation with force sensing catheters
Heart Rhythm
10/29/2013 11:00:00 PM
Background: Good catheter–tissue contact force (CF) is critical for transmural and durable lesion formation during radiofrequency (RF) ablation but is difficult to assess in clinical practice. Tissue heating during RF application results in an impedance decrease at the catheter tip.Objective: The purpose of this study was to correlate achieved CF and initial impedance decreases during atrial fibrillation (AF) ablation.Methods: We correlated achieved CF and initial impedance decreases in patients undergoing ablation for AF with two novel open-irrigated CF-sensing RF catheters (Biosense Webster SmartTouch, n = 647 RF applications; and Endosense TactiCath, n = 637 RF applications). We then compared those impedance decreases to 691 RF applications with a standard open-irrigated RF catheter (...
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Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference
Europace
10/28/2013 11:00:00 PM
The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to detect AF. Most clinical management decisions in AF patients can be based on validated parameters that encompass type of presentation, clinical factors, electrocardiogram analysis, and cardiac imaging. Despite these advances, patients with AF are still at increased risk for death, stroke, heart failure, and hospitalizations. During the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association (AFNET/EHRA) consensus conference, we identified the following opportunities to persona...

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Progressive endothelial damage revealed by multilevel von Willebrand factor plasma concentrations in atrial fibrillation patients
Europace
10/28/2013 11:00:00 PM
Conclusion Regardless of the clinical form of the arrhythmia, AF patients presented significantly higher plasma concentrations of vWF compared with sinus rhythm controls. Multilevel vWF plasma concentration assessment suggests an association between the clinical evolution of AF and the progression of endothelial dysfunction. Further studies will have to establish the exact mechanisms that link endothelial dysfunction and stroke in the context of AF. (Source: Europace)
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Ablation of atrial fibrillation with cryoballoon or duty-cycled radiofrequency pulmonary vein ablation catheter: a randomized controlled study comparing the clinical outcome and safety; the AF-COR study
Europace
10/28/2013 11:00:00 PM
Conclusion Both catheters proved comparably effective and safe in achieving acute PVI, apart from the shorter fluoroscopy times achieved with the cryoballoon. At follow-up, there was no statistically significant difference between the groups regarding freedom from AF and clinical success. The QoL increased to the same levels as for the general Swedish population in both groups. (Source: Europace)
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Catheter ablation in selected patients with depressed left ventricular ejection fraction and persistent atrial fibrillation unresponsive to current cardioversion
Europace
10/28/2013 11:00:00 PM
Conclusion Atrial fibrillation catheter ablation in selected CHF patients with persistent AF refractory to DCC and without any other evidence for secondary LV dysfunction leads to a substantial LVEF improvement in the majority of them. However, redo procedures are frequent in order to achieve mid-term SR maintenance. (Source: Europace)
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Incidence and risk factors for very late recurrence of atrial fibrillation after radiofrequency catheter ablation
Europace
10/28/2013 11:00:00 PM
Conclusion Even after a year without AF, VLR occurred annually in 7.6% cases. Continued vigilance for VLR after CA is clinically desirable, especially for patients with abnormally high preoperative CRP levels. (Source: Europace)

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Novel oral anticoagulants in a real-world cohort of patients undergoing catheter ablation of atrial fibrillation
Europace
10/28/2013 11:00:00 PM
Conclusion In this prospective observational study, anticoagulation with NOACs following AF catheter ablation was safe and effective at long-term follow-up. Fast onset of action makes NOACs especially attractive in patients without effective anticoagulation on admission and in patients following periprocedural complications. (Source: Europace)
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Real-time guidewire localization using impedance-based electroanatomic mapping: experimental results and clinical validation during cryoballoon ablation of atrial fibrillation
Europace
10/28/2013 11:00:00 PM
Conclusion This simple, novel technique provides real-time, accurate guidewire localization to enable guidewire and catheter navigation during cryoballoon AF ablation. (Source: Europace)
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Corrigendumto:Role of nitric oxide and oxidative stress in a sheep model of persistent atrial fibrillation Europace (2013) 15 (5): 754-760 first published online February 17, 2013 doi:10.1093/europace/eut012
Europace
10/28/2013 11:00:00 PM
(Source: Europace)
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Antithrombotic therapy during and after percutaneous coronary intervention in patients with atrial fibrillation.
Circulation
10/28/2013 11:00:00 PM
Authors: Verheugt FW PMID: 24166414 [PubMed - in process] (Source: Circulation)

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Rhythm outcomes after catheter ablation of atrial fibrillation. Clinical implication of biomarkers.
Hamostaseologie
10/28/2013 11:00:00 PM
Authors: Kornej J, Husser D, Bollmann A, Lip GY Abstract Atrial fibrillation (AF) occurs as the result of numerous complex physiological processes in the atria leading to AF promotion and maintenance. Improved diagnostic techniques have identified various biomarkers which may play an important role in the prediction of AF related outcomes (cardio- and cerebrovascular events, as well as mortality and rhythm outcomes). Biomarkers refer to 'biological markers' and biomarkers in blood, urine as well as imaging marker (eg, dimensions (left atrial diameter and volume), anatomical features (left appendage and pulmonary vein anatomy), and physiological pattern (LAA flow velocity)) may play important role(s) as clinically important indices in relation to outcomes after different therapeutic...
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Silent cerebral infarcts associated with cardiac disease and procedures
Nature Reviews Cardiology
10/28/2013 11:00:00 PM
Nature Reviews Cardiology 10, 696 (2013). doi:10.1038/nrcardio.2013.162 Authors: Mariëlla E. C. Hassell, Robin Nijveldt, Yvo B. W. Roos, Charles B. L. Majoie, Martial Hamon, Jan J. Piek & Ronak Delewi The occurrence of clinically silent cerebral infarcts (SCIs) in individuals affected by cardiac disease and after invasive cardiac procedures is frequently reported. Indeed, atrial fibrillation, left ventricular thrombus formation, cardiomyopathy, and patent foramen ovale have all been associated with SCIs. Furthermore, postprocedural SCIs have been (Source: Nature Reviews Cardiology)
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Factor Xa inhibitors: a step forward in the treatment of atrial fibrillation?
Cochrane Database of Systematic Reviews
10/28/2013 7:00:02 PM
Authors: Algra A PMID: 24156099 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
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[Practical issues with the use of rivaroxaban].
Revista de Neurologia
10/28/2013 5:15:03 PM
Authors: Suarez-Fernandez C, Roldan V, Vivancos J Abstract Rivaroxaban is an oral highly selective direct factor Xa inhibitor. Rivaroxaban is currently approved for the prevention of venous thromboembolism in adult patients undergoing elective hip or knee replacement surgery, for the treatment of deep vein thrombosis and pulmonary embolism and long-term secondary prevention of venous thromboembolism, and for stroke and systemic embolism prevention in patients with nonvalvular atrial fibrillation. Rivaroxaban has many advantages over vitamin K antagonists and this may facilitate its use in clinical practice. As a result, it is expected that new oral anticoagulants may change patient management strategies. On the other hand, rivaroxaban has some particularities that are necessary to ...
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Ranolazine and Dofetilide Effectively Suppress Acute Atrial Fibrillation in Isolated Sheep Hearts
Heart Rhythm
10/28/2013 11:20:35 AM
The objective was to determine the efficacy of drugs for suppression of acute AF initiated by tachypacing in the presence of continuous isoproterenol (100 nM) perfusion for up to 48 minutes.Results: After 15 minutes of isoproterenol-maintained AF, the dominant frequency (DF) of activations were 11.5 ± 0.9 and 15.2 ± 0.8 Hz in right atrial (RA) and left atrial (LA) free walls, respectively (N = 8). In 4 of 8 hearts, DF decreased to 7.3 ± 0.7 Hz and 7.6 ± 0.8 Hz in the RA and LA, respectively (P (Source: Heart Rhythm)

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Chloroquine Reduces IKACh via Both Direct Channel Blockade and Decreased Surface Expression of Kir3.1/3.4
Heart Rhythm
10/28/2013 11:20:35 AM
Background: The acetylcholine activated inward rectifier potassium current IKACh has been suggested to play a role in atrial fibrillation (AF). Therefore, IKACh reduction was proposed as an antifibrillatory intervention. Chloroquine is an antimalarial quinoline shown to be a potent anti-AF agent due, in part, to its IKACh blocking properties. We hypothesize that chloroquine decreases IKACh via 2 different mechanisms: pore block and reduction of Kir3.1/3.4 cell surface expression.Methods and Results: Patch-clamp experiments in HEK293 cells stably expressing Kir3.1 and Kir3.4 (GIRK1/4 cells) showed that acute chloroquine application blocked IKACh with an IC50 of 1.15 μM ± 0.102 (n = 5). In isolated Langendorff perfused mouse hearts, optical mapping showed that 10 μM chloroquine perfusion ...
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Arrhythmogenesis in a Novel Murine Model with KCNJ2 Mutation of Familial Atrial Fibrillation
Heart Rhythm
10/28/2013 11:20:35 AM
Conclusions: A clinically relevant mutation in KCNJ2 resulting in gain of function in IK1 and altered single channel conductance recapitulated the clinical phenotype seen in patients displaying both atrial and ventricular arrhythmias. (Source: Heart Rhythm)
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Optimal Techniques for Late Gadolinium-Enhanced MRI: Comparison of Delay Time, Slice Thickness, and Multiplanar Reconstruction vs Maximum Intensity Projection for Assessment of Fibrosis in Atrial Fibrillation
Heart Rhythm
10/28/2013 11:20:35 AM
This study evaluates whether changes in image acquisition and reconstruction parameters affect quantification of LA LGE MRI.Methods: A total of 200 LGE MRI scans were prepared using various techniques from 5 subjects. 3D respiratory and ECG-gated LGE images were acquired at 15, 20, 25, and 30 minutes after contrast. Multiplanar reconstructions (MPR) and maximum intensity projections (MIP) were created from 3D data at various slice thicknesses. LA LGE was quantified with image intensity ratio (IIR, atrial wall signal intensity divided by blood pool). Mean IIR was calculated for the entire LA as a metric of LGE burden. Additionally, in 42 consecutive preablation patients, local IIR values from 3.5-mm MPR and MIP reconstructions were separately registered to LA electroanatomic voltage maps (E...
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Leading Reentry Circuit(s) in the Right Atrial Free Wall Underlies Adenosine-Induced Atrial Fibrillation in Coronary Perfused Human Hearts
Heart Rhythm
10/28/2013 11:20:34 AM
Conclusions: This study demonstrates that in the human heart, adenosine primarily induces RAFW reentrant AF with leading reentrant circuits (rotors) anchored to the regions of shortest APD and anatomic architecture. (Source: Heart Rhythm)
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The most common and serious complication of atrial fibrillation is stroke
ESC News and Press
10/28/2013 7:43:52 AM
.  People with atrial fibrillation are at 5 times increased risk of having a stroke compared to someone of the same age and sex who does not have atrial fibrillation.  Read more about the risk factors for stroke in patients with atrial fibrillation on the EHRA patient website AFIBMatters.org. Topics: Arrhythmias, Cardiovascular Disease Prevention - Risk Assessment and Management, Peripheral Arterial Diseases, Atherosclerosis (Source: ESC News and Press)
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Robots enhance mobility for visually and physically impaired, improve treatment for atrial fibrillation
Health News from Medical News Today
10/28/2013 3:00:00 AM
Three projects have been awarded funding by the National Institutes of Health to develop innovative robots that work cooperatively with people and adapt to changing environments to improve human capabilities and enhance medical procedures. Funding for these projects totals approximately $2.4 million over the next five years, subject to the availability of funds... (Source: Health News from Medical News Today)
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Digoxin significantly improves all-cause mortality in atrial fibrillation patients with severely reduced left ventricular systolic function
International Journal of Cardiology
10/27/2013 11:00:00 PM
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population with an incidence gradually rising to 32 per 1000 person-years in individuals 80years and older . (Source: International Journal of Cardiology)
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Trends in mortality after first hospitalization with Atrial Fibrillation diagnosis in Sweden 1987 to 2006
International Journal of Cardiology
10/27/2013 11:00:00 PM
Conclusions: Survival after a first hospitalization with a diagnosis of atrial fibrillation improved regardless comorbidities. Patients aged (Source: International Journal of Cardiology)
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Simplifying atrial fibrillation ablation: How far can we go?
Heart Rhythm
10/27/2013 11:00:00 PM
The procedural end point of electrical isolation of the pulmonary veins (PVs) for the treatment of atrial fibrillation (AF) has been debated extensively. After identifying the PVs as the dominant arrhythmogenic site of paroxysmal AF, 2 fundamentally different approaches to the interventional treatment of AF were introduced. Haissaguerre et al developed a technique to electrically isolate the PVs by targeting electrophysiological (EP) breakthroughs from the left atrium to the PVs guided by a circular mapping catheter. In contrast, Pappone et al implemented an anatomical approach that used circumferential ablation lines around the PVs guided by a 3-dimensional mapping system. This latter approach used the procedural end point of local electrogram amplitude reduction on the line and assessmen...

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PR interval, P-wave duration, and mortality: New insights, additional questions
Heart Rhythm
10/27/2013 11:00:00 PM
In the past 5 years, a number of studies have explored the association of the PR interval obtained from the surface electrocardiogram (ECG) with all-cause mortality and the incidence of cardiovascular diseases, particularly atrial fibrillation (AF). Interest in this question derives from the continuous search to find noninvasive predictors of cardiovascular disease and the ease with which the PR interval can be measured. As happens with many other topics, results from these studies have been inconsistent. For example, among participants in the Framingham Heart Study, those with a PR interval >200 ms had a higher risk of AF, pacemaker implantation, and all cause-mortality compared to those with PR interval ≤200 ms. Similarly, an increased risk of AF in individuals with longer PR interval ...
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Mortality risk following replacement implantable cardioverter-defibrillator implantation at end of battery life: Results from the NCDR®
Heart Rhythm
10/27/2013 11:00:00 PM
Conclusion: In addition to age, atrial fibrillation, and congestive heart failure, noncardiac comorbidities are associated with higher mortality following ICD replacement, which should be considered in the decision to undergo this procedure. (Source: Heart Rhythm)
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Atrial fibrillation in a large population with Brugada electrocardiographic pattern: Prevalence, management, and correlation with prognosis
Heart Rhythm
10/27/2013 11:00:00 PM
Conclusion: Prevalence of AF/AFl in Brugada patients is higher than in the general population of the same age. Patients in group 1 are younger than those in group 2 and have a worse prognosis compared to both groups 2 and 3. HQ therapy has proved useful and safe in patients with AF/AFl and BrECG. (Source: Heart Rhythm)
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Medical management of connector pin thrombosis with the Amplatzer cardiac plug left atrial closure device.
World Journal of Cardiology
10/25/2013 11:00:00 PM
Authors: Fernández-Rodríguez D, Vannini L, Martín-Yuste V, Brugaletta S, Robles R, Regueiro A, Masotti M, Sabaté M Abstract Transcatheter closure of the left atrial appendage with the Amplatzer™ cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation. The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis. Nevertheless, device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients. The connecto...
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Left Atrial Volume Best Predicts Recurrence after Catheter Ablation in Patients with Persistent and Longstanding Persistent Atrial Fibrillation
Pacing and Clinical Electrophysiology : PACE
10/24/2013 11:00:00 PM
ConclusionIndexed minimal LA volume is highly associated with ablation success in patients with persistent and longstanding persistent AF. (Source: Pacing and Clinical Electrophysiology : PACE)

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Acute myocardial infarction due to coronary artery embolus associated with atrial fibrillation.
Acute Cardiac Care
10/24/2013 11:00:00 PM
We describe the case of an 80-year-old woman presenting with an acute coronary syndrome secondary to coronary artery embolus associated with atrial fibrillation, which was successfully treated with the use of a thrombectomy aspiration catheter. PMID: 24160711 [PubMed - as supplied by publisher] (Source: Acute Cardiac Care)
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CT imaging of complications of catheter ablation for atrial fibrillation
Clinical Radiology
10/24/2013 11:00:00 PM
The complication rate following radiofrequency catheter ablation for atrial fibrillation is low ( (Source: Clinical Radiology)
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A Common Variant on Chromosome 4q25 is Associated With Prolonged PR Interval in Subjects With and Without Atrial Fibrillation
The American Journal of Cardiology
10/24/2013 11:00:00 PM
Single nucleotide polymorphisms (SNPs) at chromosome 4q25 (near PITX2) are strongly associated with atrial fibrillation (AF). We assessed whether a 4q25-tagging SNP (rs2200733) is associated with PR interval duration in patients with lone and typical AF and controls. Patients with lone (n = 169) and typical (n = 269) AF enrolled in the Vanderbilt AF registry and controls (n = 1,403) derived from the Vanderbilt DNA Biobank were studied. Carriage of the rs2200733T allele (CT or TT genotype) was more common in patients with lone (39%) than typical (25%) AF or controls (21%, p (Source: The American Journal of Cardiology)
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Long‐Term Outcomes Following High Intensity Focused Ultrasound Ablation for Atrial Fibrillation
Journal of Cardiac Surgery
10/23/2013 11:00:00 PM
ConclusionsWe conclude that high intensity focused ultrasound ablation for atrial fibrillation using the Epicor system is safe and effective for surgical patients with paroxysmal AF. The persistent and LSP AF results suggest that alternative ablation strategies should be considered for these patients. (Source: Journal of Cardiac Surgery)

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Internal cardioversion of persistent atrial fibrillation in implantable cardioverter defibrillator patients: the juice is not worth the squeeze.
Netherlands Heart Journal
10/23/2013 11:00:00 PM
Authors: Berger WR, Knops RE, de Groot JR PMID: 24155104 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)
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Clinical outcome of ablation for long-standing persistent atrial fibrillation with or without defragmentation.
Netherlands Heart Journal
10/23/2013 11:00:00 PM
CONCLUSION: Our study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy. PMID: 24155102 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)
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NIH funds development of novel robots to assist people with disabilities, aid doctors
National Institutes of Health (NIH) News Releases
10/23/2013 11:01:00 AM
Robots enhance mobility for visually and physically impaired, improve treatment for atrial fibrillation. (Source: National Institutes of Health (NIH) News Releases)
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n-3 polyunsaturated fatty acids and atrial fibrillation in patients with chronic heart failure: the GISSI-HF trial
European Journal of Heart Failure
10/22/2013 11:00:00 PM
Conclusions Despite an inverse relationship between plasma n-3 PUFA levels and prevalent AF, this study found no evidence that 1 g daily n-3 PUFA supplementation in patients with chronic HF reduces incident AF. (Source: European Journal of Heart Failure)

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Lenient vs. strict rate control in patients with atrial fibrillation and heart failure: a post-hoc analysis of the RACE II study
European Journal of Heart Failure
10/22/2013 11:00:00 PM
Conclusion In patients with AF and heart failure with a predominantly preserved EF, the stringency of rate control seems to have no effect on cardiovascular morbidity and mortality, symptoms, and quality of life. (Source: European Journal of Heart Failure)
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Electromechanical Effects of 1,25‐Dihydroxyvitamin D with Anti‐Atrial Fibrillation Activities
Journal of Cardiovascular Electrophysiology
10/22/2013 11:00:00 PM
Conclusion1,25[OH]2D has direct electromechanical effects on the LA and can prevent or terminate AF.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Esophago‐pericardial Fistula Complicating Atrial Fibrillation Ablation using a Novel Irrigated Radiofrequency Multipolar Ablation Catheter
Journal of Cardiovascular Electrophysiology
10/22/2013 11:00:00 PM
We report the case of esophago‐pericardial fistula with fatal outcome after an uneventful ablation of atrial fibrillation using a novel multipolar irrigated RF ablation catheter (nMARQ™, Biosense Webster, Diamond Bar, USA). (Source: Journal of Cardiovascular Electrophysiology)
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Extracardiac Ice Formation During Second‐Generation 28 mm Cryoballoon Ablation of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/22/2013 11:00:00 PM
(Source: Journal of Cardiovascular Electrophysiology)

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An Updated Review of Target-Specific Oral Anticoagulants Used in Stroke Prevention in Atrial Fibrillation, Venous Thromboembolic Disease, and Acute Coronary Syndromes [Contemporary Reviews]
JAHA:Journal of the American Heart Association
10/22/2013 11:00:00 PM
(Source: JAHA:Journal of the American Heart Association)
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Association of GGCX gene polymorphism with warfarin dose in atrial fibrillation population in Xinjiang
Lipids in Health and Disease
10/22/2013 11:00:00 PM
Conclusion: In atrial fibrillation population in Xinjiang, patients with CT and TT genotypes in GGCX gene rs259251 loci required for significantly higher warfarin dose than those with CC genotype. Therefore, rs2592551 polymorphism may one of the factors affecting the warfarin dose in patients with atrial fibrillation. (Source: Lipids in Health and Disease)
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[As cardiologists how much do we take into account the guideline recommendations while prescribing oral anticoagulants to patients with atrial fibrillation our clinical practice? A striking result!]
The Anatolian Journal of Cardiology
10/22/2013 11:00:00 PM
Authors: Ertaş F PMID: 24172806 [PubMed - as supplied by publisher] (Source: The Anatolian Journal of Cardiology)
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Shorter Minimum P-Wave Duration Is Associated with Paroxysmal Lone Atrial Fibrillation
Journal of Electrocardiology
10/22/2013 11:00:00 PM
Conclusions: Unlike common AF, paroxysmal LAF is independently associated with shorter minPWdur. This finding suggests that both shorter and prolonged PWdur may be associated with increased risk of AF. (Source: Journal of Electrocardiology)

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Atrial Fibrillation: Food for Thought in 2013
The American Journal of Medicine
10/22/2013 11:15:37 AM
The prevalence of atrial fibrillation is on the rise. Currently, 6% of men and 3% of women over the age of 65 years, and up to 16% of men and 12% of women over the age of 75 years have this arrhythmia. Atrial fibrillation can be intermittent, so-called paroxysmal atrial fibrillation, or it may be sustained. The presence of paroxysmal atrial fibrillation is important given the nearly equal risk for thromboembolic events in both paroxysmal and chronic atrial fibrillation in a number of studies. (Source: The American Journal of Medicine)
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eComment. Mini-partial heart autotransplantation for atrial fibrillation and mitral valve surgery
Interactive CardioVascular and Thoracic Surgery
10/21/2013 11:00:00 PM
(Source: Interactive CardioVascular and Thoracic Surgery)
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Novel oral anticoagulants: A focused review for stroke physicians
International Journal of Stroke
10/21/2013 11:00:00 PM
Novel oral anticoagulants provide an effective and convenient alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, novel anticoagulants also present new challenges for stroke physicians, such as measurement of anticoagulant effect in emergency situations, use of thrombolysis in acute ischemic stroke, optimal timing of introduction of novel anticoagulants following acute ischemic stroke, and management of intracerebral hemorrhage. In this review, we propose pragmatic approaches to dealing with challenging management issues that will face stroke physicians who care for patients with acute stroke in the novel oral anticoagulant era. (Source: International Journal of Stroke)

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Gender differences in the age‐stratified prevalence of risk factors in Korean ischemic stroke patients: a nationwide stroke registry‐based cross‐sectional study
International Journal of Stroke
10/21/2013 11:00:00 PM
ConclusionKorean women with stroke had more hypertension and hyperlipidemia after middle age, more diabetes after 65 years, and more atrial fibrillation throughout all ages. Strategies to control risk factors in women at risk for stroke are eagerly needed. (Source: International Journal of Stroke)
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Mechanical antithrombotic intervention by LAA occlusion in atrial fibrillation
Nature Reviews Cardiology
10/21/2013 11:00:00 PM
Nature Reviews Cardiology 10, 707 (2013). doi:10.1038/nrcardio.2013.158 Authors: Cheuk-Man Yu, Ahmed A. Khattab, Stefan C. Bertog, Alex P. W. Lee, Joey S. W. Kwong, Horst Sievert & Bernhard Meier Stroke in patients with atrial fibrillation (AF) is often associated with substantial morbidity and mortality. Oral anticoagulation remains the first-line approach to stroke prevention in such individuals; however, for a considerable proportion of patients, traditional treatment using warfarin is limited by a number of factors, (Source: Nature Reviews Cardiology)
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Mental Stress and Cardiac Troponin Keep Calm and Carry On? ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
10/21/2013 5:20:27 PM
Cardiac troponin (cTnT) has served us well for more than a decade as the biochemical benchmark for the diagnosis of myocardial infarction. During the past years, it has become clear that cTn elevation also may be seen in many other conditions affecting cardiomyocyte integrity (e.g., congestive heart failure, stable coronary artery disease, or atrial fibrillation) (1,22). Research on this area has been fueled following the implementation of high-sensitivity assays that made it possible to detect circulating cTn levels in community-dwelling populations. Even in these individuals, cTn reflects the presence of chronic cardiac abnormalities and is highly predictive for adverse outcome, namely mortality and heart failure admissions (3,44). (Source: Journal of the American College of Cardiology: ...
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Survival After Shock Therapy in Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy-Defibrillator Recipients According to Rhythm Shocked The ALTITUDE Survival by Rhythm Study
Journal of the American College of Cardiology: Cardiovascular Interventions
10/21/2013 5:20:26 PM
ConclusionsCompared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Is Warfarin 'Dead'? CCC Meeting Debate Suggests OtherwiseIs Warfarin 'Dead'? CCC Meeting Debate Suggests Otherwise
Medscape Today Headlines
10/21/2013 2:56:19 PM
In a lively debate at the CCC meeting entitled "Is warfarin dead for stroke prevention in atrial fibrillation?" the novel oral anticoagulant side did not clearly trump warfarin as might have been expected. Heartwire (Source: Medscape Today Headlines)
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Rapid increase in use of novel oral anticoagulants in very elderly patients under scrutiny
Health News from Medical News Today
10/21/2013 4:00:00 AM
The use of novel oral anticoagulants (NOACs) has increased rapidly in Ontario, Canada, especially in people aged 85 years and over, in the 2 years since the drugs were approved for use in patients with atrial fibrillation (AF), according to new research published in CMAJ Open. This rapid increase signals the need to evaluate outcomes from the use of these drugs in an elderly, high-risk population much older than the population involved in the studies. More than 350 000 Canadians, especially older people, have AF, and anticoagulants are used for the prevention of stroke in these patients... (Source: Health News from Medical News Today)
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CardioPulse Articles * Is all heart failure the same around the globe? * Personal experiences of emigre cardiologist: Barbara Casadei * Perioperative statins trial: the climax of a new approach to atrial fibrillation * Book review * Arrhythmias 101 * Cardiologisk Forum * Cola and honey: exploring food riddles in rhythm disturbances * Announcement * Second International 4 Corners of Cardiology Meeting
European Heart Journal
10/20/2013 11:00:00 PM
(Source: European Heart Journal)
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Novel Therapeutics for Thromboprophylaxis in Nonvalvular Atrial Fibrillation
Drug Development Research
10/20/2013 11:00:00 PM
Abstract Atrial fibrillation (AF) is both a health and a social problem. AF is related to the elevated risk of thromboembolic events with stroke being the most important. It adversely affects life expectancy and quality. The risk of ischemic stroke is increased fivefold in patients with AF. Therapeutic options for lowering the risk of stroke in patients with AF consist of vitamin K antagonists and antiplatelet agents, which have relative risk reductions of approximately 60% and 20%, respectively. Alternative therapeutic options available to reduce the risk of stroke in patients with nonvalvular AF are relatively new. In recent years, new oral anticoagulants have been introduced for this indication. Reversible direct thrombin inhibitors and factor Xa inhibitors are new oral anticoagu...

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Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome in the real world: data from the Berlin AFibACS Registry.
Cardiology Journal
10/20/2013 11:00:00 PM
CONCLUSIONS: These data suggest that in AFibACS patients, antithrombotic treatment focussed on dual antiplatelet therapy for ACS, rather than on anticoagulation therapy for stroke prevention. Factors influencing therapy at discharge were age, renal failure, stent implantation, AFib category, and CHA₂DS₂-VASc score. During the study period, triple therapy increased for stented patients. PMID: 24142683 [PubMed - as supplied by publisher] (Source: Cardiology Journal)
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Activation of Histone Deacetylase-6 (HDAC6) Induces Contractile Dysfunction through Derailment of α-Tubulin Proteostasis in Experimental and Human Atrial Fibrillation.
Circulation
10/20/2013 11:00:00 PM
CONCLUSIONS: AF induces remodeling and loss of contractile function, at least in part through HDAC6 activation and subsequent derailment of α-tubulin proteostasis and disruption of the cardiomyocyte microtubule structure. In vivo inhibition of HDAC6 protects against AF-related atrial remodeling, disclosing the potential of HDAC6 as a therapeutic target in clinical AF. PMID: 24146251 [PubMed - as supplied by publisher] (Source: Circulation)
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Atrial Fibrillation, Stroke Risk, and Warfarin Therapy Revisited: A Population-Based Study [Clinical Sciences]
Stroke
10/20/2013 11:00:00 PM
Conclusions— AF is more common than present guidelines suggest. The attributable risk of AF for ischemic stroke increases with age and is close to that of hypertension in individuals aged ≥80 years. Because a majority of patients with AF with increased risk for stroke had not received anticoagulation therapy, there is a large potential for improvement. (Source: Stroke)
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Plasma Phospholipid Omega-3 Fatty Acids and Incidence of Postoperative Atrial Fibrillation in the OPERA Trial [Arrhythmia and Electrophysiology]
JAHA:Journal of the American Heart Association
10/20/2013 11:00:00 PM
Conclusions Among patients undergoing cardiac surgery, neither higher habitual circulating n-3 PUFA levels, nor achieved levels or changes following short-term fish oil supplementation are associated with risk of PoAF. Clinical Trial Registration URL: Clinicaltrials.gov Unique identifier: NCT00970489 (Source: JAHA:Journal of the American Heart Association)

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Arrhythmias and Heart Failure
Cardiology Clinics
10/20/2013 11:00:00 PM
Atrial fibrillation and ventricular tachyarrhythmias are frequently seen in patients with heart failure, and complicate the management of such patients. Both types of arrhythmia lead to increased morbidity and mortality, and often prove to be challenging issues to manage. The many randomized studies that have been performed in patients with these conditions and concomitant heart failure have helped in designing optimal treatment strategies. (Source: Cardiology Clinics)
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Very early-onset lone atrial fibrillation patients have a high prevalence of rare variants in genes previously associated with atrial fibrillation
Heart Rhythm
10/20/2013 11:00:00 PM
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Currently, 14 genes important for ion channel function, intercellular signaling, and homeostatic control have been associated with AF.Objective: We hypothesized that rare genetic variants in genes previously associated with AF had a higher prevalence in early-onset lone AF patients than in the background population.Methods: Sequencing results of KCNQ1, KCNH2, SCN5A, KCNA5, KCND3, KCNE1, 2, 5, KCNJ2, SCN1-3B, NPPA, and GJA5 from 192 early-onset lone AF patients were compared with data from the National Heart, Lung, and Blood Institute Exome Variant Server consisting of 6503 persons from 18 different cohort studies.Results: Among the lone AF patients, 29 (7.6%) alleles harbored a novel or very rare variant (minor all...
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[Association of T393C single nucleotide polymorphism of GNAS1 gene with non-valvular atrial fibrillation].
Journal of Southern Medical University
10/19/2013 11:00:00 PM
Authors: Li H, Hu ZT, Tan ZN, Hou QZ, Peng J Abstract OBJECTIVE: To analyze the association between T393C single nucleotide polymorphism (SNP) of GNAS1 gene and non-valvular atrial fibrillation (AF) in Chinese Han patients. METHODS: Ninety patients with non-valvular AF and 90 healthy subjects were examined for T393C SNP of GNAS1 gene using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The allele genotypes and the distribution of allele frequencies were analyzed and compared between the two groups. The relationship between allele frequency distribution characteristics and the heart rate variability (HRV) were also studied for analysis of the association between T393C SNP of GNAS1 gene and the autonomic nervous activation in non-valvular AF. R...
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Targeting Inflammation and Oxidative Stress in Atrial Fibrillation: Role of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibition with Statins
Antioxidants and Redox Signaling
10/19/2013 9:16:53 AM
Antioxidants & Redox Signaling , Vol. 0, No. 0. (Source: Antioxidants and Redox Signaling)
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Antiarrhythmic drug therapy for maintaining sinus rhythm early after pulmonary vein ablation in patients with symptomatic atrial fibrillation
Cardiovascular Therapeutics
10/18/2013 11:00:00 PM
ConclusionsFollowing PVA, AAD therapy is not superior to BB treatment for prevention of early atrial arrhythmias. Furthermore and confirmed by multivariate analysis, no drug was superior to another regarding the maintenance of sinus rhythm.This article is protected by copyright. All rights reserved. (Source: Cardiovascular Therapeutics)

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[Interventional prevention of stroke.]
Annales de Cardiologie et d'Angeiologie
10/18/2013 11:00:00 PM
Authors: Kamtchueng P, Teiger E Abstract Stroke is an extremely common condition, the important functional and financial impact of which requires intense prevention policy. This strategy includes the prevention of thromboembolic complications of atrial fibrillation. The management of atrial fibrillation includes risk stratification for stroke with theCHA(2)DS(2)VASc score and assessment of hemorrhagic risk with HASBLED score. The reference preventive treatment is anticoagulant therapy with vitamin K antagonists. Nevertheless, many patients potentially eligible for this treatment will not benefit from it, because of a high risk of bleeding, or because recurrence of thromboembolism occurs despite well-conducted anticoagulation. A new alternative intrventional treatment has been propo...
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Pearl: estimating renal function in patients on dabigatran (Pradaxa)
The Poison Review
10/18/2013 6:24:24 PM
I was reminded of an key point about dabigatran (Pradaxa) while reading a recent article about estimating renal function in patients on new oral anticoagulants. The RE-LY trial comparing dabigatran versus warfarin in patients with atrial fibrillation excluded patients with creatinine clearance (CrCl)  <  30 ml/min. (Recommendations in the current package insert are somewhat more liberal.) This is important, since dabigatran is eliminated almost entirely by the kidneys and can build up in patients with significant renal failure, causing over-anticoagulation. In fact, many patients who develop severe or fatal hemorrhage on the drug are elderly and have renal insufficiency. The method used in the RE-LY trial to determine renal function was the Cockcroft-Gault formula. This equation use...
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How Quickly Do Docs Prescribe New Afib Drugs? (CME/CE)
MedPage Today Primary Care
10/18/2013 12:13:16 PM
(MedPage Today) -- Dabigatran (Pradaxa) was rapidly incorporated into everyday practice in Ontario in the 2 years after it was approved for preventing stroke associated with nonvalvular atrial fibrillation, particularly in the oldest patients, researchers found. (Source: MedPage Today Primary Care)
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Pulmonary Vein Stenosis Assessed by Three‐Dimensional Transesophageal Echocardiography
Echocardiography
10/17/2013 11:00:00 PM
We report a case about a 43‐year‐old man admitted to hospital with progressive exertional dyspnea and hemoptysis. Two months before admission, he had undergone radiofrequency ablation for paroxysmal atrial fibrillation. Subsequent investigation revealed a severe obstruction of the left upper pulmonary vein (LUPV). Three‐dimensional (3D) transesophageal echocardiography improved the morphological characterization of the LUPV, including direct en face visualization from the left atrium, and enabled the performance of direct planimetry at the level of LUPV stenosis using multiplanar review mode. Our case illustrates the usefulness of 3D transesophageal echocardiography in the accurate assessment of this rare but serious complication. (Source: Echocardiography)
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Left atrial volumes and associated stroke subtypes
BMC Neurology
10/17/2013 11:00:00 PM
This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded. Results: Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p < 0.001), acute myocardial infarction (p < 0.001) and ischemic heart disease (p < 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p < .00), left ventricular thrombus (p < .00), left ventricular ejection fraction (Source: ...

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Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?
The American Journal of Medicine
10/17/2013 11:00:00 PM
Abstract: Background: Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of (Source: The American Journal of Medicine)
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Avoiding Unnecessary Aggressive ICD Programming After MADIT-RIT and ADVANCE III Trials
Journal of the American College of Cardiology
10/17/2013 11:00:00 PM
Powell et al. reported interesting data on survival after shock therapy in a large cohort of patients enrolled in the ALTITUDE study. The analysis showed that following a first implantable cardioverter-defibrillator (ICD) shock delivered for ventricular episodes or atrial fibrillation, there is an increased risk of death. The same effect is not found when the shock is delivered for a benign rhythm. Powell et al. discussed their results in the context of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial Reduce Inappropriate Therapy) data assessing whether the 2 results are contradicting and concluded that “combining the results of the 2 studies, one could conclude that unnecessary ATP [antitachycardia pacing] may increase mortality, while unnecessary shocks for sinus tac...
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Atrial Autonomic Innervation: A Target for Interventional Antiarrhythmic Therapy?
Journal of the American College of Cardiology
10/17/2013 11:00:00 PM
Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system contributes to the creation of atrial fibrillation substrates. Atrial electrophysiology is influenced differently by sympathetic and parasympathetic activation. Several strategies are available to modulate the complex interaction between the autonomic nervous system and the heart. However, different approaches target the problem differently making the prediction of arrhythmogenic and/or antiarrhythmic effects difficult. We discuss the role of the autonomic nervous system on the development of a substrate for atrial fibrillation and explore the potential antiarrhythmic and/or arrhythmogenic effect of modulation of the autonomic nervous system by renal sy...
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EHRA Webinar: Watch the recording on why, when and how you should you optimise your CRT patients
ESC News and Press
10/17/2013 12:39:32 PM
Haran Burri,  Mário Oliveira and Christophe Leclercq have shared their knowledge on CRT patient optimisation during a live and interactive session.Benefit from that knowledge Topics: Atrial Fibrillation, Arrhythmias (Source: ESC News and Press)
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Paroxysmal Atrial Fibrillation: How Safely Restore Sinus Rhythm?
Consultant Live
10/17/2013 7:00:00 AM
Precautions must be taken when considering cardioversion for a patient with atrial fibrillation of more than 48 hours duration. Here, more about the risks involved. (Source: Consultant Live)
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Response to Reduced Diurnal Variation of Heart Rate Is Associated With Increased Plasma B‐Type Natriuretic Peptide Level in Patients With Atrial Fibrillation
Clinical Cardiology
10/16/2013 11:00:00 PM
Kamikawa S et al. Clin Cardiol. 2013;36:394–400 (Source: Clinical Cardiology)
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Dabigatran Use Highest Among Elderly (FREE)
Physician's First Watch current issue
10/16/2013 11:00:00 PM
By Kelly Young Use of the oral anticoagulant dabigatran has dramatically risen since its approval for atrial fibrillation in 2010. As of 2012, it accounted for 17% of all oral anticoagulant … (Source: Physician's First Watch current issue)

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Anti‐Coagulation, anti‐platelets or no therapy in haemodialysis patients with atrial fibrillation: A decision analysis
Nephrology
10/16/2013 11:00:00 PM
ConclusionsOur results suggest that warfarin should not be the default choice for older haemodialysis patients with non‐valvular AF as it provides the fewest QALYs compared with aspirin or no therapy. (Source: Nephrology)
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Stroke and recurrent left atrial appendage thrombus in a patient with atrial fibrillation under old and new oral anticoagulants: A case report.
Thrombosis and Haemostasis
10/16/2013 11:00:00 PM
Authors: Rohla M, Freynhofer MK, Hammerl H, Weiss TW, Huber K PMID: 24136295 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
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New-Onset Atrial Fibrillation After Acute Myocardial Infarction and Its Relation to Admission Biomarkers (from the TRIUMPH Registry)
The American Journal of Cardiology
10/16/2013 11:19:48 AM
Atrial fibrillation (AF) is an independent predictor of mortality after acute myocardial infarction (AMI). We analyzed the relation between biomarkers linked to myocardial stretch (NT-pro-brain natriuretic peptide [NT-proBNP]), myocardial damage (Troponin-T [TnT]), and inflammation (high-sensitivity C-reactive protein [hs-CRP]) and new-onset AF during AMI to identify patients at high risk for AF. In a prospective multicenter registry of AMI patients (from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry), we measured NT-proBNP, TnT, and hs-CRP in patients without a history of AF (n = 2,370). New-onset AF was defined as AF that occurred during the index hospitalization. Hierarchical multivariate l...
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Bile acids induce arrhythmias in human atrial myocardium--implications for altered serum bile acid composition in patients with atrial fibrillation
Heart
10/15/2013 11:00:00 PM
Conclusions High TCA concentrations induce arrhythmias in adult human atria while ursodeoxycholic acid does not. AF is associated with higher serum levels of non-ursodeoxycholic bile acid conjugates and low levels of ursodeoxycholic acid conjugates. These data suggest that higher levels of toxic (arrhythmogenic) and low levels of protective bile acids create a milieu with a decreased arrhythmic threshold and thus may facilitate arrhythmic events. (Source: Heart)
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Does Atrial Fibrillation Affect the Automated Oscillometric Blood Pressure Measurement? [Letters to the Editor]
Hypertension
10/15/2013 11:00:00 PM
(Source: Hypertension)

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Response to Does Atrial Fibrillation Affect the Automated Oscillometric Blood Pressure Measurement? [Letters to the Editor]
Hypertension
10/15/2013 11:00:00 PM
(Source: Hypertension)
http://www.medworm.com/rss/comments.php?id=7680119
Atrial fibrillation: to map or not to map?
Netherlands Heart Journal
10/15/2013 11:00:00 PM
Authors: Yaksh A, Kik C, Knops P, Roos-Hesselink JW, Bogers AJ, Zijlstra F, Allessie M, de Groot NM Abstract Isolation of the pulmonary veins may be an effective treatment modality for eliminating atrial fibrillation (AF) episodes but unfortunately not for all patients. When ablative therapy fails, it is assumed that AF has progressed from a trigger-driven to a substrate-mediated arrhythmia. The effect of radiofrequency ablation on persistent AF can be attributed to various mechanisms, including elimination of the trigger, modification of the arrhythmogenic substrate, interruption of crucial pathways of conduction, atrial debulking, or atrial denervation. This review discusses the possible effects of pulmonary vein isolation on the fibrillatory process and the necessity of cardiac ...
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Stroke prevention in older adults with atrial fibrillation.
cmaj
10/15/2013 11:00:00 PM
Authors: Coppens M, Hart RG, Eikelboom JW PMID: 24132962 [PubMed - as supplied by publisher] (Source: cmaj)
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Proteomics discovery of biomarkers for mitral regurgitation caused by mitral valve prolapse.
Journal of Proteomics
10/15/2013 11:00:00 PM
In conclusion, haptoglobin, PBP, and C4b are down-regulated in MVP/MR. Their value as serological biomarkers of valvular pathology should be further explored. BIOLOGICAL SIGNIFICANCE: We report the first study that performed comparative proteomics of clinical human plasma samples to identify novel diagnostic biomarkers for mitral valve prolapse (MVP) patients with moderate to severe mitral regurgitation (MR). MR is a common valvular lesion that can be complicated by heart failure, sudden death and atrial fibrillation, yet many patients with severe MR are asymptomatic. Our results revealed reduced levels of haptoglobin, platelet basic protein (PBP), and complement component C4b in the MVP/MR patients as compared to the matched control cases. The plasma proteomics findings were subsequen...
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Fatty Acids and Development of Atrial FibrillationFatty Acids and Development of Atrial Fibrillation
Medscape Today Headlines
10/15/2013 8:05:22 AM
Consumption of fish and marine n-3 polyunsaturated fatty acids may be associated with a lower risk of atrial fibrillation. Can the relationship be clarified by evaluating fatty acid deposits -- in body fat? Heart (Source: Medscape Today Headlines)
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ERACEing the Risk of Cerebral Embolism From Atrial Fibrillation Ablation [Editorials]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
(Source: Circulation: Arrhythmia and Electrophysiology)
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Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction: Results of the Evaluation of Reduction of Asymptomatic Cerebral Embolism Trial [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— Applying procedural changes to MER ablation significantly reduces the ACE incidence to 1.7%, which is on the low end of reported ACE rates of any technology. Clinical Trial Registration Information— ClinicalTrials.gov; Identifier: NCT01520532. (Source: Circulation: Arrhythmia and Electrophysiology)
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Neuropsychological Effects of MRI-Detected Brain Lesions After Left Atrial Catheter Ablation for Atrial Fibrillation: Long-Term Results of the MACPAF Study [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— Ablation-related acute ischemic brain lesions persist to some extent but do not cause cognitive impairment 6 months after the ablation procedure. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01061931. (Source: Circulation: Arrhythmia and Electrophysiology)

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Prevalence, Characteristics, Mapping, and Catheter Ablation of Potential Rotors in Nonparoxysmal Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— Rotor-like re-entry with fibrillatory conduction was found in a limited number of patients with nonparoxysmal AF after pulmonary vein isolation. Those areas were characterized by rapid repetitive activity with a high degree of electrogram similarity. (Source: Circulation: Arrhythmia and Electrophysiology)
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Frequency Analysis of Atrial Action Potential Alternans: A Sensitive Clinical Index of Individual Propensity to Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— Spectral AP alternans near baseline rates can identify patients with, versus those without, clinical histories and pathophysiological substrates for AF. Future studies should examine whether the presence of spectral AP alternans during sinus rhythm may obviate the need to actually demonstrate AF, such as on ambulatory ECG monitoring. (Source: Circulation: Arrhythmia and Electrophysiology)
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Renal Dysfunction, Stroke Risk Scores (CHADS2, CHA2DS2-VASc, and R2CHADS2), and the Risk of Thromboembolic Events After Catheter Ablation of Atrial Fibrillation: The Leipzig Heart Center AF Ablation Registry [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with TE risk. The CHA2DS2-VASc score differentiated TE risk in the low-risk strata based on CHADS2 and R2CHADS2 scores and may be superior in the subgroup with AF recurrences. (Source: Circulation: Arrhythmia and Electrophysiology)
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Both Hypothyroidism and Hyperthyroidism Increase Atrial Fibrillation Inducibility in Rats [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— Both hypothyroidism and hyperthyroidism lead to increased AF vulnerability in a rat thyroidectomy model. Our results stress that normal thyroid hormone levels are required to maintain normal cardiac electrophysiology and to prevent cardiac arrhythmias and AF. (Source: Circulation: Arrhythmia and Electrophysiology)
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Selective Targeting of Gain-of-Function KCNQ1 Mutations Predisposing to Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions The enhanced sensitivity of KCNQ1 gain-of-function mutations for HMR-1556 suggests the possibility of selective therapeutic targeting, and, therefore, our data illustrate a potential proof of principle for genotype-specific treatment of this heritable arrhythmia. (Source: Circulation: Arrhythmia and Electrophysiology)

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Rearrangement of Atrial Bundle Architecture and Consequent Changes in Anisotropy of Conduction Constitute the 3-Dimensional Substrate for Atrial Fibrillation [Original Articles]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
Conclusions— During AF, atrial bundle rearrangement manifests itself in more perpendicular orientation of epicardial to endocardial bundles. Propagation of fibrillation waves is dominated by endocardial bundles in acute AF and by epicardial bundles in persistent AF. Together with the loss of endo-epicardial electrical connections, rearrangement of atrial bundles underlies endo-epicardial dissociation of electrical activity and the development of a 3-dimensional AF substrate. (Source: Circulation: Arrhythmia and Electrophysiology)
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Bachmann's Bundle: A Key Player in the Development of Atrial Fibrillation? [Advances in Arrhythmia and Electrophysiology]
Circulation: Arrhythmia and Electrophysiology
10/14/2013 11:00:00 PM
(Source: Circulation: Arrhythmia and Electrophysiology)
http://www.medworm.com/rss/comments.php?id=7678338
Percutaneous management of late leak after lariat transcatheter ligation of the left atrial appendage in patients with atrial fibrillation at high risk for stroke
Catheterization and Cardiovascular Interventions
10/14/2013 11:00:00 PM
ABSTRACT Left atrial appendage (LAA) occlusion or ligation is a novel approach to stroke prevention in atrial fibrillation that may obviate the need for long‐term anticoagulation. The Lariat device has received Food and Drug Administration 510K clearance for the approximation of soft tissue and has been applied to transcatheter LAA ligation using a combined trans‐pericardial and transseptal approach. The occurrence of late leak after transcatheter LAA ligation and its percutaneous management has not been previously reported. Herein, we report three cases of late leak with reconstitution of the LAA after initially successful Lariat closure, and present a simple percutaneous technique for leak closure. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventi...
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Persistence of Warfarin Therapy for Residents in Long-term Care Who Have Atrial Fibrillation.
Clinical Therapeutics
10/14/2013 11:00:00 PM
CONCLUSIONS: Although clinical practice guidelines exist for the prevention of stroke in AF patients, persistence on warfarin therapy seems suboptimal in many LTC residents with AF. PMID: 24139051 [PubMed - as supplied by publisher] (Source: Clinical Therapeutics)
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Higher N-Terminal Pro–B-Type Natriuretic Peptide May Be Related to Very Different Conditions
Journal of the American College of Cardiology: Cardiovascular Interventions
10/14/2013 5:20:46 PM
We read the paper by Hijazi et al. (1) with interest. The authors investigated the incremental value of measuring N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels in addition to established risk factors (including the CHA2DS2VASc [heart failure, hypertension, age 75 years and older, diabetes, and previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category (female sex, respectively)] score) for the prediction of cardiovascular and bleeding events. They concluded that NT-proBNP levels are often elevated in atrial fibrillation (AF) and independently associated with an increased risk for stroke and mortality. NT-proBNP improves risk stratification beyond the CHA2DS2VASc score and might be a novel tool for improved stroke prediction in AF. The...
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Reply Higher N-Terminal Pro–B-Type Natriuretic Peptide May Be Related to Very Different Conditions
Journal of the American College of Cardiology: Cardiovascular Interventions
10/14/2013 5:20:46 PM
We thank Dr. Balta and colleagues for their comments on our article concerning the use of N-terminal pro B-type natriuretic peptide (NT-proBNP) for atrial fibrillation (AF) in the ARISTOTLE (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) trial (1). Of the 18,201 patients with AF in the ARISTOTLE trial, 14,892 comprised the population in whom baseline NT-proBNP plasma samples were analyzed. The results showed that NT-proBNP was strongly and independently related to stroke, cardiovascular events, and mortality. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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U22 protocol as measure of symptomatic improvement after catheter ablation of atrial fibrillation.
Upsala Journal of Medical Sciences
10/14/2013 5:20:03 PM
Conclusion.U22 quantifies the symptomatic improvement after AF ablation with adequate internal consistency and construct validity. U22 mirrors aspects of the arrhythmia symptomatology other than SF-36. PMID: 24102147 [PubMed - as supplied by publisher] (Source: Upsala Journal of Medical Sciences)
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Every patient with atrial fibrillation has his (her) own optimal heart rate
Medical Hypotheses
10/13/2013 11:00:00 PM
Abstract: Heart rate control is an important part of atrial fibrillation (AF) treatment and the recommendation for the target rate has become lenient in the recent guideline. Since heart rhythm of AF patients is irregularly irregular with great rate variation, the number of effective ventricular contractions may be different within a given time period among patients with similar heart rates and it may further lead to different levels of cardiac output. Therefore, we propose that every AF patient has his (her) own optimal heart rate, or to say that, the target for rate control in each AF patient should be individualized. This optimal heart rate can be defined by pulse counting, echocardiography or cardiopulmonary exercise test. With this new target, patients will achieve higher cardiac outp...

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Candidate gene approach to identifying rare genetic variants associated with lone atrial fibrillation
Heart Rhythm
10/13/2013 11:00:00 PM
Background: Rare variants in candidate atrial fibrillation (AF) genes have been associated with AF in small kindreds. The extent to which such polymorphisms contribute to AF is unknown.Objective: The purpose of this study was to determine the spectrum and prevalence of rare amino acid coding (AAC) variants in candidate AF genes in a large cohort of unrelated lone AF probands.Methods: We resequenced 45 candidate genes in 303 European American (EA) lone AF probands (186 lone AF probands screened for each gene on average [range 89–303], 63 screened for all) identified in the Vanderbilt AF Registry (2002–2012). Variants detected were screened against 4300 EAs from the Exome Sequencing Project (ESP) to identify very rare (minor allele frequency ≤0.04%) AAC variants and these were tested f...
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Afib Higher in Whites Than Minorities (CME/CE)
MedPage Today State Required CME
10/11/2013 1:13:03 PM
(MedPage Today) -- Whites are more likely to develop atrial fibrillation than blacks and other ethnic groups, suggesting that European ancestry may be a risk factor for the disease. (Source: MedPage Today State Required CME)
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In study of 14 million patients, whites found to be more prone to atrial fibrillation than other ethnic groups
Health News from Medical News Today
10/11/2013 3:00:00 AM
An individual's race or ethnic background could be a determining factor when it comes to risk of atrial fibrillation, the most frequently diagnosed type of irregular heart rhythm, according to researchers at UC San Francisco. In a study to be published online and in the November 12 issue of Circulation, researchers discovered that self-described non-Hispanic whites are more likely to develop atrial fibrillation than people from other race or ethnic groups... (Source: Health News from Medical News Today)

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Atrial fibrillation: A kiss of death?
Netherlands Heart Journal
10/10/2013 11:00:00 PM
Authors: de Boer MJ PMID: 24114684 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)
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Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation
Heart Rhythm
10/10/2013 11:00:00 PM
Conclusion: LAA morphology relates to the burden of SCI in AF patients. Future research should corroborate if accessible methods (eg, echocardiography) are able to describe LAA morphology, permitting its use within universal thromboembolic risk predictors in AF patients. (Source: Heart Rhythm)
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Serious complications risk & high recurrence rates for pediatric atrial fibrillation
Health News from Medical News Today
10/10/2013 2:00:00 AM
Atrial fibrillation (AF), characterized by a rapid and irregular heartbeat, is the most common chronic arrhythmia in adults, but is rare in children. In one of the first studies of pediatric "lone AF" (AF without associated heart disease), researchers found a nearly 40% recurrence rate and that AF in the young is accompanied by substantial symptoms. Three patients had significant complications: one with a stroke and two with substantially impaired heart function. The researchers' findings are published in the October issue of the Canadian Journal of Cardiology... (Source: Health News from Medical News Today)

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Cross-talk between mineralocorticoid receptor/angiotensin II type 1 receptor and mitogen-activated protein kinase pathways underlies aldosterone-induced atrial fibrotic responses in HL-1 cardiomyocytes
International Journal of Cardiology
10/9/2013 11:00:00 PM
Conclusions: Elevated MR activity plays a central role in aldosterone-mediated activation of the MAPK signaling pathway and subsequent profibrotic effects in HL-1 atrial cells. MR/AT1 and the MAPK signaling pathway interact to trigger the molecular mechanism underlying the aldosterone-induced atrial fibrotic response. Our results support the view that MR blockade in conjunction with AT1 blockade can prevent the occurrence of atrial fibrillation. (Source: International Journal of Cardiology)
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More or Less Irregularity in Understanding an Irregular Rhythm: Atrial Fibrillation Classification and Racial Differences [Editorials]
JAHA:Journal of the American Heart Association
10/9/2013 11:00:00 PM
(Source: JAHA:Journal of the American Heart Association)
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Learning electrocardiogram on YouTube: How useful is it?
Journal of Electrocardiology
10/9/2013 11:00:00 PM
Abstract: Background: YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube.Methods: YouTube was searched on May 28, 2013 for the search terms “AF ecg” for atrial fibrillation, “AVNRT” for atrioventricular nodal reentrant tachycardia, “AVRT” for atrioventricular reentrant tachycardia, “AV block or heart block” for atrioventricular block, “LBBB, RBBB” for bundle branch block, “left anterior fascicular block or left posterior fascicular block” for fascicular blocks, “VT ecg” for ventricular tachycardia, “long QT” and “Brugada ecg”. Non-English language, unrelated and non-educational videos were excluded...
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Incidence and Cost of Stroke and Hemorrhage in Patients Diagnosed with Atrial Fibrillation in France
Journal of Stroke and Cerebrovascular Diseases
10/9/2013 7:00:00 PM
Conclusions: The incidence and cost of hospitalization for hemorrhage should be considered in the global burden of AF. These data should be useful for pharmacoeconomic evaluation of new oral anticoagulant medications. Such real-world studies may be relevant for monitoring mid- to long-term morbidity and mortality in the AF population. (Source: Journal of Stroke and Cerebrovascular Diseases)

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Wonder compound resveratrol the basis for new potential treatment for atrial fibrillation
Health News from Medical News Today
10/9/2013 3:00:00 AM
An international research team led by medical scientists at the University of Alberta has shown that new medications based on resveratrol - a compound found in red wine and nuts - may be used to treat a common heart-rhythm problem known as atrial fibrillation. Faculty of Medicine & Dentistry researcher Peter Light and his colleagues recently published their findings in the peer-reviewed journal, British Journal of Pharmacology... (Source: Health News from Medical News Today)
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Whites more prone to certain heart condition than other ethnic groups
EurekAlert! - Social and Behavioral Science
10/8/2013 11:00:00 PM
(University of California - San Francisco) An individual's race or ethnic background could be a determining factor when it comes to risk of atrial fibrillation, the most frequently diagnosed type of irregular heart rhythm, according to researchers at UC San Francisco. (Source: EurekAlert! - Social and Behavioral Science)
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When your heart is aflutter and you're weak at the knees: a case report
Journal of Neurology, Neurosurgery and Psychiatry
10/8/2013 11:00:00 PM
A 49 year old gentleman presented to Neurology with a 10 year history of deteriorating mobility. He described an evolving bilateral foot drop from his mid–thirties, with progressive symptoms affecting his left hand, manifesting as difficulties performing fine tasks such as snapping his fingers. He also had bilateral sensorineural deafness. He was known to cardiology with a tachy–brady syndrome which had evolved into persistent atrial fibrillation not requiring a pacemaker. His mother had Alzheimer's disease, with a "shuffling gait". His brother suffered from childhood polio. On examination, he was dysarthric, with wasting and weakness of the interossei and thenar eminence in both hands. There was wasting of the calf muscles and of tibialis anterior, with normal arched feet. Wea...
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Incidence, outcome and future projections of atrial fibrillation-related stroke and systemic embolism at age >=80 years: 10-year results of a population-based study
Journal of Neurology, Neurosurgery and Psychiatry
10/8/2013 11:00:00 PM
Conclusion Numbers of AF–related ischaemic strokes at age ≥80 years are projected to treble by 2050, along with numbers of systemic emboli, unless rates of anticoagulation in older patients increase. (Source: Journal of Neurology, Neurosurgery and Psychiatry)

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Newly detected paroxysmal atrial fibrillation after tia and ischaemic stroke on cardiac monitoring: systematic review and meta-analysis in relation to duration of recording
Journal of Neurology, Neurosurgery and Psychiatry
10/8/2013 11:00:00 PM
Conclusion Cardiac monitoring after TIA or ischaemic stroke detects clinically important rates of pAF in studies of unselected populations, with high rates of subsequent anticoagulation. A monitoring period of 5–7 days appears to be adequate. (Source: Journal of Neurology, Neurosurgery and Psychiatry)
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Incidence of atrial fibrillation in a population with impaired glucose tolerance: The contribution of glucose metabolism and other risk factors. A post hoc analysis of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research trial
American Heart Journal
10/8/2013 11:00:00 PM
Conclusions: In a trial population with impaired glucose tolerance, fasting plasma glucose and well-known risk factors (age, hypertension, and elevated body weight), but not progression to diabetes, predict risk of AF. (Source: American Heart Journal)
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Whites at Highest Risk for Irregular Heart Rhythm, Study Finds
WebMD Health
10/8/2013 5:05:47 PM
It's possible that a gene in European ancestry is linked to atrial fibrillation, researcher says (Source: WebMD Health)

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Bisphosphonates Raise Afib Risk (CME/CE)
MedPage Today State Required CME
10/8/2013 1:43:20 PM
(MedPage Today) -- Bisphosphonate use was associated with significantly increased risks of atrial fibrillation and serious atrial fibrillation, researchers found. (Source: MedPage Today State Required CME)
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The unappreciated importance of blood pressure in recent and older atrial fibrillation trials
Journal of Hypertension
10/8/2013 11:19:41 AM
Atrial fibrillation and arterial hypertension represent two common clinical conditions that frequently coexist, especially in older individuals, and are associated with increased risk of stroke. Antihypertensive therapy reduces the risk of stroke by approximately 40%. It has been observed that stroke rates were reduced by 10% for every 2-mmHg reduction of blood pressure. Antithrombotic therapy reduces significantly the risk for ischemic stroke in patients with atrial fibrillation at the expense of increased risk of intracranial bleeding. The importance of hypertension in patients with atrial fibrillation is recognized by its inclusion both in the CHA2DS2-VASc (risk for stroke) and the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile ...
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Whites More Prone to Certain Heart Condition than Other Ethnic Groups
UCSF Medical Center
10/8/2013 3:00:00 AM
An individual's race or ethnic background could be a determining factor when it comes to risk of atrial fibrillation, the most frequently diagnosed type of irregular heart rhythm, according to a new study at UC San Francisco. (Source: UCSF Medical Center)
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Comment on B‐Type Natriuretic Peptide Predicts Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation
Echocardiography
10/7/2013 11:00:00 PM
(Source: Echocardiography)
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Incident Atrial Fibrillation Among Asians, Hispanics, Blacks, and Whites.
Circulation
10/7/2013 11:00:00 PM
CONCLUSIONS: In a large hospital-based cohort, Whites have an increased risk of AF whether compared to Blacks, Asians, or Hispanics. The heightened AF risk among Whites is most pronounced in the absence of cardiovascular comorbidities. PMID: 24103419 [PubMed - as supplied by publisher] (Source: Circulation)

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Managing Uncertainty in Couples Living With Atrial Fibrillation.
The Journal of Cardiovascular Nursing
10/7/2013 11:00:00 PM
CONCLUSIONS:: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples' daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF. PMID: 24108265 [PubMed - as supplied by publisher] (Source: The Journal of Cardiovascular Nursing)
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Persistence of Atrial Septal Defect After Cryoballoon Ablation of Atrial Fibrillation
Journal of the American College of Cardiology: Cardiovascular Interventions
10/7/2013 5:23:18 PM
Persistent iatrogenic atrial septal defect (iASD) after transseptal puncture for radiofrequency (RF) ablation of atrial fibrillation (AF) using 8-F sheaths has been reported at rates of 0 to 19% at medium-term follow-up, depending on the transseptal puncture technique, the follow-up interval, and whether transthoracic echocardiography (TTE) or transesophageal echocardiography was used for assessment (1). Cryoballoon ablation is an emerging technology for the treatment of patients with AF that uses a 12-F inner diameter (15-F outer diameter) sheath (FlexCath, Medtronic, Minneapolis, Minnesota). The effect of this larger sheath size is poorly described; a single study using transesophageal follow-up in only 13 patients (without a comparison group) reported residual iASD in 38% at 6 months ...
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A Randomized Controlled Trial to Prevent Post-Operative Atrial Fibrillation by Antioxidant Reinforcement
Journal of the American College of Cardiology: Cardiovascular Interventions
10/7/2013 5:23:17 PM
ConclusionsThis safe, well-tolerated, and low-cost regimen, consisting of n-3 polyunsaturated fatty acids plus vitamins C and E supplementation, favorably affected post-operative atrial fibrillation, increased antioxidant potential, and attenuated oxidative stress and inflammation. (Prevention of Post-Operative Atrial Fibrillation: Pathophysiological Characterization of a Pharmacological Intervention Based on a Novel Model of Nonhypoxic Pre-Conditioning; ISRCTN45347268) (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)
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Are Post-Operative Arrhythmias in Patients With Metabolic Syndrome a Sign of Dysfunctional Mitochondria? ∗
Journal of the American College of Cardiology: Cardiovascular Interventions
10/7/2013 5:23:17 PM
Post-operative atrial fibrillation (POAF) is the most common cause of morbidity after coronary surgery, with an incidence that increases with patient age (1,22). The burdens of POAF include increased hospitalization stays/costs and poorer patient prognosis. Patients experiencing POAF have an increased propensity for adverse coronary events, a greater incidence of cerebrovascular accidents, and a higher degree of long-term mortality (3). The incidence of POAF is particularly problematic for patients with metabolic syndrome, which is known to be an independent risk factor for POAF (4,55). (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Pediatric atrial fibrillation, rare, but has serious complications risk & high recurrence rates
EurekAlert! - Medicine and Health
10/6/2013 11:00:00 PM
(Elsevier Health Sciences) Atrial fibrillation (AF), characterized by a rapid and irregular heartbeat, is the most common chronic arrhythmia in adults, but is rare in children. In one of the first studies of pediatric "lone AF" (AF without associated heart disease), researchers found a nearly 40 percent recurrence rate and that AF in the young is accompanied by substantial symptoms. Three patients had significant complications: one with a stroke and two with substantially impaired heart function. (Source: EurekAlert! - Medicine and Health)
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UAlberta medical research team designing new drug for common heart condition
EurekAlert! - Medicine and Health
10/6/2013 11:00:00 PM
(University of Alberta Faculty of Medicine & Dentistry) An international research team led by medical scientists at the University of Alberta has shown that new medications based on resveratrol -- a compound found in red wine and nuts -- may be used to treat a common heart-rhythm problem known as atrial fibrillation. (Source: EurekAlert! - Medicine and Health)
http://www.medworm.com/rss/comments.php?id=7657261
Cessation of oral anticoagulation in relation to mortality and the risk of thrombotic events in patients with atrial fibrillation.
Thrombosis and Haemostasis
10/6/2013 11:00:00 PM
In conclusion, in AF patients AF, VKA cessation is independently associated with mortality stroke and cardiovascular events. Specifically, VKA cessation independently increased the risk of stroke, even after adjusting for CHA2DS2-VASc score. TTR was an independent risk factor for major bleeding following initiation of VKA therapy. PMID: 24096615 [PubMed - as supplied by publisher] (Source: Thrombosis and Haemostasis)
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Perioperative Conduction Disturbances After Transcatheter Aortic Valve Replacement
Journal of Cardiothoracic and Vascular Anesthesia
10/6/2013 11:00:00 PM
Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. Given this evidence gap and clinical necessity, it is likely that clinical trials in the near future will be designed and implemented to address these issues.Prompt recognition and proper management of atrioventricular block remain essential in the management of patients undergoing TAVR, because heart block of all types is common and may require permanent pacemaker implantation. The current evidence base has describ...
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Magnetic resonance image intensity ratio, a normalized measure to enable interpatient comparability of left atrial fibrosis
Heart Rhythm
10/6/2013 11:00:00 PM
Background: The measurement of late gadolinium–enhanced magnetic resonance imaging (LGE-MRI) intensity in arbitrary units limits the objectivity of thresholds for focal scar detection and interpatient comparisons of scar burden.Objective: To develop and validate a normalized measure, the image intensity ratio (IIR), for the assessment of left atrial (LA) scar on LGE-MRI.Methods: Electrocardiogram- and respiratory-gated 1.5 Tesla LGE-MRI was performed in 75 patients (75% men; 62 ± 8 years) before atrial fibrillation ablation. The local IIR was defined as LA myocardial signal intensity for each of the 20 sectors on contiguous axial image planes divided by the mean LA blood pool image intensity. Intracardiac point-by-point sampled electroanatomic map points were coregistered with the corre...
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Global left ventricular longitudinal systolic strain as a major predictor of cardiovascular events in patients with atrial fibrillation
Heart
10/5/2013 11:00:00 PM
Conclusions GLS was a major parameter and stronger than LVEF and Sa in predicting adverse CV events and could offer an additional prognostic benefit over conventional clinical and echocardiographic systolic parameters in AF. (Source: Heart)
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A case of paroxysmal atrial fibrillation following low voltage electrocution - Navinan MR, Kandeepan T, Kulatunga A.
SafetyLit: All (Unduplicated)
10/5/2013 11:15:36 AM
BACKGROUND: Electrical injury may result in arrhythmias, however atrial fibrillation following low voltage electrocution is not a common occurrence. CASE PRESENTATION: A 70-year-old South-Asian woman with no prior history of cardiovascular disease presente... (Source: SafetyLit: All (Unduplicated))
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Low efficacy of cardioversion of persistent atrial fibrillation with the implantable cardioverter-defibrillator.
Netherlands Heart Journal
10/3/2013 11:00:00 PM
CONCLUSION: Internal cardioversion of AF in ICD patients has a low success rate but may be attempted in those with small atria, a long right atrial fibrillatory cycle length and a short total AF history, especially when a dual-coil ICD is present. Otherwise, it seems reasonable to prefer external over internal cardioversion when it comes to termination of persistent AF. PMID: 24092363 [PubMed - as supplied by publisher] (Source: Netherlands Heart Journal)
http://www.medworm.com/rss/comments.php?id=7660836
Association of inflammatory factors with occurrence and recurrence of atrial fibrillation: A meta-analysis
International Journal of Cardiology
10/3/2013 11:00:00 PM
Conclusion: Increased circulating inflammatory factors, such as CRP and IL-6, are associated with greater AF risk in general population and patients who underwent CABG, as well as with AF recurrence after EC or ablation. Future research is warranted to elucidate the roles of other inflammatory markers, such as white blood cell, IL-8, and transforming growth factor-β1, in occurrence and recurrence of well-established different clinical subtypes of AF. (Source: International Journal of Cardiology)

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Relationship between Complex Fractionated Atrial Electrograms during Atrial Fibrillation and the Critical Site of Atrial Tachycardia that Develops after Catheter Ablation for Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/2/2013 11:00:00 PM
ConclusionsThe areas showing CFAE and their border zones were frequently associated with termination of ATs presenting after AF ablation. The mean CL of ATs originating near CFAEs was significantly shorter than that of those terminated in non‐CFAE areas. The targeted CFAE areas also provided the arrhythmogenic milieu for AT developing after AF ablation.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Quantitative Magnetic Resonance Imaging Analysis of the Relationship between Contact Force and Left Atrial Scar Formation after Catheter Ablation of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/2/2013 11:00:00 PM
ConclusionThere is a correlation between FTI and LGE SI in MRI following AF ablation. Real‐time FTI maps are feasible and may prevent inadequate lesion formation.This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)
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Extra Cardiac Ice Formation During Second Generation 28 mm Cryoballoon Ablation of Atrial Fibrillation
Journal of Cardiovascular Electrophysiology
10/2/2013 11:00:00 PM
This article is protected by copyright. All rights reserved. (Source: Journal of Cardiovascular Electrophysiology)

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The impact of smoking on thromboembolism and mortality in patients with incident atrial fibrillation: insights from the Danish Diet, Cancer and Health study.
Chest
10/2/2013 11:00:00 PM
CONCLUSIONS Smoking is associated with a higher risk of thromboembolism or death in patients with AF even after adjusting for well-recognised risk factors used in stroke risk stratification schemes. The associations may be modified by sex, as the associations were strongest among women. PMID: 24091709 [PubMed - as supplied by publisher] (Source: Chest)
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Loss of cardiac resynchronization during DDD pacing: What is the mechanism?
International Journal of Cardiology
10/2/2013 11:00:00 PM
A 58-year-old man with nonischemic dilated cardiomyopathy which was diagnosed by patient's history, physical examination, electrocardiogram, echocardiogram, and coronary angiograph, based on the criteria published in 1995 by the World Health Organization (WHO)/International Society and Federation of Cardiology Task Force (ISFC) on the definition and classification of cardiomyopathy , and left ventricular end-diastolic dimension of 74mm, left ventricular ejection fraction of 29%, left bundle branch block and QRS duration 167ms, paroxysmal atrial fibrillation (AF), and New York Heart Association class III heart failure symptoms underwent implantation of cardiac resynchronization with defibrillation capability (CRT-D), for primary prevention of fatal ventricular arrhythmia (Epic™+HF V-350, ...
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A novel KCNQ1 missense mutation identified in a patient with juvenile-onset atrial fibrillation causes constitutively open IKs channels
Heart Rhythm
10/2/2013 11:00:00 PM
Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. In some patients, the disease is inheritable; however, hereditary aspects of AF remain not fully elucidated.Objective: The purpose of this study was to identify genetic backgrounds that contribute to juvenile-onset AF and to define the mechanism.Methods: In 30 consecutive juvenile-onset AF patients (onset age (Source: Heart Rhythm)
http://www.medworm.com/rss/comments.php?id=7909279
Atrial fibrillation and the 4P medicine. Commentary.
Annali dell'Istituto Superiore di Sanita
10/2/2013 1:15:02 AM
Authors: Censi F, Cianfrocca C, Purificato I Abstract Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation. PMID: 24071602 [PubMed - in process] (Source: Annali dell'Istituto Superiore...
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Successful closure of residual leak following LARIAT procedure in a patient with high risk of stroke and hemorrhage.
Catheterization and Cardiovascular Interventions
10/1/2013 11:00:00 PM
Abstract Percutaneous left atrial appendage suture ligation with the LARIAT® device (Sentre HEART, Redwood City, California) was successfully performed on an 84‐year‐old woman with non‐valvular atrial fibrillation who developed intracranial hemorrhage on warfarin. However, a large gap developed at follow‐up precluding warfarin cessation. To the best of our knowledge, this case report represents the first description of the use of a Gore® Helex® Septal Occluder (W. L. Gore and Associates, Newark, Delaware) as a novel Removed: and effectiveapproach to close a gap following percutaneous LAA suture ligation. © 2013 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Statin therapy prior to CABG surgery may improve outcomes
Health News from Medical News Today
10/1/2013 4:00:00 AM
Patients receiving statin therapy before coronary artery bypass grafting (CABG) surgery appear to have a reduced risk of post-surgical mortality, stroke, and atrial fibrillation (irregular or rapid heart rate), according to an article in the October 2013 issue of The Annals of Thoracic Surgery. These same benefits from statins could not be demonstrated for patients undergoing aortic valve replacement (AVR). "Heart surgery patients typically have a number of other disorders, so we need to optimize the patient's preoperative condition and help ensure the best possible result," said Elmar W... (Source: Health News from Medical News Today)
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Renin-Angiotensin System Inhibitors Prevent the Recurrence of Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials
Journal of Cardiovascular Pharmacology
10/1/2013
Conclusions:ACEI/ARBs are effective on the secondary prevention of AF, especially in patients receiving AAD and suffering from hypertension. (Source: Journal of Cardiovascular Pharmacology)
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