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Latest & greatest articles for atrial fibrillation
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on atrial fibrillation or other clinical topics then use Trip today.
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Does mitral annuloplasty fall under the definition of “valvular atrialfibrillation”? Chiefs’ Inquiry Corner – 3/16/20 – Clinical Correlations Search Chiefs’ Inquiry Corner – 3/16/20 March 16, 2020 2 min read Conventionally, anticoagulation with warfarin has been the prefered method of stroke prevention in patients with valvular atrialfibrillation. In January 2019, the AHA/ACC/HRS Guidelines on the Management of AtrialFibrillation clarified the definition of valvular a fib, restricting
What is the appropriate initial workup for a patient with newly diagnosed atrialfibrillation? Chiefs’ Inquiry Corner – 3/2/20 – Clinical Correlations Search Chiefs’ Inquiry Corner – 3/2/20 March 2, 2020 2 min read Beyond considerations for rate or rhythm control and anticoagulation, it is recommended that all patients newly diagnosed with atrialfibrillation undergo a basic workup to determine any underlying etiologic causes. This includes a thorough history and physical exam. Additionally
External Performance of the HAVOC Score for the Prediction of New Incident AtrialFibrillation Background and Purpose- The HAVOC score (hypertension, age, valvular heart disease, peripheral vascular disease, obesity, congestive heart failure, coronary artery disease) was proposed for the prediction of atrialfibrillation (AF) after cryptogenic stroke. It showed good model discrimination (area under the curve, 0.77). Only 2.5% of patients with a low-risk HAVOC score (ie, 0-4) were diagnosed
Oral Anticoagulation for Patients With AtrialFibrillation on Long-Term Hemodialysis Patients on long-term dialysis are at increased risk of bleeding. Although oral anticoagulants (OACs) are recommended for atrialfibrillation (AF) to reduce the risk of stroke, randomized trials have excluded these populations. As such, the net clinical benefit of OACs among patients on dialysis is unknown.This study aimed to investigate the efficacy and safety of OACs in patients with AF on long-term
Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with AtrialFibrillation: the Valkyrie Study Vitamin K antagonists (VKAs), although commonly used to reduce thromboembolic risk in atrialfibrillation, have been incriminated as probable cause of accelerated vascular calcification (VC) in patients on hemodialysis. Functional vitamin K deficiency may further contribute to their susceptibility for VC. We (...) investigated the effect of vitamin K status on VC progression in 132 patients on hemodialysis with atrialfibrillation treated with VKAs or qualifying for anticoagulation.Patients were randomized to VKAs with target INR 2-3, rivaroxaban 10 mg daily, or rivaroxaban 10 mg daily plus vitamin K2 2000 µg thrice weekly during 18 months. Systemic dp-ucMGP levels were quantified to assess vascular vitamin K status. Cardiac and thoracic aorta calcium scores and pulse wave velocity were measured to evaluate VC
[Nurse-led educational intervention in patients with atrialfibrillation discharged from the emergency department reduces complications and shortterm admissions]. To assess whether a nurse-led patient educational intervention for patients with atrialfibrillation (AF) discharged from the emergency department (ED) can improve the patients' understanding of arrhythmia and its treatment and reduce the number of complications and arrhythmia-related admissions.Prospective study of an intervention
Antithrombotic Therapy in Patients With AtrialFibrillation and Acute Coronary Syndrome Treated Medically or With Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial The safety and efficacy of antithrombotic regimens may differ between patients with atrialfibrillation who have acute coronary syndromes (ACS), treated medically or with percutaneous coronary intervention (PCI), and those undergoing elective PCI.Using a 2×2 (...) factorial design, we compared apixaban with vitamin K antagonists and aspirin with placebo in patients with atrialfibrillation who had ACS or were undergoing PCI and were receiving a P2Y12 inhibitor. We explored bleeding, death and hospitalization, as well as death and ischemic events, by antithrombotic strategy in 3 prespecified subgroups: patients with ACS treated medically, patients with ACS treated with PCI, and those undergoing elective PCI.Of 4614 patients enrolled, 1097 (23.9%) had ACS treated
Association of Anticoagulant Therapy With Risk of Fracture Among Patients With AtrialFibrillation Warfarin is prescribed to patients with atrialfibrillation (AF) for the prevention of cardioembolic complications. Whether warfarin adversely affects bone health is controversial. The availability of alternate direct oral anticoagulant (DOAC) options now make it possible to evaluate the comparative safety of warfarin in association with fracture risk.To test the hypothesis that, among patients
Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident AtrialFibrillation in a Healthy Population (From a Nationwide Danish Cohort Study) A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrialfibrillation (AF), with good discrimination and internal calibration. To define high-risk patients
Cryoballoon or Radiofrequency Ablation for AtrialFibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial Advanced generation ablation technologies have been developed to achieve more effective pulmonary vein isolation (PVI) and minimize arrhythmia recurrence after atrialfibrillation (AF) ablation.We randomly assigned 346 patients with drug-refractory paroxysmal AF to contact force-guided radiofrequency ablation (CF-RF; n=115), 4-minute cryoballoon ablation (Cryo-4; n=115 (...) ), or 2-minute cryoballoon ablation (Cryo-2; n=116). Follow-up was 12 months. The primary outcome was time to first documented recurrence of symptomatic or asymptomatic atrial tachyarrhythmia (AF, atrial flutter, or atrial tachycardia) between days 91 and 365 after ablation or a repeat ablation procedure at any time. Secondary end points included freedom from symptomatic arrhythmia and AF burden. All patients received an implantable loop recorder.One-year freedom from atrial tachyarrhythmia defined
Nurse-led vs. usual-care for atrialfibrillation Nurse-led integrated care is expected to improve outcome of patients with atrialfibrillation compared with usual-care provided by a medical specialist.We randomized 1375 patients with atrialfibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint
Maximum-fixed energy shocks for cardioverting atrialfibrillation Direct-current cardioversion is one of the most commonly performed procedures in cardiology. Low-escalating energy shocks are common practice but the optimal energy selection is unknown. We compared maximum-fixed and low-escalating energy shocks for cardioverting atrial fibrillation.In a single-centre, single-blinded, randomized trial, we allocated elective atrialfibrillation patients to cardioversion using maximum-fixed (360 (...) -360-360 J) or low-escalating (125-150-200 J) biphasic truncated exponential shocks. The primary endpoint was sinus rhythm 1 min after cardioversion. Safety endpoints were any arrhythmia, myocardial injury, skin burns, and patient-reported pain after cardioversion. We randomized 276 patients, and baseline characteristics were well-balanced between groups (mean ± standard deviation age: 68 ± 9 years, male: 72%, atrialfibrillation duration >1 year: 30%). Sinus rhythm 1 min after cardioversion
Antithrombotic Therapy for AtrialFibrillation with Stable Coronary Disease. There are limited data from randomized trials evaluating the use of antithrombotic therapy in patients with atrialfibrillation and stable coronary artery disease.In a multicenter, open-label trial conducted in Japan, we randomly assigned 2236 patients with atrialfibrillation who had undergone percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG) more than 1 year earlier or who had (...) for noninferiority). Rivaroxaban monotherapy was superior to combination therapy for the primary safety end point, with event rates of 1.62% and 2.76% per patient-year, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P = 0.01 for superiority).As antithrombotic therapy, rivaroxaban monotherapy was noninferior to combination therapy for efficacy and superior for safety in patients with atrialfibrillation and stable coronary artery disease. (Funded by the Japan Cardiovascular Research Foundation; AFIRE