Tag Archives: atrial fibrillation

Relationship between diabetes and AF Mass screening of AF in the STROKESTOP study2 discovered diabetes, heart failure and previous stroke/transient ischaemic attack (TIA) to be the strongest predictors for AF in multi-variate analysis. This confirms findings from the historical Framingham study, where diabetes conferred a 1.4-fold increased risk of stroke in men and a 1.6-fold increased risk in women.3 A recent review of the evidence from AF screening studies in those with perceived high risks, has demonstrated the prevalence of AF in people with diabetes ranges from 2.9%4 to 18.5%.2 Chan and Choy’s study (2016)5 did not find diabetes to be

Introduction Atrial fibrillation (AF) increases an individual’s risk of stroke fivefold.1 Oral anticoagulation (OAC) with warfarin reduces the risk of stroke by 64%.2 Novel or direct oral anticoagulants are non-inferior to warfarin in preventing stroke in non-valvular AF and have a similar bleeding profile, but with a lower risk of fatal intracranial haemorrhage and several practical advantages.3-7 While several antiplatelet agents have been shown to reduce the risk of recurrent stroke, they are considerably less effective than OAC, with a similar risk of major bleeding, and, therefore, are no longer recommended in national guidelines for

Dr Mark Mills The question: medicate, or ablate? To medicate (with anti-arrhythmics), or to ablate: that is the question. In the management of atrial fibrillation (AF), the answer, depending on those questioned and the evidence cited, might be one, the other, both, or neither. Anti-arrhythmic drugs, compared with rate-control drugs, confer no prognostic benefit.1 Furthermore, emerging evidence suggests that ablation confers no mortality benefit over drug therapy.2 This equivocality presents a challenge in clinical practice. Here, consideration is given to each of these standpoints, while highlighting gaps in current knowledge and future direc

Until recently, warfarin was the drug of choice for patients with atrial fibrillation. Data 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),1 ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation),2 RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy)3 and ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48)4 trials demonstrated non-inferior or superior reduction in str

Background, epidemiology and rationale for study The PIONEER AF-PCI (Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects with Atrial Fibrillation who Undergo Percutaneous Coronary Intervention) trial addressed an important medical question, which is potentially relevant for the 20–45% of atrial fibrillation (AF) patients who also have coronary artery disease and are likely to undergo percutaneous coronary intervention (PCI). Prior to the PIONEER AF-PCI trial, there was an unmet need for evidence-based recommendati

New practical NOACs guide A new version of EHRA Practical Guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) was launched at the congress. ESC guidelines state that NOACs should be preferred over vitamin K antagonists, such as warfarin, for stroke prevention in AF patients, except those with a mechanical heart valve or rheumatic mitral valve stenosis, and their use in clinical practice is increasing. The guide gives concrete, practical advice on how to use NOACs in specific clinical situations. The guide is published in European Heart Journal (doi: 10.1093/eurheartj/ehy136). Anti

The initiative was launched in February 2015 and in a relatively short period of time, the project achieved success in all three areas with measurable improvement in outcomes, including a reduction in hospitalisations. Over 24 months, there have been around 21,000 clinical interventions, with the emphasis being on delivering change at scale, whilst being fastidious about minimising any extra workload on primary care. In this period, 13,000 patients either started statins or had their statins changed, more than 1,000 patients with atrial fibrillation were anticoagulated, and more than 5,200 hypertensive patients reached a blood pressure targe

Approximately 20–30% of patients with AF, who are continuously taking an oral anticoagulant to reduce their risk of AF-related stroke, have coexisting coronary artery disease and may require PCI. The current practice of administering triple therapy with warfarin and two antiplatelet agents in patients with AF after a PCI is associated with high rates of major bleeding. RE-DUAL PCI tested an alternative treatment strategy: dual therapy with dabigatran and a single antiplatelet agent (P2Y12 inhibitor). Selected for one of the meeting’s hotline sessions and simultaneously published in the New England Journal of Medicine (https://doi.org/10.

Figure 1. Mechanisms of coagulation during catheter ablation of atrial fibrillation (AF) and sites of action for non-vitamin K antagonist oral anticoagulants (NOACs) So how do we mitigate the thromboembolic risk during catheter ablation? Intravenous (IV) heparin is used with an activated clotting time (ACT) target of >300 s during the procedure and the use of saline-irrigated catheters seems to reduce risk further by decreasing the incidence of emboli from the catheter tip.3 Guidelines currently recommend oral anticoagulation three to four weeks before ablation,2,4 but there remains some debate about the management of oral anticoagulation

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th