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Tag Archives: atrial fibrillation

August 2017 Br J Cardiol 2017;24:90–2 doi:10.5837/bjc.2017.022

Are NOACs safe in catheter ablation of atrial fibrillation?

Adam J Graham, Richard J Schilling

Abstract

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

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Introduction

November 2016 Br J Cardiol 2016;23(suppl 2):S1–S12 doi:10.5837/bjc.2016.s02

Introduction

BJCardio Staff

Abstract

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

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Direct current cardioversion and thromboprophylaxis in atrial fibrillation

November 2016 Br J Cardiol 2016;23(suppl 2):S1–S12 doi:10.5837/bjc.2016.s02

Direct current cardioversion and thromboprophylaxis in atrial fibrillation

BJCardio Staff

Abstract

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

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Highlights from international meetings: ACC, EAS and ADA

July 2016 Br J Cardiol 2016;23:93 Online First

Highlights from international meetings: ACC, EAS and ADA

BJCardio Staff

Abstract

American College of Cardiology The Annual Scientific Session of American College of Cardiology (ACC) took place in Chicago, USA, from April 2nd–4th 2016. FIRE AND ICE: to freeze or fry the atrium? Cryoballoon atrial ablation was found to be non-inferior to radiofrequency (RF) ablation with respect to efficacy for the treatment of patients with drug-refractory paroxysmal atrial fibrillation (AF). There was also no significant difference between the two procedures in regard to patient safety, according to late-breaking clinical trial research presented at ACC and simultaneously published in the New England Journal of Medicine (doi: 10.1056/NE

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October 2015 Br J Cardiol 2015;22:138–142 Online First

News from the European Society of Cardiology Congress 2015

BJCardio Staff

Abstract

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August 2015 Br J Cardiol 2015;22:87 doi:10.5837/bjc.2015.028

Initiating oral anticoagulation in hospitalised AF patients: it’s time to talk

Matthew Fay

Abstract

Dr Matthew Fay (Westcliffe Medical Practice, Shipley) Honarbakhsh et al. highlight an important point in their paper: when should this be done and who should take responsibility. Their review of patients who have been admitted acutely with AF or atrial flutter, looking at the outcome of anticoagulation if risk factors are present, seems to provide lamentable data, with only 57% being referred for oral anticoagulation. Of course, there may be a question as to whether, with patient-led decision-making, the acute hospital ward is the right environment for a considered and final decision as regards this important question. We need to consider the

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August 2015 Br J Cardiol 2015;22:105–9 doi:10.5837/bjc.2015.030

Oral anticoagulation in hospitalised patients with newly diagnosed AF: a story of too little, too late

Shohreh Honarbakhsh, Leigh-Ann Wakefield, Neha Sekhri, Kulasegaram Ranjadayalan, Roshan Weerackody, Mehul Dhinoja, R Andrew Archbold

Abstract

Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a reported worldwide prevalence of 0.6% in men and 0.4% in women.1 AF is independently associated with a five-fold increased rate of stroke, which is comparable with the risk seen in patients with three or more other stroke risk factors.2,3 Furthermore, strokes related to AF are associated with higher rates of disability and mortality than other strokes.4-6 The cost of AF-related strokes in the UK is estimated to be around £750 million per year.7 AF-related stroke is thought to be secondary to thromboembolism from the left atrium to the cerebral circulation. Ora

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Calling the cardioverted: an audit of long-term anticoagulation in patients attending for DCCV

July 2015 Br J Cardiol 2015;22:(3) doi:10.5837/bjc.2015.025 Online First

Calling the cardioverted: an audit of long-term anticoagulation in patients attending for DCCV

Philippa Howlett, Michael Hickman, Edward Leatham

Abstract

Introduction Atrial fibrillation (AF) is the most common arrhythmia in the UK and is estimated to affect 2% of the general population, rising to affect 8% of individuals aged over 75 years.1 Without appropriate antithrombotic therapy, non-valvular AF confers a five-fold risk of stroke and thromboembolism.2 Oral anticoagulation effectively reduces stroke risk by two-thirds.3 Direct current (DC) cardioversion (DCCV) is one strategy to restore sinus rhythm in patients with AF (see figure 1), and has been used in clinical practice since the 1960s. This procedure has relatively high initial success rates, however, it has become increasingly evid

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The new NICE AF guideline and NOACs: safety first or safety last?

June 2015 Br J Cardiol 2015;22:50–2 doi:10.5837/bjc.2015.018

The new NICE AF guideline and NOACs: safety first or safety last?

Adrian J B Brady, Derek T Connelly, Andrew Docherty

Abstract

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The new NICE AF guideline and NOACs: a response

June 2015 Br J Cardiol 2015;22:53–5 doi:10.5837/bjc.2015.019

The new NICE AF guideline and NOACs: a response

Campbell Cowan, Matthew Fay, Neal Maskrey

Abstract

We believe that the new guideline2 will be a major advance in stroke prevention in AF. We would suggest that Professor Brady and colleagues, in their focus on non-vitamin K oral anticoagulants (NOACs), have overlooked the importance of a number of crucial aspects of the guideline. It represents a paradigm change in stroke management. The GDG were very keen to promote the concept that, whereas previously risk assessment was undertaken to define patients at high risk of stroke requiring anticoagulation, under the new guideline anticoagulation has become the norm for all but the lowest-risk patients. It represents a considerable simplification

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