Tag Archives: atrial fibrillation

Introduction Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% of the general population, this rises to 18% in those aged 85 years and above.1 The most effective method for correcting persistent AF is direct current cardioversion (DCCV). However, DCCV is associated with an increased risk of thromboembolic events.2 Anticoagulation with warfarin reduces the risk of thromboembolism from approximately 6% to less than 1%.3 The current recommendations advise therapeutic anticoagulation for at least three weeks prior to, and four weeks after cardioversion.4 A nurse-led elective DCCV service at Raigmore Hospital was establish

National survey of patients with AF in the acute medical unit: a day in the life survey Dear Sirs, The first national survey examining the management of atrial fibrillation (AF) within acute medical units up and down the country has just been published in the British Journal of Cardiology.1 Essentially it seems to show that secondary care is just as bad as primary care in initiating warfarin for AF patients. This group of patients is five times more likely to have a thromboembolic cerebrovascular accident than matched populations in sinus rhythm and yet doctors are ineffective at influencing change. This study took place over a 24-hour period

With the number of patients with atrial fibrillation (AF) set to double by 2050, appropriate anticoagulation for this growing condition was highlighted in a special session at the meeting – a ‘State of The Art Lecture’. Professor Stefan H Hohnloser (JW Goethe University, Frankfurt, Germany) described how stroke in Europe costs an estimated €38 billion per year, with 20% attributable to AF. Yet a decade ago, around 40% of AF patients did not receive appropriate anticoagulation. Of those receiving therapy, only around 50% of time in therapeutic range (TTR) is seen. With this in mind, novel oral anticoagulants (NOACs) are non-inferior to

Patients with paroxysmal AF rate their heath-related quality of life (HRQoL) lower than their physicians do, according to results from the ANTIPAF (Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation) trial. The study found these patients show signs of depression, sleeping disorders and low levels of physical activity even in the absence of significant concomitant cardiac disease. Researchers led by Professor Karl Ladwig (Helmholtz Centre, Munich, Germany) analysed data from patients enrolled in the ANTIPAF trial, which examined discordance between AF patients and their doctors. Between February 2004 and September 2008, 334 patients (

Introduction Atrial fibrillation (AF) is the most common cardiac dysrrhythmia, whose sequelae include stroke, heart failure and poor quality of life.1 In parallel with an ageing population, the prevalence of AF is increasing, with persistent or permanent forms affecting 10–15% of the population over the age of 75 years.2-6 The effective management of AF has been a source of recurring debate, leading to the publication of combined American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC), and National Institute for Health and Clinical Excellence (NICE) guidelines in 2006.7,8 In addition to evidenc

(more…)

The guide, which has been published online in the European Heart Journal and Europace, covers four new oral anticoagulants: dabigatran, rivaroxaban and apixaban (which are all now on the market for AF), and edoxaban, which is included provisionally, as it is not yet approved. The guide notes that: “Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice,” and “Many unresolved questions on how to optimally use these drugs in specific clinical situations remain”. It sets out 15 clinical scenarios and gives “as practical answers as possible” for each one. The topics are: Pra

The statement, published online in the European Heart Journal (25th April 2013, doi: 10.1093/eurheartj/eht154), is written by a committee led by Dr Felix Mahfoud (Saarland University, Saar, Germany). They state that the data support the concept that radiofrequency ablation of the renal nerves reduces blood pressure and improves blood-pressure control in these difficult-to-treat patients, with results now extending to 36 months. The statement also reviews the appropriate screening measures necessary to select patients eligible for renal denervation. These are: office-based blood pressure >160 mmHg (>150 mmHg in patients with type 2 diab

Stroke risk assessment in AF New insights on stroke risk assessment were provided by Dr Ami Banerjee (University of Birmingham), in a session supported by the Atrial Fibrillation Association. Table 1. CHADS2 score The CHADS2 risk stratification scoring system (table 1) is currently the indicator for the Quality and Outcomes (QoF) framework used to determine whether an atrial fibrillation (AF) patient warrants anticoagulation. It may underestimate risk and those with a score of zero may actually be at substantial stroke risk. He also pointed out that the system has inherent disadvantages. It does not include many of the risk factors for stroke

First UK operation for HF with nerve-stimulating implant The UK’s first operation to tackle heart failure (HF) with a novel nerve-stimulating device was performed recently at Glenfield Hospital, Leicester. The operation was part of the INOVATE-HF clinical trial, a global investigation to determine the safety and efficacy of the an implantable electrical stimulation device (CardioFit,® BioControl Medical), designed to improve heart function in patients with HF. The study will evaluate the system’s ability to reduce hospitalisation and death among patients with HF, while also exploring whether combined treatment with the system and pres