Tag Archives: ROCKET-AF

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

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

Obstructive sleep apnoea and neurovascular disease The association between obstructive sleep apnoea (OSA) and neurovascular disease was discussed by Dr David Hargroves (British Association of Stroke Physicians Education and Training Chair) and colleagues from East Kent during the training day at the conference. Dr Hargroves presented previously published data which shows that OSA is not uncommon: 24% of men and 9% of women in the general population may have OSA, 3−4% with clinically ‘obvious’ sequelae, and 60% of older and obese people may have OSA.1 Clinicians treating patients with neurological presentations should have a high index o

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

X-VERT: rivaroxaban▼ an alternative to VKA in cardioversion for AF Watch Professor Keith Fox, Chairman of the ESC programme committee discussing the relevance of X-VERT and other studies for UK practice in our podcast from the ESC Oral anticoagulant therapy with rivaroxaban is an alternative to vitamin K antagonists (VKAs) in patients with AF who are undergoing elective cardioversion according to the results of the X-VERT study.1 In addition, rivaroxaban may potentially have one important advantage over VKAs, with a shorter time to cardioversion, the study suggests. Professor Riccardo Cappato (University of Milan, Italy), the co-principal

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Advances in imaging and diagnosis Dr Nik Abidin (Consultant Cardiologist, Salford Royal NHS Foundation Trust) kicked off the theme of ‘Advances in diagnosis’ with a tantalising taster of the future of echocardiography, and a demonstration of what is already possible. Patients with chronic kidney disease (CKD) have a high incidence of cardiac dysfunction, with 75% of patients with significant CKD demonstrating left ventricular hypertrophy. In such patients, left ventricular dilatation occurs late with advanced disease, and left ventricular mass is an earlier predictor of cardiac mortality. An increase in left atrium size is the downstream

PREVAIL not presented but eases safety concerns on Watchman The PREVAIL trial of a new device which closes the left atrial appendage in the heart (Watchman®, Boston Scientific) attracted huge controversy at the ACC meeting when it was removed from the programme within an hour of its presentation because of an embargo break by the sponsor, Boston Scientific. But the slides and a press release were still made available to the media, and preliminary results appear to suggest some reassurance on safety concerns generated in a previous study. The device, which is implanted via a trans-septal catheter-based delivery system, is already available in