scholarly journals Comparison of two smartphone based atrial fibrillation screening application in Indonesian population

2021 ◽  
Author(s):  
Alexander Edo Tondas ◽  
Rolando Agustian Halim ◽  
Muhammad Rizki Felani ◽  
Fianirazha Primesa Caesarani ◽  
Indash Puspita ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pacemaker Implantation ◽  
Smartphone Application ◽  
Adverse Outcomes ◽  
Diagnostic Ability ◽  
Indonesian Population ◽  
The Mean ◽  
Convenience Sampling ◽  
Hospital General ◽  
Distinct Method

Background: Due to its adverse outcomes and thromboembolic complications, early detection of atrial fibrillation (AF) is advisable in the general population. This study aims to compare the diagnostic ability of two distinct method in smartphone application format, namely : AliveCor KardiaMobile and FibriCheck. Methods: This study was conducted in Mohammad Hospital General Hospital Palembang with convenience sampling of 170 participants aged 18 years or older. The subjects underwent Fibricheck and KardiaMobile recordings followed by 12 lead electrocardiogram read by board-certified cardiologist as the diagnostic standard. Results: After the exclusion of previous pacemaker implantation (n=7), 163 patients were included in the study. The mean age was 51±15 years with gender distribution of 74.8% men and 25.2% women. Most of the subjects were asymptomatic (87.1%) with mean blood pressure of 130/80 mmHg. The Fibricheck readings showed sensitivity of 73% and specificity of 93%, meanwhile Kardiamobile was able to detect AF with sensitivity of 77% and specificity of 98%.  Conclusion: In our study, KardiaMobile demonstrated overall greater sensitivity and specificity when compared to FibriCheck. However, KardiaMobile requires an external metal sensor that must be puchased separately. To the best of our knowledge, this is the first study to directly compare both methods in the Indonesian population.

scholarly journals Cox-maze III Procedure for Atrial Fibrillation during Valve Surgery: A Single Institution Experience

2020 ◽  
Author(s):  
Changtian Wang ◽  
Lei Zhang ◽  
Tao Qin ◽  
Zhi-long Xi ◽  
Lei Sun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Valve Surgery ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Efficacy And Safety ◽  
Single Institution ◽  
The Mean

Abstract Objectives Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF. Methods A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. Results 66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2±8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4±32.9 and 115.6±22.8 minutes respectively. The first 24hours drainage was 488.6±293.3ml. The postoperative hospital stay was 14.8±8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5%, 1.5%, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7%, 93.1%, 94.5%, 92.9% and 91.4% at 1, 3, 6, 12, and 24 months respectively. Conclusions The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.

P1457Preliminary results of the FLASH-AF: Validation of the device independent nature of a pulse deriving smartphone application for the detection of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Proesmans ◽  
C Smeets ◽  
P Dreesen ◽  
J Vanhaeren ◽  
P Vandervoort
Keyword(s):  
Atrial Fibrillation ◽  
Diagnostic Accuracy ◽  
Medical Information ◽  
Low Cost ◽  
Smartphone Application ◽  
Cardiac Monitoring ◽  
Attractive Alternative ◽  
Handheld Device ◽  
The Mean ◽  
Quality Measurements

Abstract Background Smartphone applications using photoplethysmography (PPG) technology through their camera are becoming an attractive alternative for atrial fibrillation (AF) screening due to their low cost, convenience, and broad accessibility. However, some important questions concerning their diagnostic accuracy, robustness and device independent nature remain to be answered. Purpose This study evaluated the diagnostic accuracy of a PPG-based pulse-deriving smartphone application with respect to handheld single-lead ECG and 12-lead ECG. In addition, the device dependent nature and robustness of the performance of the application was assessed. Methods 300 Patients who are scheduled for a regular consultation or procedure (i.e. ablation or cardioversion) will be recruited from the cardiology ward. Additionally, patients hospitalized for continuous cardiac monitoring will be recruited to enrich the database with AF measurements. After obtaining written informed consent, the patients fill in a questionnaire collecting demographic and medical information. The pulse-deriving application will be tested on total of 14 different smartphones, 7 iOS devices and 7 Android devices. In total, each device will be measured with 150 times. The patients will additionally perform a single-lead ECG measurement with a handheld device. Subsequently, a 12-lead ECG will be recorded to obtain the reference diagnosis. Results A total of 164 patients already participated in the study. The mean age was 64 (±19) years, 58% was male. The AF-prevalence was 37%. On average, patients in AF had a higher CHA2DS2-VASc score; 3.93 (±1.80) compared to 2.02 (±1.63) for non-AF patients. The amount of insufficient quality measurements recorded with the pulse-deriving smartphone application ranged from 4% (iOS) to 13% (Android). Averaged for all the smartphone devices, the pulse-deriving application scored 81.2% (±5%) sensitivity, 97.1% (±1%) specificity, 88.8% (±2%) NPV, 95.0% (±1%) PPV, and 90.9% (±2%) accuracy. The handheld single-lead ECG device had 78.2% sensitivity, 95.5% specificity, 87.6% NPV, 91.5% PPV, and 88.9% accuracy. The same calculations were preformed after excluding regular atrial flutter measurements. On average, the pulse-deriving application scored 90.1% (±2%) sensitivity, 97.1% (±1%) specificity, 95.2% (±1%) NPV, 94.0% (±1%) PPV, and 94.8% (±1%) accuracy. The handheld single-lead ECG device had 90.2% sensitivity, 97.7% specificity, 97.7% NPV, 95.1% PPV, and 96.9% accuracy. Conclusion The diagnostic accuracy of the pulse-deriving smartphone application and the handheld single-lead ECG device was strongly influenced by the presence of regular atrial flutters, stressing the importance of further thorough validation. For the pulse-deriving smartphone application, there was no significant influence from device type in terms of diagnostic accuracy for the detection of AF. Insufficient quality measurements were more frequently performed on Android devices.

scholarly journals Cox-maze III Procedure for Atrial Fibrillation during Valve Surgery: A Single Institution Experience 

2020 ◽  
Author(s):  
Changtian Wang ◽  
Lei Zhang ◽  
Tao Qin ◽  
Zhi-long Xi ◽  
Lei Sun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pacemaker Implantation ◽  
Valve Surgery ◽  
Valve Disease ◽  
Heart Valve Disease ◽  
Rf Ablation ◽  
Efficacy And Safety ◽  
Single Institution ◽  
The Mean

Abstract Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF. Methods: A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. In this trial, we used a monopolar radiofrequency (RF) ablation in addition to cut and sew technique to treat AF.Results: 66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2±8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4±32.9 and 115.6±22.8 minutes respectively. The first 24hours drainage was 488.6±293.3ml. The postoperative hospital stay was 14.8±8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5%, 1.5%, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7%, 93.1%, 94.7%, 93.3% and 89.5% at 1, 3, 6, 12, and 24 months respectively.Conclusions: The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.

Efektivitas Comprehensive Breastfeeding Education terhadap Keberhasilan Pemberian Air Susu Ibu Postpartum

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Irma Nurbaeti ◽  
Kustati Budi Lestari
Keyword(s):  
Repeated Measures ◽  
Breastfeeding Support ◽  
Breastfeeding Practices ◽  
Breastfeeding Education ◽  
Repeated Measures Analysis ◽  
Post Test ◽  
Quasi Experimental ◽  
The Mean ◽  
Convenience Sampling ◽  
Postpartum Mothers

Pemberian Air Susu Ibu (ASI) masih merupakan masalah bagi pemenuhan kebutuhan nutrisi bayi baru lahir. Dukungan agar ibu menyusui bayi merupakan hal penting dalam menginisiasi dan mempertahankan pemberian ASI. Strategi dibutuhkan untuk mendukung keberhasilan menyusui. Tujuan penelitian adalah menganalisis efektivitas comprehensive breastfeeding education terhadap keberhasilan pemberian (ASI) pada periode postpartum. Jenis penelitian ini menggunakan kuasi eksperimen one group pre post test repeated measured design. Jumlah sampel sebanyak 22 ibu dengan menggunakan teknik accidental sampling. Pengumpulan data dilaksanakan pada bulan September–Oktober 2013 di Puskesmas wilayah Kota Tangerang Selatan. Intervensi dilakukan selama 30 menit. Pengumpulan data dilakukan sebelum intervensi, 3 hari setelah intervensi (post1), dan 10 hari setelah intervensi (post 2). Pengumpulan data menggunakan kuesioner dan observasi. Keberhasilan pemberian ASI berdasar pada parameter pengetahuan, langkah menyusui, perlekatan bayi, dan kecukupan ASI. Analisis data menggunakan general linear model repeated measureANOVA. Hasil penelitian menunjukkan adanya signifikansi comprehensive breastfeeding education (p=0.001). Rata-rata keberhasilan pemberian ASI sebelum dan setelah intervensi meningkat. Sebesar 93,9% intervensi memengaruhi tingkat keberhasilan. Rata-rata sebelum intervensi 56,74 (SD 5,92), post 1 sebesar 60,83 (SD 6,38) dan post2 sebesar 74,55 (SD 5,32). Subvariabel yang memiliki efek secara signifikan setelah intervensi adalah pengetahuan (p=0.001) dan langkah menyusui (p=0.001), sedangkan subvariabel perlekatan bayi (p=0.061) dan kecukupan ASI (p=0.162) tidak secara signifikan berbeda antara sebelum dan setelah intervensi. Pelaksanaanbreastfeeding education disarankan pada ibu agar dapat melakukan posisi perlekatan bayi yang benar sehingga dapat mengurangi masalah-masalah berkaitan dengan perlekatan yang tidak sesuai seperti puting perih, lecet atau berdarah, dan bayi kurang puas dalam menyusu yang bisa mengakibatkan gagalnya program ASI ekslusif.Kata kunci:Menyusui, pendidikan, perlekatan, postpartum AbstractBreastfeeding have still been problem for adequate newborn nutrition. Adequate breastfeeding support is essential for mothers to initiate and maintain optimal breastfeeding practices. A strategic needed to support successful breastfeeding. The purpose of research is to analyze the effectiveness comprehensive breastfeeding education on successful breastfeeding at postpartum periods. A quasi-experimental one group pretest, post test, repeated mesaured was used. This study was conducted at public health in Tangerang Selatan municipality in September–October 2013 among 22 postpartum mothers, convenience sampling methods. Intervention was done 30 minute. Data were collected before intervention (pretest), third day after intervention (post 1) and tenth day after intervention (repeated/post 2) using four parameter, that are knowledge, breastfeeding steps, proper lacth-on and adequate breastmilk. Using repeated measures analysis of variance there was a significant increase (p=0.001) in the overall Successful breastfeeding mean. Around 93,9% the effectiveness of intervention influence on successful. The mean before intervention is 56,74 (SD 5,92), increased at post 1:60,83 (SD 6,38) and post 2:74,55 (SD 5,32). Subvariable which has effect significantly after intervention is knowledge (p=0.001) and breastfeeding steps (p=0.001), in contrary, proper latch-on (p=0,061) and adequate breastmilk (p=0.162) have no significant effect after intervention. Suggestion to support breastfeeding education and counselling proper latch-on adequately that can decrease the problem such as painful, creaks or bloody putting.Key words: Breastfeeding, education, latch-on, postpartum

scholarly journals POSTERS (2)96CONTINUOUS VERSUS INTERMITTENT MONITORING FOR DETECTION OF SUBCLINICAL ATRIAL FIBRILLATION IN HIGH-RISK PATIENTS97HIGH DAY-TO-DAY INTRA-INDIVIDUAL REPRODUCIBILITY OF THE HEART RATE RESPONSE TO EXERCISE IN THE UK BIOBANK DATA98USE OF NOVEL GLOBAL ULTRASOUND IMAGING AND CONTINUEOUS DIPOLE DENSITY MAPPING TO GUIDE ABLATION IN MACRO-REENTRANT TACHYCARDIAS99ANTICOAGULATION AND THE RISK OF COMPLICATIONS IN PATIENTS UNDERGOING VT AND PVC ABLATION100NON-SUSTAINED VENTRICULAR TACHYCARDIA FREQUENTLY PRECEDES CARDIAC ARREST IN PATIENTS WITH BRUGADA SYNDROME101USING HIGH PRECISION HAEMODYNAMIC MEASUREMENTS TO ASSESS DIFFERENCES IN AV OPTIMUM BETWEEN DIFFERENT LEFT VENTRICULAR LEAD POSITIONS IN BIVENTRICULAR PACING102CAN WE PREDICT MEDIUM TERM MORTALITY FROM TRANSVENOUS LEAD EXTRACTION PRE-OPERATIVELY?103PREVENTION OF UNECESSARY ADMISSIONS IN ATRIAL FIBRILLATION104EPICARDIAL CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA ON UNINTERRUPTED WARFARIN: A SAFE APPROACH?105HOW WELL DOES THE NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) GUIDENCE ON TRANSIENT LOSS OF CONSCIOUSNESS (T-LoC) WORK IN A REAL WORLD? AN AUDIT OF THE SECOND STAGE SPECIALIST CARDIOVASCULAT ASSESSMENT AND DIAGNOSIS106DETECTION OF ATRIAL FIBRILLATION IN COMMUNITY LOCATIONS USING NOVEL TECHNOLOGY'S AS A METHOD OF STROKE PREVENTION IN THE OVER 65'S ASYMPTOMATIC POPULATION - SHOULD IT BECOME STANDARD PRACTISE?107HIGH-DOSE ISOPRENALINE INFUSION AS A METHOD OF INDUCTION OF ATRIAL FIBRILLATION: A MULTI-CENTRE, PLACEBO CONTROLLED CLINICAL TRIAL IN PATIENTS WITH VARYING ARRHYTHMIC RISK108PACEMAKER COMPLICATIONS IN A DISTRICT GENERAL HOSPITAL109CARDIAC RESYNCHRONISATION THERAPY: A TRADE-OFF BETWEEN LEFT VENTRICULAR VOLTAGE OUTPUT AND EJECTION FRACTION?110RAPID DETERIORATION IN LEFT VENTRICULAR FUNCTION AND ACUTE HEART FAILURE AFTER DUAL CHAMBER PACEMAKER INSERTION WITH RESOLUTION FOLLOWING BIVENTRICULAR PACING111LOCALLY PERSONALISED ATRIAL ELECTROPHYSIOLOGY MODELS FROM PENTARAY CATHETER MEASUREMENTS112EVALUATION OF SUBCUTANEOUS ICD VERSUS TRANSVENOUS ICD- A PROPENSITY MATCHED COST-EFFICACY ANALYSIS OF COMPLICATIONS & OUTCOMES113LOCALISING DRIVERS USING ORGANISATIONAL INDEX IN CONTACT MAPPING OF HUMAN PERSISTENT ATRIAL FIBRILLATION114RISK FACTORS FOR SUDDEN CARDIAC DEATH IN PAEDIATRIC HYPERTROPHIC CARDIOMYOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS115EFFECT OF CATHETER STABILITY AND CONTACT FORCE ON VISITAG DENSITY DURING PULMONARY VEIN ISOLATION116HEPATIC CAPSULE ENHANCEMENT IS COMMONLY SEEN DURING MR-GUIDED ABLATION OF ATRIAL FLUTTER: A MECHANISTIC INSIGHT INTO PROCEDURAL PAIN117DOES HIGHER CONTACT FORCE IMPAIR LESION FORMATION AT THE CAVOTRICUSPID ISTHMUS? INSIGHTS FROM MR-GUIDED ABLATION OF ATRIAL FLUTTER118CLINICAL CHARACTERISATION OF A MALIGNANT SCN5A MUTATION IN CHILDHOOD119RADIOFREQUENCY ASSOCIATED VENTRICULAR FIBRILLATION120CONTRACTILE RESERVE EXPRESSED AS SYSTOLIC VELOCITY DOES NOT PREDICT RESPONSE TO CRT121DAY-CASE DEVICES - A RETROSPECTIVE STUDY USING PATIENT CODING DATA122PATIENTS UNDERGOING SVT ABLATION HAVE A HIGH INCIDENCE OF SECONDARY ARRHYTHMIA ON FOLLOW UP: IMPLICATIONS FOR PRE-PROCEDURE COUNSELLING123PROGNOSTIC ROLE OF HAEMOGLOBINN AND RED BLOOD CELL DITRIBUTION WIDTH IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY124REMOTE MONITORING AND FOLLOW UP DEVICES125A 20-YEAR, SINGLE-CENTRE EXPERIENCE OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD) IN CHILDREN: TIME TO CONSIDER THE SUBCUTANEOUS ICD?126EXPERIENCE OF MAGNETIC REASONANCE IMAGING (MEI) IN PATIENTS WITH MRI CONDITIONAL DEVICES127THE SINUS BRADYCARDIA SEEN IN ATHLETES IS NOT CAUSED BY ENHANCED VAGAL TONE BUT INSTEAD REFLECTS INTRINSIC CHANGES IN THE SINUS NODE REVEALED BY I (F) BLOCKADE128SUCCESSFUL DAY-CASE PACEMAKER IMPLANTATION - AN EIGHT YEAR SINGLE-CENTRE EXPERIENCE129LEFT VENTRICULAR INDEX MASS ASSOCIATED WITH ESC HYPERTROPHIC CARDIOMYOPATHY RISK SCORE IN PATIENTS WITH ICDs: A TERTIARY CENTRE HCM REGISTRY130A DGH EXPERIENCE OF DAY-CASE CARDIAC PACEMAKER IMPLANTATION131IS PRE-PROCEDURAL FASTING A NECESSITY FOR SAFE PACEMAKER IMPLANTATION?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl 2) ◽  
pp. ii36-ii47
Author(s):  
T. Philippsen ◽  
M. Orini ◽  
C.A. Martin ◽  
E. Volkova ◽  
J.O.M. Ormerod ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Day Case ◽  
Single Centre ◽  
Subcutaneous Icd

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction <40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P<0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Comparison of Left Atrial Appendage Occlusion versus Non-Vitamin-K Antagonist Oral Anticoagulation in High-Risk Atrial Fibrillation: An Update

2021 ◽  
Vol 8 (6) ◽  
pp. 69
Author(s):  
Shaojie Chen ◽  
K. R. Julian Chun ◽  
Zhiyu Ling ◽  
Shaowen Liu ◽  
Lin Zhu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Vitamin K ◽  
Major Bleeding ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Vitamin K Antagonists ◽  
Left Atrial Appendage Occlusion ◽  
The Mean

Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64–1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to “contemporary NOACs”. The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.

scholarly journals Adverse outcomes after worsening renal function in patients with atrial fibrillation: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Ogawa ◽  
Y An ◽  
S Ikeda ◽  
Y Aono ◽  
K Doi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Funding Source ◽  
Worsening Renal Function ◽  
Gault Formula ◽  
Bayer Healthcare ◽  
Artery Disease

Abstract Background Patients with atrial fibrillation (AF) commonly coexist with chronic kidney disease (CKD). Non-vitamin K antagonist oral anticoagulants (NOAC) are recommended for stroke prevention in patients with non-valvular atrial fibrillation (AF), and worsening renal function (WRF) as well as CKD is an important issue in using NOAC. However, little is known about the clinical outcomes of patients after WRF. Purpose We aimed to investigate outcomes after WRF in AF patients. Methods The Fushimi AF Registry is a community-based prospective survey of the AF patients in our city. Follow-up data including prescription status were available for 4,441 patients. Of them, 1,890 patients who have baseline and at least 1 follow-up creatinine clearance (CrCl) measurements, estimated by the Cockcroft-Gault formula, were analyzed in the present study. WRF was defined as a decrease of ≥20% from baseline CrCl measurement at any time point during follow-up. We evaluated demographics and outcomes after WRF in AF patients. Results During the median follow-up period of 2,194 days, mean CrCl decrease of 2.2 ml/min/year was observed and WRF occurred in 981 patients (51.9%). Patients with WRF were significantly more often female (with vs. without WRF; 40.3% vs. 35.4%; p=0.03), older (73.4 vs. 71.1 years of age; p<0.01), more often paroxysmal type (49.9% vs. 47.1%; p<0.01), and more likely to have prior stroke (17.9% vs. 12.7%; p<0.01), heart failure (30.8% vs. 24.8%; p<0.01), diabetes (31.7% vs. 27.1%; p=0.03), and coronary artery disease (19.9% vs. 12.1%; p<0.01) than those without WRF. Co-existing of CKD and mean CrCl at baseline were comparable (37.4% vs. 36.9%; p=0.82, 65.3 vs. 63.5 ml/min; p=0.66, respectively). Mean CHA2DS2-VASc score was significantly higher in WRF patients (3.55 vs. 3.03; p<0.01). On landmark analysis, all-cause mortality occurred in 135 patients (8.6 /100 person-years) after WRF and 82 patients (1.7 /100 person-years) without WRF, with an adjusted hazard ratio (HR) of 6.33 (95% confidence interval [CI], 4.33–9.50; p<0.01), adjusted by sex, age, body weight, serum creatinine, type of AF, oral anticoagulant prescription and comorbidities. Stroke or systemic embolism occurred in 45 patients after WRF (3.0 /100 person-years) and 78 (1.7 /100 person-years) patients without WRF (adjusted HR 1.60 [95% CI, 1.04–2.49; p=0.03]) (Figure). Conclusions AF patients after WRF had higher incidence of various adverse events. Incidence of Adverse Outcomes Funding Acknowledgement Type of funding source: Other. Main funding source(s): The Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus from Japan Agency for Medical Research and Development. Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi-Sankyo, Novartis Pharma, MSD, Sanofi-Aventis, and Takeda Pharmaceutical.

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