Fibrillation Research Articles

Stroke - Challenge in Patients with COPD, Chronic Pulmonary Heart and COVID-19 Infection

Abstract Chronic obstructive pulmonary disease (COPD) is the respiratory condition with the highest prevalence, with over 10% of individuals over the age of 40 presenting with this disease .(1) The COVID-19 infection has significantly increased morbidity and mortality among COPD patients, as well as the rate of complications within this pathology. COVID-19 infection is a systemic inflammatory condition, with primary pulmonary involvement, but also with secondary gastrointestinal, cardiovascular, endocrinological, hepatic, renal, and, not least, neurological effects .(2) The degree of pulmonary involvement and bacterial superinfection have increased the risk of thromboembolic complications: stroke, atrial fibrillation (FiA), and death.

A Simple Score for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source in a Tunisian Cohort Study.

The annualized recurrent stroke rate in patients with Embolic Stroke of Undetermined Source (ESUS) under antiplatelet therapy is around 4.5%. Only a fraction of these patients will develop atrial fibrillation (FA), to which a stroke can be attributed retrospectively. The challenge is to identify patients at risk of occult AF during follow-up. This work aims to determine clinical factors and electrocardiographic and ultrasound parameters that can predict occult AF in patients with ESUS and build a simple predictive score applicable worldwide. This is a single-center, registry-based retrospective study conducted at the stroke unit of Sahloul University Hospital, Sousse, Tunisia, between January 2016 and December 2020. Consecutive patients meeting ESUS criteria were monitored for a minimum of one year, with a standardized follow-up consisting of outpatient visits, including ECG every three months and a new 24-hour Holter monitoring in case of palpitations. We performed multivariate stepwise regression to identify predictors of new paroxysmal AF among initial clinical, electrocardiographic (ECG and 24-hour Holter monitoring) and echocardiographic parameters. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integerbased point-scoring system. Three hundred patients met the criteria for ESUS. Among them, 42 (14%) patients showed at least one episode of paroxysmal AF during a median follow-up of two years. In univariate analysis, age, gender, coronary artery disease, history of ischemic stroke, higher NIHSS at admission and lower NIHSS at discharge, abnormal P-wave axis, prolonged P-wave duration, premature atrial contractions (PAC) frequency of more than 500/24 hours, and left atrial (LA) mean area of more than 20 cm2 were associated with the risk of occurrence of paroxysmal AF. We proposed an AF predictive score based on (1.771 x NIHSS score at admission) + (10.015 x P-wave dispersion; coded 1 if yes and 0 if no) + (9.841x PAC class; coded 1 if ≥500 and 0 if no) + (9.828x LA class surface; coded 1 if ≥20 and 0 if no) + (0.548xNIHSS score at discharge) + 0.004. A score of ≥33 had a sensitivity of 76% and a specificity of 93%. In this cohort of patients with ESUS, NIHSS at both admission and discharge, Pwave dispersion, PAC≥500/24h on a 24-hour Holter monitoring, and LA surface area≥20 cm2 provide a simple AF predictive score with very reasonable sensitivity and specificity and is applicable almost worldwide. An external validation of this score is ongoing.

Heart rate disorders in patients with Tako-tsubo syndrome

ObjectivesThis study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (TdR) in Tako-tsubo syndrome (STT). BackgroundSTT is associated with TdR. The TdR prognostic value is not well characterized in STT yet. MethodsThe TdR of patients included in the National Registry of Tako-tsubo syndrome (XXX1), admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. ResultsAll types of TdR were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with STT. TdR was more associated with Diabetes Mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent TdR was a new onset of atrial fibrillation (FA). During hospitalization, patients with TdR showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more MACE, but with a non-significant correlation. ConclusionsThe incidence of TdR in patients with STT is not infrequent. STT, when associated with TdR, presents more complications and a worse prognosis both in hospital and in the long term.

Outcomes in Patients with Acute Myocardial Infarction and Known Sleep Apnea: A Nationwide Analysis.

Background. Sleep apnea (SA) is a common breathing disorder characterized by repetitive upper airway narrowing and closure. Although SA has been demonstrated to be an independent risk factor for all-cause mortality, the direct contribution of SA to worse cardiovascular prognosis may be difficult to evaluate, and its independent association with the different types of cardiovascular outcomes may be debated, particularly in the context of patients with acute myocardial infarction (AMI). The aim of this study was to assess the impact of known SA on the outcomes of hospitalized patients who have had an AMI by analyzing 10-year data collected from a national registry. Methods. This longitudinal cohort study was based on the national hospitalization database that covers hospital care for the entire French population, including all patients admitted with AMI from January 2010 to June 2019. The clinical outcomes for the analysis were as follows: all-cause death, cardiovascular death, ischemic stroke, new-onset atrial fibrillation (FA), and re-hospitalization for heart failure (HF). Results. Among the 797,212 patients who presented with an AMI (528,351 men and 268,861 women), 37,075 (4.7%) had documented SA. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1-3.1] years), 163,845 deaths (of which 85,649 were cardiovascular deaths), 20,168 ischemic strokes, 58,498 new-onset AF, and 92,381 rehospitalizations due to HF were recorded. Patients with known SA had a worse prognosis in the short and medium term, but after adjusting for all covariables, SA was only independently associated with a higher risk of rehospitalization for HF and new-onset AF in men and women. Conclusion. Data from our large nationwide analysis confirm that known SA is associated with poor cardiovascular outcomes in patients who have had an AMI. However, this impact is tem-pered when the model is adjusted for age, cardiovascular risk, or other covariables. Further studies need to be conducted to assess the independent impact of SA on the prognosis of patients with AMI.

Android Application for Initial Screening of Atrial Fibrillation Using The Dempster Shafer Method

Atrial Fibrillation (FA) is one of the most common types of heart rhythm abnormalities found in clinical practice in Indonesia. Atrial fibrillation can cause a stroke risk 5 times. Meanwhile, stroke cases themselves tend to rise and become one of the main causes of death every year. The cause of the high number of FA cases is the lack of public knowledge and awareness/sensitivity to the early symptoms of the disease. The purpose of this study was to design an android device for early screening of suspected FA through examination of pulse, complaints/symptoms and disease risk factors. The dempster shafer method is used as a decision making tool for suspected FA or not FA. The results of the detection system performance test, obtained a sensitivity of 93.5%, a specificity of 89.7%, and an accuracy of 91.7%. The test results of the android application design, namely Visual Design and User Interaction, Functionality, Stability and Performance and Overall Satisfaction, show a "good" response in all aspects.

178 ARRHYTHMIC STORM IN ATTR WILD TYPE AMYLOIDOSIS: AN UNUSUAL COMBINATION

Abstract Cardiac amyloidosis (CA) is characterized by extracellular protein fibril deposition in the myocardium leading to restrictive heart failure. Both atrial and ventricular arrhythmias are common in CA. Study have shown up to one half of patients with CA die suddenly. However, the most common cause of sudden death has been historically through to be secondary electromechanical dissociation rather than a lethal ventricular arrhythmia. We present the case of a 84 years old man, with a history of hypertension, dyslipidaemia, and prior smoking. In June 2020 the patient was admitted to the emergency room of our hospital due to an episode of hemodynamically unstable sustained ventricular tachycardia (SVT). The patient underwent electrical cardioversion with restoration of sinus rhythm. An echocardiogram that showed a slightly reduced ejection fraction (FE = 45%), severe concentric hypertrophy, grade 3 diastolic dysfunction with high pressures in the left ventricular (LV) cavity, and a reduced GLS (-13.8%) with a typical apical-sparing aspect. A cardiac magnetic resonance (Fig.1). was performed showing a diffuse area of LGE with a subepicardial pattern involving left ventricular and atrial segments, compatible with myocardial storage disease. In order to complete the diagnostic workout, we performed a bone scintigraphy (Fig.2). (Positive for CA, with Perugini score grade 2), a genetic test (negative for hATTR-CA mutations) and free light chain in serum (negative for AL-CA). The patient was discharged at home after ICD implantation in secondary prevention and prescribed appropriate heart failure therapy. In May 2022 the patient was readmitted in emergency room for dyspnea during an arrhythmic storm characterized by several SVTs and ICD interventions, and atrial fibrillation (FA). After stabilization of clinical parameters, the patient was hospitalized in our ward. We optimized medical therapy with metaprololo 100 mg 1 cp BID, cordarone 600 mg ev and mexiletina 200 mg cp BID. During the hospitalization we succeeded in reducing SVT burden. However, ventricular PVCs and slow SVT remained. For this reason, we decided to perform an electrophysiological study (EPS) followed by catheter ablation. The EPS found two low voltage areas (Fig.3). The first were found under the aortic valve; the second was an area of dense scar and fragmented potentials along the basal-posterior wall. After ablation of the first area we succeeded in removing clinical PVCs. During the ablation of the second area the procedure was complicated by ventricular fibrillation that required advanced life support and many electrical shocks. The patient was discharged at home in absence of further episodes of SVTs with optimized therapy At a three moths follow up no arrhythmic events were recorded.

Вплив стратегії лікування на когнітивні функції пацієнтів з пароксизмальною та персистуючою формами фібриляції передсердь

З метою оцінки когнітивних функцій (КФ) у пацієнтів з фібриляцією передсердь (ФП) залежно від обраної стратегії лікування й особливостей амбулаторного спостереження обстежено 96 пацієнтів. Ведення хворих здійснювалося в рамках двох загальноприйнятих стратегій: відновлення й подальшого підтримання синусового ритму (СР) і збереження ФП з контролем частоти серцевих скорочень (ЧСС). На першому етапі вивчалися фактори, що впливають на вибір стратегії лікування пацієнтів, госпіталізованих з приводу нападу ФП. За допомогою спеціалізованих шкал проводилася оцінка переносимості ФП, рівня КФ, тривоги й депресії. Другий етап полягав в амбулаторному спостереженні за пацієнтами. Пацієнти були рандомізовані на дві групи: 1-ша — група активного спостереження, 2-га — група звичайного спостереження. Вибір стратегії лікування хворих з ФП визначався такими факторами, як вік, зловживання алкоголем, розмір лівого передсердя, форма ФП (пароксизмальна/персистуюча), а також бажання самого пацієнта. При безпосередньому опитуванні як найважливіші фактори для вибору стратегії контролю ЧСС лікарі вказували тривалість пароксизму ФП понад 1 рік і задовільну переносимість ФП. При прийнятті рішення про відновлення СР найбільше значення мали бажання пацієнта, відсутність значимої дилатації лівого передсердя, рідкісні (менше від 4 разів на рік) пароксизми й молодий вік пацієнтів. КФ хворих з ФП, лікування яких здійснюється в рамках стратегії контролю ЧСС, були істотно нижчими, ніж у пацієнтів, у яких відновлюють і підтримують СР. Крім того, серед даної групи хворих поширеність депресії була істотно вище. Динаміка КФ хворих із ФП не залежала від стратегії лікування, але залежала від статі, вихідного рівня КФ, характеру амбулаторного спостереження й соціальних факторів (проживання без сім’ї). Пацієнти з більш високим рівнем КФ мали більшу прихильність до призначеного лікування та були менш схильні до самостійної відміни аміодарону (протягом 24 місяців спостереження).

Досвід ведення хворих на артеріальну гіпертензію із супутньою фібриляцією передсердь, стентованих з приводу коронарних стенозів та атеротромбозу

Матеріали та методи. В дане дослідження були включені 1008 хворих на артеріальну гіпертензію (АГ) у поєднанні з коронарною хворобою серця (КХС) та фібриляцією передсердь (ФП). У всіх пацієнтів проведено селективну коронароангіографію, динамічні вимірювання артеріального тиску (АТ), реєстрацію електрокардіограми, ехокардіограми, коагулограми, ліпідограми та інші клінічні й біохімічні дослідження. Результати. Вперше встановлено, що коморбідність АГ, КХС та ФП після стентування коронарних артерій з приводу стабільної ішемічної хвороби серця створює додаткові труднощі щодо досягнення цільового значення АТ і тривалого утримування тиску крові в оптимально-нормальних межах. Доведено ефективність комплексного комбінованого лікування хворих на АГ у поєднанні з КХС та ФП із використанням антигіпертензивних препаратів першої лінії (інгібіторів ангіотензинперетворюючого ферменту/антагоністів рецепторів ангіотензину ІІ, діуретиків, β-адреноблокаторів) та засобів подвійної антитромботичної терапії (аспірин або клопідогрель чи тикагрелор у поєднанні з ривароксабаном) за умови потенціювання антигіпертензивних та антиішемічних ефектів з допомогою магній/калієвої солі пентагідроксикапронової кислоти (ритмокор) та аденозинумісного препарату адвокард, здатного посилювати антиішемічні ефекти фармакологічного прекондиціонування. Висновок. Застосування антигіпертензивних засобів першої лінії в поєднанні з ривароксабаном, ритмокором і адвокардом підвищує антикоагуляційний і дезагрегаційний потенціал крові, прискорює відновлення синусового ритму за наявності ФП, запобігає рестенозам і тромбозам стентів, усуває феномени slow flow та slow reflow щодо коронарного кровотоку.

A Phase 1 Trial of the Combination of Ibrutinib and Azacitidine for the Treatment of Higher Risk Myelodysplastic Syndromes: University of California Hematologic Malignancies Consortium (UCHMC) Study 1503

Introduction: Higher risk myelodysplastic syndromes (HR-MDS) have poor outcomes, particularly after hypomethylating agent (HMA) failure. The HMA azacitidine (AZA) is a standard of care for HR-MDS and works through several mechanisms, including inhibition of NF-kB signaling. Ibrutinib (IBR) inhibits Bruton9s Tyrosine Kinase (BTK) and has an antiproliferative effect on myeloblasts in preclinical models through BTK binding and inhibition of NF-kB signaling. IBR also has immunomodulatory activity mediated through binding interleukin-2-inducible kinase (ITK) and promoting Th1-polarized immunity, which is decreased in HR-MDS. These features suggest that the combination of IBR and AZA may improve outcomes in HR-MDS. Methods: This is an ongoing multicenter prospective Phase 1 dose-escalation trial of IBR in combination with AZA in patients with HR-MDS (NCT02553941). Results of the dose escalation phase are reported. Eligibility included World Health Organization or French-American-British classification-defined MDS and Revised International Prognostic Scoring System (IPPS-R) intermediate or higher risk. Any prior therapy was allowed or patients could be untreated if unfit for, or had refused, high intensity chemotherapy. Transfusion-dependent patients were eligible. Patients received AZA 75 mg/m2 IV/SC daily for 7 days and IBR orally daily for 28 days. Cycles repeated every 28 days. Dose-escalation used a 3+3 design with IBR dose levels of 420 mg (Cohort 1) and 560 mg (Cohort 2). The primary objective was to determine the safety and tolerability of IBR in combination with AZA. Adverse events (AEs) were monitored throughout treatment, and dose-limiting toxicities (DLT) were assessed during cycle 1. The secondary objective was to assess preliminary efficacy using modified International Working Group Response Criteria. Exploratory objectives evaluated pharmacodynamic and biological effects of the combination, including BTK occupancy in CD34+ bone marrow mononuclear cells (BMMC). Results: As of June 1, 2017, 9 patients [89% male, median age 80 years (range 64-81)] were enrolled into Cohort 1 (n=3) and Cohort 2 (n=6). MDS subtypes included single lineage dysplasia (n=1), multilineage dysplasia (n=1), excess blasts (EB)-1 (n=2), EB-2 (n=3), refractory anemia with EB in transformation (n=1) and unclassifiable (n=1). IPSS-R scores were intermediate (n=2), high (n=2) and very high (n=5). Three patients were HMA-naive and six had prior HMA therapy [AZA (n=3), decitabine (n=2), both (n=1)]. All patients completed cycle 1. No DLTs were observed. All patients experienced at least one treatment-emergent adverse event (TEAE). Seven patients experienced a grade 3-4 TEAE with neutropenia (n=6), thrombocytopenia (n=3) and febrile neutropenia (n=3) most common. Four patients (three in Cohort 1 and one in Cohort 2) experienced a serious adverse event including febrile neutropenia (n=3) and gastric hemorrhage (n=1). No patients experienced atrial fibrillation. Median time on study was 160 days (range 42-283) with a median of five cycles (range 1-10) received. Six patients remain on IBR plus AZA, and three patients have discontinued study therapy (two disease progression and one withdrawal of consent and subsequent death on hospice). Four patients have reduced AZA to 5 days per cycle per investigator discretion, and four patients have had interruptions of IBR dosing due to febrile neutropenia (n=3) and concurrent azole use (n=1). Three patients (33%) achieved complete remission (CR), one (11%) had a partial remission (PR), and five (55%) had stable disease (SD). All three CRs occurred in patients without prior HMA exposure and included one complete and two partial cytogenetic responses. CR was achieved after 1, 4 and 6 cycles in these patients. One patient (11%) with SD had a hematologic improvement-erythroid response (HI-E). The overall hematologic normalization rate (CR+PR+HI) was 55%. BTK occupancy in CD34+ BMMC after cycle 1 was 42.0% and 51.7% in two patients at IBR 420 mg and 41.5% in one patient at IBR 560 mg. Conclusions: The combination of IBR and AZA demonstrates a tolerable safety profile in patients with HR-MDS. No DLTs were observed at either IBR dose level. The combination shows promising preliminary efficacy, including responses in patients with prior HMA exposure. CD34+ BMMC BTK occupancy was seen. An expansion cohort at the IBR 560 mg dose level in AZA-naive patients is ongoing. Disclosures Jonas: AbbVie, Celgene, Daiichi Sankyo, Pharmacyclics, Genentech/Roche, Glycomimetics, Esanex, Kalobios: Research Funding; Celgene: Membership on an entity9s Board of Directors or advisory committees; Rigel: Consultancy. Logan: Novartis: Consultancy, Research Funding; Incyte: Consultancy; Astellas: Research Funding; Shire: Consultancy; Kite: Research Funding; Amgen: Consultancy; Pharmacyclics: Research Funding; Jazz: Consultancy. Abedi: Takeda: Speakers Bureau; Seattle Genetics: Speakers Bureau; Gilead: Speakers Bureau; BMS: Speakers Bureau; Amgen: Research Funding; Celgene: Membership on an entity9s Board of Directors or advisory committees, Research Funding, Speakers Bureau; California Institute of Regenerative Medicine: Research Funding. Bejar: Celgene: Consultancy, Honoraria, Other: DSMB, Steering Committee, Research Funding; Genoptix: Consultancy, Honoraria, Patents & Royalties; AbbVie/Genetech: Honoraria, Other: Ad-hoc advisory board; Foundation Medicine: Honoraria, Other: Ad-hoc advisory board; Otsuka/Astex: Honoraria, Other: Ad-hoc advisory board; Modus Outcomes: Consultancy, Honoraria. Wieduwilt: Reata Pharmaceuticals: Equity Ownership; Sigma-Tau: Research Funding. Curtin: Amgen, Celgene, Onconova, Pharmacyclics: Research Funding.

Major impact of left auricular cardiopathy when associated to supraventricular ectopy?

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Left atrial cardiopathy (LAC) is an independent predictor of atrial fibrillation (FA) and embolic stroke. It is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The current definition doesn’t include supraventricular ectopy. AIM The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding the number of atrial premature complexes per hour (APC/h) to LAC criteria. METHODS Retrospective analysis of 123 ESUS patients (pts) admitted to Neurology service from 2014 to 2019. LAC was defined according to two criteria (LAC2: severe left atrial enlargement or p-wave terminal force in lead V1 [PTFV1] >5000 µV*ms) or 3 criteria (LAC3: additionally, >30 APC/h). Survival analysis for the occurrence of AF, stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves. RESULTS 43 (35%) of the ESUS pts had LAC2. Pts with LAC2 (35.0%) were older (p = 0.007), more frequently had hypertension (p = 0.004) and lower total cholesterol levels (p = 0.044) than patients without LAC2. The incidence of AF (median follow-up 21 months, IQR = 9-35) was higher both in LAC2 (p = 0.038) and LAC3 (p = 0.001). There were no differences in stroke recurrence or death between patients with or without LAC2 or 3. Among the 3 atrial dysfunction criteria included in LAC3 definition, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC = 0.822). Cox regression revealed that PTFV1 > 5000 µV·ms (HR = 5.12, IC95%=1.28-20.56, p = 0.021) and >30 APC/h (HR = 13.02, IC95%=3.57-47.56) were independent predictors of AF. In addition, the single predictor of the composite endpoint (occurrence of AF, stroke recurrence and death) was >30 APC/h (HR = 5.2, p < 0,001). CONCLUSION In ESUS pts, the subgroup with LAC2 had different clinical characteristics and a higher AF incidence. APC/h were also independently associated with AF incidence and had better diagnostic test performance than the other criteria. In sum, APC/h inclusion as a diagnostic criterion for LAC should be considered and may help in a better therapeutic approach.

After Ablation of AF, Early Recurrence Matters

Early recurrences of atrial fibrillation (AF) after ablation are relatively common and have been thought to be due to inflammation related to the

DOACs Are Effective for Stroke Prevention in Valvular AF

The early randomized controlled trials comparing direct-acting oral anticoagulants (DOACs) and warfarin for atrial fibrillation (AF) excluded patients

Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State

Novel oral anticoagulants (NOACs) have made the use of anticoagulation in patients with atrial fibrillation (AFib) much more convenient and predictable. It is a very common practice to hold anticoagulation either in anticipation of surgical procedures (to prevent excessive bleeding) or in case of acute bleeding episodes. This abrupt withdrawal of anticoagulation tilts the balance in favor of pro-thrombotic state in the body. We present a case of a 60-year-old man with past medical history of AFib who abruptly discontinued his apixaban (Eliquis). This patient presented to emergency room with the complaint of weakness and numbness of left arm and left half of the face. Stroke code was activated, and patient received tissue plasminogen activator (t-PA). This resulted in significant improvement of symptoms within hours of receiving treatment. Later during the same day, patient developed numbness and tingling of fingers of left hand. On physical exam, left hand was cold to touch and radial pulse was absent. Arterial duplex revealed occluded ulnar and radial arteries. Vascular surgery performed embolectomy to establish blood flow in the radial and ulnar arteries. Transthoracic echocardiogram revealed large left atrial mass attached to the atrial septum. Most likely t-PA infusion in the setting of atrial mass led to distal showering of emboli resulting in stenosis of radial and ulnar arteries. The left atrial mass was most likely thrombus as patient had cardiac imaging including transthoracic echocardiogram and computed tomography of heart prior to these events which did not reveal any mass in left atrium. In short, as clinicians we should be aware of the hypercoagulability associated with withdrawal of anticoagulation. In addition, we should be wary of the challenges associated with differentiating cardiac masses of different etiology. J Med Cases. 2021;12(6):243-247 doi: https://doi.org/10.14740/jmc3656

Fish Oil and Vitamin D Fail to Reduce Atrial Fibrillation

The search for dietary supplements to reduce the risk for atrial fibrillation (AF) has a long history. Observational data have often shown an

Seek and Ye Shall Find ... Atrial Fibrillation

Nearly all treatment trials of atrial fibrillation (AF) involve patients with AF that was clinically diagnosed, either because of symptoms or through

Ischemic Stroke

A patient with a history of chronic atrial fibrillation was diagnosed with sudden onset of right hemiparalysis in the hospital. The patient had been normal two hours prior and was referred to the cerebral vascular center. Images: Head CT images showed early ischemic changes in the left frontal lobe, insula, and temporal lobe(Alberta Stroke Program Early CT Score[ASPECTS]: 6 points). A hyperdense internal carotid artery(ICA)sign was found at the top of the left internal carotid artery. MRI DWI-ASPECTS was performed at 6 points. The MRA showed loss of the left internal carotid, anterior cerebral, and middle cerebral arteries. T2*WIs showed a susceptibility vessel sign(SVS)at the top of the left ICA and FLAIR vessel hyperintensity(FVH)in the left ICA to the middle cerebral artery. The patient was diagnosed with acute cerebral embolism with clinical-DWI mismatch and treated with endovascular therapy. Early CT signs are important in determining cerebral ischemic lesions, and hyperdense ICA/MCA signs are useful in identifying occluded vessels. Early ischemic changes can be seen more easily on MRI-DWI, and the location of the occluded vessel can be estimated by evaluating MRA, SVS, and FVH together.

Patients with Heart Failure Benefit from Ablation for Atrial Fibrillation

CABANA, one of the largest randomized controlled trials of ablation for atrial fibrillation (AF), did not demonstrate a benefit of ablation, compared

Position Document on the Use of Direct Oral Anticoagulants in Nonvalvular Atrial Fibrillation

ArgentineFederation of Cardiology have carried out a detailedanalysis of the recent Ninth Health TechnologyAssessment Report by the National Commission forHealth Technology Assessment (CONETEC) on theuse of direct oral anticoagulants in nonvalvular atrialfibrillation. (1)Atrial fibrillation (AF) represents 60% of the indicationsfor anticoagulation in Argentina and worldwide.The view of AF reality in our country shouldtake into account that AF is not systematically detected,anticoagulation is rarely performed, and when itis, the levels of time in therapeutic range (TTR) areinadequate, as we have verified in our records.We believe that this assessment has its limitations:it was carried out under economistic rather thanhealthcare criteria, which means that the conclusionsdrawn are not oriented towards the correct use of avaluable resource such as the new non-vitamin K-dependentdirect oral anticoagulants (DOACs) and theirpositive impact on AF patients, but rather to theirrestrictive use due to their high cost, without counterbalancingaspects as the correct training of physiciansin concepts such as the rational prescription ofDOACs.

Women Also Do Well with Ablation of Atrial Fibrillation

Many clinicians believe — primarily based on data from observational registries — that women have more complications with ablation of atrial

Choosing Anticoagulants for Patients with Atrial Fibrillation and Previous Gastrointestinal Bleeding

Most patients with atrial fibrillation (AF) require oral anticoagulants for long-term stroke prevention. The existence of a previous gastrointestinal