Journal of atrial fibrillation最新文献

{"title":"Impact of Variableorientation and Flow Rates on Radiofrequency Ablation Lesions Created by Externally Irrigated Catheters: An Ex-Vivo Study.","authors":"Nishaki Mehta,&nbsp;Katerina Morgaenko,&nbsp;William Sauer,&nbsp;William Stevenson,&nbsp;David Haines","doi":"10.4022/jafib.2353","DOIUrl":"https://doi.org/10.4022/jafib.2353","url":null,"abstract":"<p><p>The impact of variability in irrigation rates and catheter orientation on radiofrequency ablation (RF) lesion creation has not been studied systematically for the uniformly irrigated 56-pore (56P) catheter. This study aimed to analyze the impact of irrigation flow rates (IFRs) and catheter orientation (CO) settings on RF lesions sizes produced by a 56P irrigation catheter in a power-controlled mode using an ex-vivo model. RF lesions were created in strips of chicken muscle in a saline bath heated to 37°C with 56P and 6P catheters using low flow rate (LFR) at 2 cc/min and standard flow (SFR) irrigation rates at 8 cc/min for 56P and 17 cc/min for 6P with horizontal (HO) and vertical (VO) catheter orientations. Ablation power of 20W was delivered for 30 seconds with a mean contact force of 10 g. Sixty RF lesions were analyzed. For the 56P catheter, in contrast to the 6P catheter lesion geometry was independent of CO and IFR in our model. Although 6P catheter had slightly deeper lesions, the overall lesion volumes were similar for 6P and 56P catheters. CO and IFR appeared to have minimal impact on lesion volume creation with 56P catheter. In head-to-head comparison the 6P and 56P irrigated catheters performed similarly.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2353"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691337/pdf/jafib-13-02353.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39759794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Brain Natriuretic Peptide Level Predicts The Prevalence Of Low-Voltage Areas And Poor Rhythm Outcome In Patients Undergoing Atrial Fibrillation Ablation.","authors":"Yasuhiro Matsuda,&nbsp;Masaharu Masuda,&nbsp;Mitsutoshi Asai,&nbsp;Osamu Iida,&nbsp;Shin Okamoto,&nbsp;Takayuki Ishihara,&nbsp;Kiyonori Nanto,&nbsp;Takashi Kanda,&nbsp;Takuya Tsujimura,&nbsp;Shota Okuno,&nbsp;Yosuke Hata,&nbsp;Hiroyuki Uematsu,&nbsp;Toshiaki Mano","doi":"10.4022/jafib.2279","DOIUrl":"https://doi.org/10.4022/jafib.2279","url":null,"abstract":"<p><strong>Backgrounds: </strong>The prevalence of residual left atrial low-voltage areas (LVAs) is associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation. Brain natriuretic peptide (BNP) may be increased in AF patients and may raise AF recurrence risk after catheter ablation. We investigated the association between BNP and the prevalence of LVAs.</p><p><strong>Methods: </strong>One hundred and eighty three consecutive AF cases were retrospectively enrolled that underwent initial ablation for AF (persistent AF, 82 [45%] patients). Serum BNP was measured before ablation and the natural logarithm of BNP (log-BNP) was calculated. Low-voltage points were defined as sites with left atrial electrogram amplitude <0.5 mV. LVAs were defined as regions with ≥5% low-voltage points across the total surface area of the left atrium.</p><p><strong>Results: </strong>Of the 183 patients, 38 (21%) had LVAs. Patients with LVAs demonstrated higher log-BNP (4.8±0.9 vs. 3.9±1.2, P<0.001). The optimal cut-off value of log-BNP was 4.4, which was equivalent to 81 pg/mL of BNP. LVAs were more frequent in patients with higher log-BNP. In multivariate analysis, log-BNP >4.4 was an independent predictor of LVAs (odds ratio 2.7 [95% confidence interval 1.01-7.1], P=0.048). Freedom from AF recurrence was significantly lower in patients with than without high log-BNP (P=0.007).</p><p><strong>Conclusions: </strong>BNP correlated with the prevalence of left atrial LVAs and AF recurrence in patients with AF undergoing catheter ablation.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2279"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691330/pdf/jafib-13-02279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39759787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Wall Isolation for Atrial Fibrillation: Effects on Echocardiographic Parameters of cardiac function.","authors":"Xin Zhang,&nbsp;Neil Beri,&nbsp;Pankaj Malhotra,&nbsp;Rakhee Makhija,&nbsp;Eric Nordsieck,&nbsp;Adam Oesterle,&nbsp;Dali Fan,&nbsp;Nayereh Pezeshkian,&nbsp;Uma Srivatsa","doi":"10.4022/jafib.2315","DOIUrl":"https://doi.org/10.4022/jafib.2315","url":null,"abstract":"<p><strong>Background: </strong>Posterior wall isolation (PWI) in addition to circumferential pulmonary vein isolation (CPVA) requires more ablation of left atrial tissue. We compared the effect of PWI versus non-PWI methods (CPVA + linear lesions) on echocardiographic parameters of left atrial and left ventricular function.</p><p><strong>Methods: </strong>We selected patients who had pre and post ablation echocardiogram at our institution. Parameters assessed were: Left ventricular outflow tract velocity time integral (VTI), left ventricular ejection fraction (LVEF), atrial Doppler velocity across mitral valve (A), E/E', and deceleration time.</p><p><strong>Results: </strong>Of the 72 patients studied, 32.5% had PWA in addition to CPVA. The mean duration between echocardiograms was 650 + 542 days. PWA group had an average postoperative VTI 0.21 + 0.05 vs 0.21 + 0.05 in the non-PWA (p=0.61) group. Average improvement compared to pre ablation parameters: VTI was 0.03 + 0.06 vs 0.008 + 0.05 (p=0.17), postoperative A was 0.49 + 0.19 vs 0.57 + 0.19 (p=0.16), postoperative LVEF was 57.5 + 9.9% vs 57.8 + 10.8 % (p=0.89), with average change in LVEF 1.5 ± 7.8 vs 0.86 ± 9.7 (p=0.78) in PWA and non-PWA groups respectively. There was no significant difference in change in deceleration time or E/E' when comparing the two groups.</p><p><strong>Conclusions: </strong>PWA did not adversely affect echocardiographic parameters of left atrial function or left ventricular systolic or diastolic function when compared to other types of ablation.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2315"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691332/pdf/jafib-13-02315.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39759790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors of Incomplete Surgical Closure of the Left Atrial Appendage on Follow-up Transesophageal Echocardiogram.","authors":"Billy Lin,&nbsp;Brian D Jaros,&nbsp;Eugene A Grossi,&nbsp;Muhamed Saric,&nbsp;Michael S Garshick,&nbsp;Robert Donnino","doi":"10.4022/jafib.2357","DOIUrl":"https://doi.org/10.4022/jafib.2357","url":null,"abstract":"<p><strong>Objectives: </strong>In patients with atrial fibrillation, incomplete left atrial appendage (LAA) closure is associated with an increased risk for cardio-embolic events compared to complete closure. In this study, we aimed to determine the prevalence and risk factors for incomplete surgical closure of the LAA in the modern surgical era.</p><p><strong>Methods: </strong>Records of 74 patients with surgical LAA closure who underwent follow-up transesophageal echocardiogram for any reason between 2010 and 2016, were assessed for incomplete closure. Complete closure was defined by absence of Doppler or color flow between the left atrial appendage and the left atrial body in more than 2 orthogonal views.</p><p><strong>Results: </strong>Surgical LAA closure was incomplete in 21 patients (28%) and complete in 53 patients (72%). All included cases were completed via oversewing method with a double layer of running suture with or without excision of the LAA. While no individual demographic, echocardiographic, or surgical feature was significantly different between groups, incomplete closure of the LAA was more prevalent in patients with two or more of the risk factors; female sex, hypertension, and hyperlipidemia (OR 5.1, 95%Cl 1.5-17).</p><p><strong>Conclusions: </strong>A significant rate of incomplete surgical LAA closure still exists in the modern surgical era, and the presence of multiple risk factors associate an increased risk of incomplete closure.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2357"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691336/pdf/jafib-13-02357.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39847484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Transesophageal Echocardiography in Atrial Fibrillation Before Electrical Cardioversion to Detect Left Atrial Thrombosis and Echocontrast.","authors":"Sebastian Feickert,&nbsp;Giuseppe D Ancona,&nbsp;Hüseyin Ince,&nbsp;Kristof Graf,&nbsp;Elias Kugel,&nbsp;Monica Murero,&nbsp;Erdal Safak","doi":"10.4022/jafib.2364","DOIUrl":"https://doi.org/10.4022/jafib.2364","url":null,"abstract":"<p><strong>Background: </strong>Transesophageal echocardiography (TEE) before electrical cardioversion (ECV) in atrial fibrillation (AF) is not routinely performed in anticoagulated patients.</p><p><strong>Methods: </strong>Starting from TEE findings of anticoagulated and non-anticoagulated patients referred for ECV, we investigated the rate of spontaneous echo-contrast (SEC) and left atrial thrombus (LAT) and identified their independent predictors.</p><p><strong>Results: </strong>A total of 403 patients were included: 262 (65%) had no anticoagulation, 47 (11.7%) were onnovel oral anticoagulant (rivaroxaban), 74 (18.4%) on warfarin INR>2, and 20 (5.0%) on warfarin INR<2.In 41 (10.1%) there was LAT and in 154 (38.2%) SEC. Patients with LAT had a significantly lower left ventricular ejection fraction (LVEF%) (p=0.001). Patients with SEC were significantly older (p=0.04), had lower LVEF% (p<0.0001),higher CHADSVASC score (p<0.0001), and higher rate of coronary artery disease (CAD) (p=0.03). In 56.8% of warfarin patients (INR>2) there was SEC (p=0.002). At multivariate analysis therapeutic anticoagulation with warfarin (p=0.003; OR:2.2; CI: 1.3-3.7),CHADSVASC score (p<0.0001; OR=1.2; CI: 1.1-1.4), and LVEF% (p<0.0001; OR:0.95; CI: 0.93-0.97; inverse relationship) were SEC predictors. A 3.5 CHADSVASC score cut-off was predictor of SEC (AUC: 0.7; p<0.0001). LVEF% was the only predictor of LAT (p=0.02; OR=0.96; CI: 0.93-0.99; inverse relationship).</p><p><strong>Conclusions: </strong>Echocardiography before ECV identifies clear LAT/SEC in more than a third of AF patients, independently by their anticoagulation regimen. LAT/SEC rates increasewith decrement of LVEF%. Increment of CHADSVASC score increases SEC risk. In anticoagulated patients SEC rate remains higher than expected. Therapeutic anticoagulation with Warfarin appears positively and independently correlated to SEC occurrence.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2364"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691341/pdf/jafib-13-02364.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39847485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Heart Rate Deficit' from Dysautonomia in a Bariatric Surgery Patient - An Unusual Cause of Recurrent Syncope.","authors":"Rakesh Gopinathannair,&nbsp;Iftekhar Ahmed,&nbsp;Krishna Akella,&nbsp;Luis Couchonnal,&nbsp;Ghulam Murtaza,&nbsp;Dhanunjaya Lakkireddy,&nbsp;Brian Olshansky","doi":"10.4022/jafib.2390","DOIUrl":"https://doi.org/10.4022/jafib.2390","url":null,"abstract":"","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 3","pages":"2390"},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691338/pdf/jafib-13-02390.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39847926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Conundrums in Cardiac Sarcoidosis: A Series on Skin Disease in Immunosuppression.","authors":"Daisy Young,&nbsp;Sri Harsha Kanuri,&nbsp;Krishna Akella,&nbsp;Ghulam Murtaza,&nbsp;Rakesh Gopinathannair,&nbsp;Dhanunjaya Lakkireddy","doi":"10.4022/jafib.2247","DOIUrl":"https://doi.org/10.4022/jafib.2247","url":null,"abstract":"<p><p>Sarcoidosis is a complex systemic condition resulting in formation of non-caseating granulomas. Infiltrative disease in cardiac sarcoidosis can have significant ramifications on mortality and is one of the few indications for systemic immunosuppressive therapy. In the patient on immunosuppressive medication, resultant sequelae such as skin and soft tissue infections are common and must be differentiated from cutaneous forms of sarcoidosis and other skin pathologies. Patients with humoral or cellular immunodeficiencies may have cutaneous lesions secondary to endemic fungi, mycobacterium, viral diseases, parasites, or encapsulated organisms. We report a rare case of cardiac sarcoidosis on immunosuppressive therapy, with a series of cutaneous sequelae due to opportunistic infection.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 2","pages":"2247"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691317/pdf/jafib-13-02247.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39871658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of A Simple Clinical Risk Prediction Model for New-Onset Postoperative Atrial Fibrillation After Cardiac Surgery: Nopaf Score.","authors":"Lucrecia María Burgos,&nbsp;Andreina Gil Ramírez,&nbsp;Victoria Galizia Brito,&nbsp;Leonardo Seoane,&nbsp;Juan Francisco Furmento,&nbsp;Juan Espinoza,&nbsp;Mirta Diez,&nbsp;Mariano Benzadon,&nbsp;Daniel Navia","doi":"10.4022/jafib.2249","DOIUrl":"https://doi.org/10.4022/jafib.2249","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative atrial fibrillation (POAFib) occurs in 20 to 40% of patients following cardiac surgery, and is associated with an increased perioperative morbidity and mortality. We aimed to develop and validate a simple clinical risk model for the prediction of POAFib after cardiac surgery.</p><p><strong>Methods: </strong>An analytical single center retrospective cohort study was conducted, including consecutive patients undergoing cardiac surgery between 2004 and 2017 with POAFib. To create the predictive risk score, a logistic regression model was performed using a random sample of 75% of the population. Coefficients of the model were then converted to a numerical risk score, and three groups were defined: low risk (≤1 point), intermediate risk (2-5 points) and high risk (≥6 points). The score was validated using the remaining 25% of the patients. Discrimination was evaluated through the area under the curve (AUC) ROC, and calibration using the Hosmer-Lemeshow (HL) test, calibration plots, and ratio of expected and observed events (E/O).</p><p><strong>Results: </strong>Six thousand five hundred nine patients underwent cardiac surgery: 52% coronary artery bypass grafting (CABG), 20% valve surgery, 14% combined (CABG and valve surgery) and 12% other. New-onset AF occurred in 1222 patients (18.77%). In the multivariate analysis, age, use of cardiopulmonary bypass pump, severe reduction in left ventricular ejection fraction (LVEF), chronic renal disease and heart failure were independent risk factors for POAFib, while the use of statins was a protective factor. The NOPAF score was calculated by adding points for each independent risk predictor. In the derivation cohort, the AUC was 0.71 (CI95% 0.69-0.72), and in the validation cohort the model also showed good discrimination (AUC 0.67 IC 0.64-0.70) and excellent calibration (HL P = 0.24). The E/O ratio was 1 (CI 95%: 0.89-1.12). According to the risk category, POAFib occurred in 5% of low; 11% of intermediate and 27.7% of high risk patients in the derivation cohort (P <0.001), and 5.7%; 12.6%; and 23.6% in the validation cohort respectively (P <0.001).</p><p><strong>Conclusion: </strong>From a large hospitalized population, we developed and validated a simple risk score named NOPAF, based on clinical variables that accurately stratifies the risk of POAFib. This score may help to identify high-risk patients prior to cardiac surgery, in order to strengthen postoperative atrial fibrillation prophylaxis.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 2","pages":"2249"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691308/pdf/jafib-13-02249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39871659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paroxysmal Atrial Fibrillation: An Independent Risk Factor for Prothrombotic Conditions.","authors":"Mariya Negreva,&nbsp;Krasimira Prodanova,&nbsp;Ana Zarkova","doi":"10.4022/jafib.2297","DOIUrl":"https://doi.org/10.4022/jafib.2297","url":null,"abstract":"<p><strong>Objective: </strong>It remains unclear whether atrial fibrillation (AF) alone determines systemic changes in hemocoagulation. Our aim was to examine the prothrombin fragment F1+2 and fibrinopeptide A (FPA) as early markers of coagulation activity still in the first twenty-four hours of paroxysmal AF (PAF) and to correlate them with the arrhythmia onset.</p><p><strong>Methods: </strong>51 non-anticoagulated patients (26 men, 25 women, aged 59.84±1.6 years) and 52 controls (26 men, 26 women, aged 59.50±1.46 years) were sequentially selected. F1+2 and FPA plasma levels were measured by enzyme-linked immunoassays.</p><p><strong>Results: </strong>F1+2 was significantly higher in patients (292.61pmol/L±14.03pmol/L vs 183.40pmol/L±8.38pmol/L; p<0.001). FPA was also substantially higher (4.47ng/mL±0.25 ng/mL vs 3.09ng/mL±0.15ng/mL, p<0.001). Among the potential predictors for these deviations: age, gender, BMI, PAF duration and CHA₂DS₂-VASc score, it was established that higher F1+2 and FPA plasma levels were independently associated only with PAF duration (p<0.05). Moreover, longer episodes were associated with higher values of F1+2 (Adjusted R2 = 0.68) and FPA (Adjusted R2 = 0.70).</p><p><strong>Conclusions: </strong>Increased coagulation activity was present still in the first twenty-four hours of PAF clinical presentation. The disease itself was associated with increasing hypercoagulability over time, suggesting its importance as an independent risk factor for thromboembolic events.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 2","pages":"2297"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691306/pdf/jafib-13-02297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39871662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Characteristics and Clinical Outcomes of Direct Oral Anticoagulantsin Patients with Atrial Fibrillation and Chronic Kidney Disease: From the Database of A Single-Center Registry.","authors":"Takao Sato,&nbsp;Yoshifusa Aizawa,&nbsp;Hitoshi Kitazawa,&nbsp;Masaaki Okabe","doi":"10.4022/jafib.2308","DOIUrl":"https://doi.org/10.4022/jafib.2308","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the characteristics and clinical outcomes (major bleeding [MB] and thromboembolic events [TEEs]) of atrial fibrillation (AF) patients with chronic kidney disease (CKD)who receiveddirect oral anticoagulant (DOAC) therapy.</p><p><strong>Methods: </strong>Data prospectivelycollected from a single-center registry containing 2,272 patients with DOAC prescription for AF (apixaban [n=1,014], edoxaban [n=267], rivaroxaban [n=498], and dabigatran[n=493]) were retrospectively analyzed. Patients were monitored for two years and classified into the CKD (n=1460) andnon-CKD groups(n=812). MB and TEEs were evaluated.</p><p><strong>Results: </strong>The mean age was 72±10 years, with the CHADS2,CHA2DS2-VASc, and HAS-BLED scores being 1.95±1.32, 3.21±1.67, and 1.89±0.96,respectively.Incidence rates of MB and TEEs were 2.3%/year and 2.1%/year, respectively. The CKD groupwasolderand had lower body weight and higher CHADS2,CHA2DS2-VASc, and HAS-BLED scoresthanthe non-CKD group.Kaplan-Meier curve analysis revealed that the incidence of MB and TEEs was higher in the CKD group. Multiple logistic regression analysis in the CKD group revealed thatage andstroke history were independent determinants of TEEs, and low body weighttended to be a determinant of MB.The inappropriate low dose use was higher for apixaban than other DOACs in the CKD group. Consequently, for apixaban, the incidence of stroke was significantly higherin the CKD group than in the non-CKD group.</p><p><strong>Conclusions: </strong>Patients with CKDwere characterized by factors that predisposed them to MB and TEEs, such as older age and low body weight. In a single-center registry, only treatment with apixaban in the CKD group led to a higher incidence of TEEs.</p>","PeriodicalId":15072,"journal":{"name":"Journal of atrial fibrillation","volume":"13 2","pages":"2308"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8691312/pdf/jafib-13-02308.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39759361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}