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Background Whether patients with atrial fibrillation (AF) and liver disease are also prone to cerebrovascular events and respond similarly favorably to antithrombotic therapy remains under-investigated. Methods Patients ≥ 18 years with newly-diagnosed AF in the period 2005 to 2009 were scrutinized from the “Longitudinal Health Insurance Database 2005” (1 million beneficiaries) of Taiwan's National Health Insurance Institute. Patients were categorized into the Liver ( N = 433) or the Non-liver ( N = 3490) cohort according to whether they had a diagnosis of advanced liver disease. Patients were then followed to determine cumulative incidence of hospitalization-requiring cerebrovascular events, preventive effects of antithrombotics, and predictors of cerebrovascular events by Cox regression analysis. Results Within a mean follow-up of 3.3 ± 1.4 years, ischemic stroke (89.2 vs. 50.3 per 1000 person-years, adjusted HR 1.502, 95% CI 1.207–1.868, p < 0.001) and overall cerebrovascular events (102.3 vs. 56.4 per 1000 person-years, adjusted HR 1.535, 95% CI 1.251–1.883, p < 0.001) occurred significantly more often in the Liver than in the Non-liver cohort. Cox models identified aging (≥ 65 years), DM, and CHA2DS-VASc score ≥ 2 points as risk factors for overall cerebrovascular events in the Liver cohort, whereas antiplatelet agents (HR 0.932, 95% CI 0.128–6.803, p = NS) and vit-K antagonistic anticoagulants (HR 1.087, 95% CI 0.150–7.862, p = NS) showed no correlation. Conclusion AF patients comorbid with advanced liver disease are more vulnerable to ischemic and therein overall cerebrovascular events, especially in those with old age, DM, or high CHA2DS-VASc scores. This propensity to cerebrovascular events, however, can't be altered by antithrombotic therapy. [ABSTRACT FROM AUTHOR]

Abstract: Background: We investigated atrial fibrillation (AF) prevalence, incidence and the risk of stroke and all-cause death because little is known about AF risk among ethnic Chinese. Methods: We conducted a community-based prospective cohort study among 3560 participants. Prevalent and incident AF was documented by using the 12-lead ECG in baseline and serial follow-ups, and the stroke and all-cause death events were ascertained. Results: Overall prevalence rates of AF in the cohort were 1.4% in men and 0.7% in women. Incidence rates of AF were 1.68 per 1000 person-years for men and 0.76 per 1000 person-years for women. During a median 13.8 years'' follow-up, we documented 208 cases of stroke and 776 deaths. As compared with those without AF, participants with AF had nearly 4 times the age, gender-adjusted risk of stroke (relative risk [RR], 3.87, 95% confidence interval [CI], 2.12–7.15), and twice the risk of death associated with all causes (RR, 2.23, 95% CI, 1.52–3.27). Further adjustment for body mass index, lifestyle factors, socioeconomic status and clinical diseases slightly attenuated these risks. In addition, after adjusting for echocardiographic measures, the following risks remained significant: the multivariate RRs were 2.90 (95% CI, 1.28–6.59) for risk of stroke and 2.05 (95% CI, 1.27–3.32) for risk of all-cause death among participants with AF. Conclusion: Our data demonstrate that AF is a significant risk factor for stroke and all-cause death for the Chinese. [Copyright &y& Elsevier]

Abstract: Background: Congestive heart failure in sinus rhythm ranks second after atrial fibrillation (AF) among cardiogenic risk-factors for stroke. Clinical and echocardiographic predictors of stroke in this high-risk population remain poorly defined. Methods: Retrospective screening of 1886 consecutive patients with severe systolic dysfunction (LVEF ≤35%) at a tertiary medical center echocardiography database (Nov 2005–Sep 2008) identified 83 patients in sinus rhythm with cardioembolic stroke. Patients with AF on follow-up, prosthetic valve, ventricular arrhythmia and lack of consensus between reviewing neurologists were excluded (n =10). Consecutive age and gender-matched controls in sinus rhythm formed GpII (n =73). Results: The incidence of stroke was 3.9% (73/1886) over 35 months in this study. There were no significant differences in prevalence of established clinical risk-factors for stroke. There was a significantly higher prevalence of LV non-compaction (p =0.02), aneurysm (p <0.01), spontaneous echo-contrast (p <0.01) and pulmonary hypertension (p <0.001) in GpI. Conclusions: LV non-compaction, aneurysm, spontaneous echo-contrast and pulmonary hypertension are associated with an increased risk of stroke. While anticoagulation of these high-risk subgroups appears reasonable, further study in a prospective randomized clinical trial merits consideration. [ABSTRACT FROM AUTHOR]

Abstract: Patients with atrial fibrillation are at an increased risk of having a cardioembolic stroke. Most of the thrombi responsible for these ischemic events originate in the left atrial appendage (LAA). Several surgical and percutaneous endovascular techniques have been explored to occlude the LAA. As an alternative of the surgical closure, percutaneous exclusion of the LAA is a new approach used to prevent strokes in high-risk patients with AF and contraindication to long-term oral anticoagulant therapy. Currently, two devices have been developed specifically for percutaneous occlusion of the LAA the PLAATO system and the WATCHMAN filter system. Although the Amplatzer septal occluder device was not originally intended to occlude the LAA it has been used with success in our centre for this purpose. We present an illustrative case of a patient with AF no longer suitable for chronic OCA referred for percutaneous exclusion of the LAA. She was treated successfully with an Amplatzer septal occluder. Although our experience with this device holds promise, future trials will be necessary to explore this strategy. [Copyright &y& Elsevier]