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Approximately 25% of all ischemic insults are caused by cardiac emboli in atrial fibrillation. Therefore, in patients with atrial fibrillation, oral anticoagulation is initiated or transesophageal echocardiography is performed before electroconversion to exclude blood clots in the heart. This shows that virtually all cardiac thrombi (>90%) are localized in the atrial ear. Therefore, for many decades surgeons have been removing the atrial tube during open heart surgery to eliminate it as a source of emboli. As a minimally invasive alternative, various screens for percutaneous closure of the atrial ear have been developed in the past 10–20 years. The requirements, techniques, and results will be discussed in the following article. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common arrhythmia and its prevalence is rising. Therapeutic options include drug treatment and interventional catheter ablation via pulmonary vein isolation (PVI).This procedure was associated with long fluoroscopy times which carried risks for patients and physicians. Electroanatomical mapping (EAM) is a tool to visualize anatomy, voltage and activation of the heart chambers. Current EAM systems used in clinical practice include CARTO®, EnSite NavX® and Rhythmia®. Magnetic fields and impendance approaches are used to create 3D shells of the chambers. The catheter can be used to either collect electrograms or to ablate the target tissue. When using EAM, fluoroscopy time is significantly decreased, and complications can be monitored. Images from CT, MRI or intracardiac echo can be used as a template for creating a map or merged with an existing map to enhance anatomic accuracy. [ABSTRACT FROM AUTHOR]

Increasing life expectancy in Western countries is associated with a high prevalence of multiple chronic diseases which is defined by the term "multimorbidity". Many of these patients suffer from chronic kidney disease (CKD) and thrombogenic comorbidities such as atrial fibrillation with the need for oral anticoagulation. For decades vitamin K antagonists have been exclusively prescribed for oral anticoagulation. However, due to altered pharmacokinetics and bioavailability of these drugs in CKD, a significant risk of bleeding exists. The introduction of direct oral anticoagulants as a new and promising alternative to vitamin K antagonists was -especially for CKD patients - highly anticipated. However, data from randomized studies are missing for older patients with advanced CKD. Consequently, a careful evaluation of the risk-benefit ratio is recommended for this sensitive patient population. [ABSTRACT FROM AUTHOR]

Atrial fibrilla tio n (AF) is the most common supraventriculararrhyth mia world wide and typically occurs in patients suffering from cardiovascular risk factors or acardiomyopathy. Patients with an AF can be asymptom atic, but m ay also suffer from severe heart failure symptom s. The gold standard fo r th e diagnosis of AF is a sim p le 12-lead ECG; nonetheless, fo r each p a tie n t with docum ented AF a cardiac exam ination incluing echocardiography is indicated. Regarding treatment, the first is sue which has to be discussed is prevention o f t rom boembolic events includ n g stroke using oral an tico a g u la tio n in pa tie n ts a t increased risk (in dependently o f type o f AF). in add ition to th e a n tia rrh y th m ic tre a tm ent of AF, control a n d /o r tre a tm e n t of cardiovascular risk factors is e sse n tia l in th e m anagem ent of AF pa tie n ts. These days, in te rve n tio n a l a b la tion of AF (pulm onary vein isolation) has becomeanestablishe d and effective option for heart rhythm control. [ABSTRACT FROM AUTHOR]

Left Atrial Appendage Closure- An Alternative to Continuous Anticoagulation for Atrial Fibrillation? Abstract. Approximately 25% of all ischemic insults are caused by cardiac emboli in atrial fibrillation. Therefore, in patients with atrial fibrillation, oral anticoagulation is initiated or transesophageal echocardiography is performed before electroconversion to exclude blood clots in the heart. This shows that virtually all cardiac thrombi (>90%) are localized in the atrial ear. Therefore, for many decades surgeons have been removing the atrial tube during open heart surgery to eliminate it as a source of emboli. As a minimally invasive alternative, various screens for percutaneous closure of the atrial ear have been developed in the past 10-20 years. The requirements, techniques, and results will be discussed in the following article.

Stroke prophylaxis in patients with non-valvular atrial fibrillation is becoming an increasingly dynamic field. The new guidelines from the European Society of Cardiology (ESC) recommend a stroke- and bleeding risk-assessment in patients with non-valvular atrial fibrillation using the CHA2DS2VASc and the HAS-BLED scores, respectively. Furthermore, new drugs for stroke prophylaxis such as dabigatran, rivaroxaban and apixaban are undergoing approval in Europe and will undoubtedly challenge the well-established vitamin K antagonists. Hence, stroke prophylaxis is likely to become a much more individualized treatment in the future. This review should help to critically weigh the pros and the cons of the new therapeutic options. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common heart rhythm disorder, with increasing prevalence in the aging population. The clinical presentation and evolution of AF can be highly variable. Therefore, treatment of AF can be challenging in some patients. This review summarizes recent developments in both prevention of thromboembolic events and rate/rhythm control highlighting the possibilities of behavioral, pharmacological, and catheter-based perspectives. [ABSTRACT FROM AUTHOR]

Use of oral anticoagulants is common in elderly persons. Oral anticoagulation can be used safely in the elderly if careful titration of the loading dose, careful changes in maintenance doses as well as consideration of drug interactions are taken into account. Frequent monitoring of the INR is essential, especially with changes in medical status and in co-medication. Correction of elevated INRs can be done following the recommendations. If vitamin K is used in stable patients, only small doses are required. In patients with atrial fibrillation, ischemic stroke risk and bleeding risk are predicted by overlapping factors. So patients who profit most from stroke risk reduction also show high bleeding risk. Risk stratification for ischemic stroke can be done easily with CHADS2-Score. Fall risk tends to be overestimated as a contraindication, whereas cognitive decline in combination with an unstable social network argues against anticoagulation. In the end, the decision to start or withhold anticoagulation has to be taken individually. [ABSTRACT FROM AUTHOR]

Usefulness of Electroanatomical Mapping in Rhythmology Abstract. Atrial fibrillation is the most common arrhythmia and its prevalence is rising. Therapeutic options include drug treatment and interventional catheter ablation via pulmonary vein isolation (PVI). This procedure was associated with long fluoroscopy times which carried risks for patients and physicians. Electroanatomical mapping (EAM) is a tool to visualize anatomy, voltage and activation of the heart chambers. Current EAM systems used in clinical practice include CARTO®, EnSite NavX® and Rhythmia®. Magnetic fields and impendance approaches are used to create 3D shells of the chambers. The catheter can be used to either collect electrograms or to ablate the target tissue. When using EAM, fluoroscopy time is significantly decreased, and complications can be monitored. Images from CT, MRI or intracardiac echo can be used as a template for creating a map or merged with an existing map to enhance anatomic accuracy.

The Multimorbid Patient: Use of New Oral Anticoagulants in Patients with Chronic Kidney Disease Abstract. Increasing life expectancy in Western countries is associated with a high prevalence of multiple chronic diseases which is defined by the term "multimorbidity". Many of these patients suffer from chronic kidney disease (CKD) and thrombogenic comorbidities such as atrial fibrillation with the need for oral anticoagulation. For decades vitamin K antagonists have been exclusively prescribed for oral anticoagulation. However, due to altered pharmacokinetics and bioavailability of these drugs in CKD, a significant risk of bleeding exists. The introduction of direct oral anticoagulants as a new and promising alternative to vitamin K antagonists was -especially for CKD patients - highly anticipated. However, data from randomized studies are missing for older patients with advanced CKD. Consequently, a careful evaluation of the risk-benefit ratio is recommended for this sensitive patient population.