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Le cancer est associé à un état d'hypercoagulabilité et constitue un facteur de risque indépendant bien connu de maladie thromboembolique veineuse, alors que l'association entre le cancer et la maladie thromboembolique artérielle est moins bien établie. La maladie thromboembolique artérielle, principalement définie comme un infarctus du myocarde ou un accident vasculaire cérébral, est significativement plus fréquente chez les patients atteints de cancer, indépendamment des autres facteurs de risque maladie vasculaire. Elle est associée à un risque de mortalité trois fois plus élevé. Les patients atteints d'un cancer du cerveau, du poumon, du pancréas ou colorectal ont le risque relatif le plus élevé de développer une maladie thromboembolique artérielle. Les traitements antithrombotiques doivent être utilisés avec prudence en raison du risque accru d'hémorragie. Cancer is associated with a hypercoagulable state and is a well-known independent risk factor for venous thromboembolism, whereas the association between cancer and arterial thromboembolism is less well established. Arterial thromboembolism, primarily defined as myocardial infarction or stroke is significantly more frequent in patients with cancer, independently of vascular risk factors and associated with a three-fold increase in the risk of mortality. Patients with brain cancer, lung cancer, colorectal cancer and pancreatic cancer have the highest relative risk of developing arterial thromboembolism. Antithrombotic treatments should be used with caution due to the increased risk of haemorrhage, as specified in current practice guidelines. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Percutaneous left atrial appendage closure (LAAC) is a procedure designed to exclude the left atrial appendage from the circulation using a sealed prosthesis. Its primary goal is to prevent ischemic events commonly associated with atrial fibrillation (AF). LAAC is typically performed on patients at high risk of bleeding, who cannot tolerate long-term anticoagulation. Following the implantation of the LAAC device, an antithrombotic treatment is recommended to prevent prosthesis thrombosis, a complication associated with an increased risk of ischemic events and the potential need to resume anticoagulant therapy. However, determining the optimal antithrombotic treatment after LAAC, one that strikes the right balance between ischemic protection and bleeding risk, remains uncertain. Over the course of a decade, a wide array of antithrombotic treatments has been employed in clinical practice, yielding a substantial amount of observational data. The objective of this review is to evaluate the available evidence for each antithrombotic regimen and provide insights to assist healthcare practitioners in making informed choices regarding antithrombotic therapy after LAAC. Several ongoing randomized studies are expected to significantly contribute to addressing this critical question. [ABSTRACT FROM AUTHOR]

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]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This meta-analysis of cohort studies was performed to investigate the effect of cross-country skiing on atrial fibrillation risk. Databases of PubMed, EMBASE, Web of Science, and China National Knowledge Internet were searched from the inception dates to April 25, 2021. Two reviewers independently extracted data and assessed the quality of the studies. A meta-analysis using random-effects model was performed to estimate the overall relative risks (RR) of atrial fibrillation incidence and 95% confidence intervals (CIs) for the individuals with cross-country skiers and general population. After screening 116 titles/abstracts and 11 full-text studies identified in the search, 6 studies (from 11 cohorts) and a total of 1,901,833 participants were included in the meta-analysis. Compared to non-skiers, the overall relative risks (RR) of atrial fibrillation incidence had no significant difference (RR, 0.93; 95%CI: 0.80–1.07, P = 0.25) and had a high heterogeneity. Results of Meta-analysis indicated sex was a main source of heterogeneity. After excluding the 2 female cohorts (RR = 0.63, RR = 0.47, respectively) and 1 relative low quality cohort, the result of 8 cohorts shows there was an 8% increased risk of atrial fibrillation (pooled RR = 1.08; 95%CI: 1.02–1.14). Findings from this meta-analysis indicate that male cross-country skiers are associated with increased risk of atrial fibrillation, but a reduced risk in female skiers. [ABSTRACT FROM AUTHOR]

Résumé: La fibrillation auriculaire non rhumatismale représente l'étiologie la plus fréquente des infarctus cérébraux cardioemboliques. Elle est souvent asymptomatique ou peu symptomatique, ne gêne pas la vie quotidienne et est méconnue par la population générale, ce qui rend difficile sa découverte, souvent lors des stades de complications comme les infarctus cérébraux, alors qu'à ces stades, les conséquences sont graves et souvent handicapantes tout au long de la vie. Quant aux patients déjà victimes d'un AVC cardioembolique, le risque de récidive est important s'il est secondaire à une FA qui n'est pas dépistée. Dans la pratique quotidienne en unité de Neurologie du CHU Joseph Raseta Befelatanana, la recherche des FA au décours des infarctus cérébraux est systématique bien que toutes les investigations nécessaires pour le dépistage ne soient pas toujours toutes réalisées. Ainsi, la découverte et la connaissance sur les caractéristiques de ces FA à l'origine des infarctus cérébraux permettraient d'en améliorer la prévention secondaire. Non-rheumatic atrial fibrillation is the most frequent etiology of cardioembolic cerebral infarction. It is often asymptomatic or slightly symptomatic, does not interfere with daily life and is unknown to the general population, which makes it difficult to discover, often during the stages of complications such as cerebral infarction, whereas at these stages the consequences are severe and often disabling throughout life. As for patients who have already suffered a cardioembolic stroke, the risk of recurrence is high if it is secondary to AF that is not detected. In daily practice in the Neurology Unit of the CHU Joseph Raseta Befelatanana, the search for FA after cerebral infarction is systematic although all the investigations necessary for screening are not always all carried out. Thus, the discovery and knowledge of the characteristics of these AFs at the origin of cerebral infarctions would make it possible to improve their secondary prevention. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

L'accident vasculaire cérébral cryptogénique est une définition ancienne pour classer un événement neurologique ischémique sans cause bien identifiée. La forte probabilité d'un mécanisme thromboembolique pour expliquer certains infarctus cérébraux cryptogéniques, a conduit à une nouvelle définition : l'accident vasculaire cérébral embolique de source indéterminée. Ce sous-groupe des accidents vasculaires cérébraux cryptogéniques reste hétérogène en raison des nombreuses sources thromboemboliques potentielles et pouvant être associées. La fibrillation auriculaire occulte est sans doute moins souvent en cause que prévue initialement, au contraire de l'athérome extracrânien et intracrânien. Le cardiologue doit s'impliquer dans la démarche diagnostique en aidant le neurologue à identifier la cause la plus probable. Des recherches complémentaires sont nécessaires pour sélectionner les populations qui pourraient bénéficier d'un traitement préventif individualisé plus efficace. Cryptogenic stroke is an old definition that designates an ischemic stroke with no identifiable cause. The term of the embolic stroke of undetermined source was then introduced to identify non-lacunar strokes in whom thromboembolism was the likely mechanism. This subgroup of cryptogenic strokes remains heterogeneous with many potential and possibly associated embolic causes. Covert atrial fibrillation is probably less often involved than initially expected, in contrast to intracranial and extracranial atherosclerosis. The cardiologist should be involved in the search of underlying causes of ischemic stroke by helping the neurologist to identify the most likely diagnosis. Further research is necessary to select populations that may benefit from more effective and individualized treatment. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Le scanner coronaire est indiqué dans le bilan de douleurs thoraciques chez tous les patients avec une préférence pour ceux ayant un risque faible à intermédiaire de coronaropathie. Les études récentes ont complété cette indication en démontrant sa fiabilité dans le bilan de douleurs thoraciques chez les patients à haut risque de coronaropathie, notamment dans le syndrome coronaire aigu (SCA) sans élévation du segment ST. Il apparaît également intéressant et prometteur pour le dépistage cardiovasculaire en prévention primaire chez un patient porteur de facteurs de risque cardiovasculaire, permettant ainsi d'ajuster la stratégie préventive et notamment le traitement par statine, ainsi que pour le suivi du coronarien stenté ou ponté. Le score calcique a démontré être un marqueur prédictif du risque de mortalité, cardiovasculaire et totale, indépendant des autres facteurs de risque connus et son usage est recommandé dans la stratification du risque cardiovasculaire. Cependant, son interprétation reste délicate de même que le changement dans la prise en charge que le résultat implique pour le patient. Un score calcique supérieur à zéro marque la présence d'une athérosclérose coronaire et doit faire discuter un traitement hypolipémiant. Dans le cadre du bilan pré-TAVI, le scanner cardiaque est devenu le gold standard pour la mesure de l'anneau aortique et le choix de la prothèse à implanter, ainsi que pour toutes les mesures réglementaires avant la procédure. Enfin, le bilan pré-ablation de fibrillation auriculaire comprend désormais un scanner cardiaque permettant d'éliminer un thrombus de l'oreillette gauche ou de l'auricule gauche, de rechercher un retour veineux pulmonaire anormal et de fournir un support 3-D pour la navigation lors de la procédure rythmologique interventionnelle d'ablation. Cardiac CT-scan is recommended for sorting patients presenting with stable or acute chest pain with low to intermediate risk of coronary artery disease (CAD). Recent studies have shown its reliability for diagnosing CAD in high-risk patients, notably those with acute coronary syndrome (ACS) without ST-elevation. Coronary CT-scan also represents a great opportunity for the screening of atherosclerosis in patients at risk and allows a better prevention of coronary artery disease by introduction of preventive treatments in patients with abnormal coronary CT-scan, especially statins. It is useful for the follow-up of patients who underwent a coronary arteries revascularization with either stents or bypasses. Coronary arteries calcium scoring appears to be an independent predictive factor of cardiovascular and total mortality and its use is recommended for stratifying the cardiovascular risk. However, its interpretation remains unobvious and the patient management is poorly improved by the results. Anyway, if the score is above zero, atherosclerosis is present and therefore a lipid lowering treatment should be discussed. Cardiac CT-scan has become the Gold Standard exam before an aortic valve replacement, for the measurement of the aortic root notably, allowing the best prothesis selection. Before atrial fibrillation ablation procedure by pulmonary vein isolation, the cardiac CT-scan allows a 3-D visualization of the two atria, especially the left atrium, and rules out any suspicion of cardiac thrombus. It allows the research of an anomalous pulmonary venous connection. The 3-D support will also enable the operator to navigate in the heart during the ablation procedure. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

L'évaluation fonctionnelle des sténoses coronaires par FFR fractional flow reserve (FFR) est une technique d'application quotidienne dans les salles de cathétérisme ; elle est réputée fiable, reproductible et très sure avec un très faible taux d'effets indésirables ; nous rapportons l'observation d'un patient de 68 ans sans antécédents d'arythmie chez lequel une injection intracoronaire d'adénosine pendant une mesure de FFR pour évaluation d'une sténose intermédiaire de la coronaire droite a immédiatement induit un passage en fibrillation auriculaire nécessitant une hospitalisation de 24 h pour cardioversion pharmacologique. Fractional flow reserve (FFR) measurement for functional evaluation of haemodynamic relevance of coronary artery stenoses is a well established and straightforward method applied on daily basis in cardiac catheterization laboratory; it is known to be reliable, reproducible and secure associated with a low rate of adverse events. We report the case of a 68-year-old man with no history of arrhythmias in whom intracoronary injection of adenosine for FFR assessment immediately induced atrial fibrillation mandating hospitalization for pharmacological cardioversion. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Atrial fibrillation is associated with increased risk of morbidity and mortality. There's limited data on the outcomes of atrial fibrillation patients in Africa. We aimed at evaluating the clinical outcomes and their associated factors in patients with atrial fibrillation on antithrombotic therapy in Douala. The Douala atrial fibrillation registry is a prospective, observational cohort study of patients with atrial fibrillation followed by cardiovascular specialists in 3 specialized care centres. From January to April 2018, all patients with electrocardiographic diagnosis of atrial fibrillation, aged 21 years or older, were included in the registry provided their consent. The composite endpoint of heart failure, stroke, major bleeding, hospitalisation and mortality as well as their individual occurrence were assessed at 12 months. Of 113 participants that were included, 6(5.3%) were lost to follow-up. The mean age was 70 ± 12 years, with a female predominance (68%). After a mean follow-up time of 12.2 ± 0.7 months, 51 patients (47.7%) had at least one outcome. Hospitalisation, all-cause mortality, heart failure, stroke and major bleeding rates were 33.3%, 16.8%, 15.2%, 4.8% and 2.9% respectively. There was no significant difference in the composite outcome and mortality according to the antithrombotic treatment. Previous heart failure [aHR = 3.07, 95% CI (1.48–6.36) p = 0.003], new onset atrial fibrillation [aHR= 4.00, 95% CI (0.96–8.19) p < 0.001] and paroxystic atrial fibrillation [aHR= 3.74, 95% CI (1.33–10.53) p = 0.013] were significant predictors of outcome. Half of patients with atrial fibrillation in this registry developed an outcome after one year of follow-up, with heart failure, new onset and paroxystic atrial fibrillation being the main predicting factors. Diagnosing and managing atrial fibrillation in patients with heart disease should therefore be considered as a key priority. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation is associated with increased risk of morbidity and mortality. There's limited data on the outcomes of atrial fibrillation patients in Africa. We aimed at evaluating the clinical outcomes and their associated factors in patients with atrial fibrillation on antithrombotic therapy in Douala., Methods: The Douala atrial fibrillation registry is a prospective, observational cohort study of patients with atrial fibrillation followed by cardiovascular specialists in 3 specialized care centres. From January to April 2018, all patients with electrocardiographic diagnosis of atrial fibrillation, aged 21 years or older, were included in the registry provided their consent. The composite endpoint of heart failure, stroke, major bleeding, hospitalisation and mortality as well as their individual occurrence were assessed at 12 months., Results: Of 113 participants that were included, 6(5.3%) were lost to follow-up. The mean age was 70 ± 12 years, with a female predominance (68%). After a mean follow-up time of 12.2 ± 0.7 months, 51 patients (47.7%) had at least one outcome. Hospitalisation, all-cause mortality, heart failure, stroke and major bleeding rates were 33.3%, 16.8%, 15.2%, 4.8% and 2.9% respectively. There was no significant difference in the composite outcome and mortality according to the antithrombotic treatment. Previous heart failure [aHR = 3.07, 95% CI (1.48-6.36) p = 0.003], new onset atrial fibrillation [aHR= 4.00, 95% CI (0.96-8.19) p < 0.001] and paroxystic atrial fibrillation [aHR= 3.74, 95% CI (1.33-10.53) p = 0.013] were significant predictors of outcome., Conclusion: Half of patients with atrial fibrillation in this registry developed an outcome after one year of follow-up, with heart failure, new onset and paroxystic atrial fibrillation being the main predicting factors. Diagnosing and managing atrial fibrillation in patients with heart disease should therefore be considered as a key priority., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé La fermeture d'auricule gauche (FAG) est une alternative thérapeutique au traitement anticoagulant oral chez les patients avec fibrillation auriculaire non valvulaire. Cette intervention est en France réservée aux patients contre-indiqués aux AVK ou inhibiteurs directs de la thrombine. Elle permet de réduire le risque d'accidents ischémiques (par rapport à l'absence de traitement anticoagulant) et le risque d'évènements hémorragiques (par rapport à la poursuite du traitement anticoagulant) avec un risque limité de complications per-procédurales. Les patients âgés de plus de 75 ans présentent un risque ischémique mais aussi hémorragique plus important que les sujets plus jeunes, tout en étant régulièrement sous traités. Ces patients sont donc potentiellement ceux pouvant le plus bénéficier de la procédure. Les différentes études réalisées ont confirmé l'efficacité de la FAG dans cette population et sa sécurité à long terme, tout en soulignant le risque potentiel accru de complications péri-procédurales, notamment péricardique. Cependant, cette option reste tout à fait séduisante et pertinente pour la prise en charge de la fibrillation auriculaire dans cette population et devra s'intégrer dans une prise en charge globale pluridisciplinaire du patient. Abstract Left atrial appendage occlusion (LAAO) is an alternative option to oral anticoagulation therapy in patients with non-valvular atrial fibrillation. According to French regulations, this procedure is currently reserved for patients with formal contraindications to VKA and direct thrombin inhibitors. LAAO procedures reduce ischemic and stroke risks compared to no treatment and also reduce bleeding events compared to VKA therapy in eligible patients. The peri-procedural complications risk has been reported to be limited in the different series published so far. Although elderly patients (> 75 years) have either higher ischemic and bleeding risk than younger subjects, they hardly benefit from optimal anticoagulation. Thus, these subjects might greatly benefit from LAAO. Published studies reported excellent feasibility and efficiency of LAAO procedure in elderly patients. Yet there is a trend towards a higher incidence of peri-procedural complications (including tamponade), long-term safety is excellent and comparable to what is observed in patients < 75 years. Therefore, interventional percutaneous LAAO is an attractive strategy in elderly patients with atrial fibrillation that should be incorporated in a multidisciplinary management. [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]

Résumé Les tachycardies supra-ventriculaires et leur traitement ont été peu étudiées chez les patients critiques. But de l’étude Évaluer l’efficacité et l’innocuité de la cardioversion pour tachycardie supra-ventriculaire en réanimation. Patients et méthode Inclusion prospective de tous les patients qui ont présenté des tachyarythmies supra-ventriculaire incluant la fibrillation auriculaire, prolongée ≥ 30 secondes dans une réanimation médico-chirurgicales, à l’exception du postopératoire de chirurgie cardiaque. Les médicaments anti-arythmiques et/ou les chocs électriques ont été administrés de façon libérale. Résultats Au cours de la période d’étude de 15 mois, 108/846 (12,8 %) patients ont présenté des tachycardies supra-ventriculaires. Les médicaments anti-arythmiques ont été administrés chez 78 patients (72 %) ; pour la plupart de l’amiodarone (92 %), et/ou du magnésium (23 %), ce qui a entraîné un taux de conversion en rythme sinusal global de 68 %. Le choc électrique externe a été utilisé chez 26 patients (24 %), (médicaments anti-arythmiques reçus préalablement chez 24 patients) avec un taux succès immédiat de 80,8 %. Conclusion Le choc électrique externe a été associé à une conversion soutenue en rythme sinusal à 80,8 %, chez des patients de réanimation avec tachycardie supra-ventriculaire, alors que la plupart d’entre eux avait déjà reçu des médicaments anti-arythmiques. Supra-ventricular tachyarrhythmia and its treatment have been poorly investigated in ICU patients. Aims To evaluate efficacy and safety of cardioversion for supra-ventricular tachyarrhythmia in the intensive care unit (ICU). Patients and methods Prospective inclusion of all patients who presented supra-ventricular tachyarrhythmias lasting ≥ 30 seconds in a single medico-surgical ICU, except cardiac surgery. Anti-arrhythmic drugs and/or direct-current cardioversion were administered on a liberal basis. Results During the 15-month study period, 108/846 patients (12.8%) experienced supra-ventricular tachyarrhythmias. Anti-arrhythmic drugs were administered in 78 patients (72%); mostly amiodarone (92%), and/or magnesium (23%), resulting in an overall conversion rate of 68%. Direct-current cardioversion was used in 26 patients (24%), (24 patients received drug enhancement by anti-arrhythmic drugs) with an immediate 80.8%-success rate. Conclusion Direct-current cardioversion was associated with sustained conversion to sinus rhythm in 80.8% of ICU patients with supra-ventricular tachyarrhythmias, although most of them had already received drug enhancement. [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 fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of morbidity and mortality. Traditional antiarrhythmic agents used for restoration of sinus rhythm have limited efficacy in long-term AF and they may possess ventricular proarrhythmic adverse effects, especially in patients with structural heart disease. The acetylcholine receptor-activated potassium channel ( IK,ACh) represents an atrial selective target for future AF management. We investigated the effects of the IK,ACh blocker tertiapin-Q (TQ), a derivative of the honeybee toxin tertiapin, on chronic atrial tachypacing-induced AF in conscious dogs, without the influence of anesthetics that modulate a number of cardiac ion channels. Action potentials (APs) were recorded from right atrial trabeculae isolated from dogs with AF. TQ significantly and dose-dependently reduced AF incidence and AF episode duration, prolonged atrial effective refractory period, and prolonged AP duration. The reference drugs propafenone and dofetilide, both used in the clinical management of AF, exerted similar effects against AF in vivo. Dofetilide prolonged atrial AP duration, whereas propafenone increased atrial conduction time. TQ and propafenone did not affect the QT interval, whereas dofetilide prolonged the QT interval. Our results show that inhibition of IK,ACh may represent a novel, atrial-specific target for the management of AF in chronic AF. [ABSTRACT FROM AUTHOR]

Résumé Les stimulateurs et défibrillateurs cardiaques ont des capacités holter permettant d’enregistrer la survenue d’épisodes d’arythmie. La question lorsqu’un épisode d’arythmie est enregistré par le stimulateur cardiaque est de savoir à partir de quelle durée ou de charge en arythmie que le risque d’AVC est augmenté et donc de l’indication de traitement anticoagulant. Cet article traite de l’attitude à avoir en cas de détection d’épisode rythmique rapide aux mémoires holter des prothèses implantables. Pacemakers and defibrillators have holter capabilities that can record episodes of arrhythmias. Different studies evaluated the effect on the risk of strokes of different durations of arrhythmias. The question of the management of patients depending on the duration of the arrhythmia episode is addressed in this article depending on the duration of the episode and the arrhythmia burden. [ABSTRACT FROM AUTHOR]

Résumé La fibrillation auriculaire est l’arythmie cardiaque la plus fréquemment observée en pratique quotidienne. Elle est grevée d’une morbi-mortalité importante, en particulier de mort subite, d’insuffisance cardiaque et d’accident vasculaire cérébral. La validation de marqueurs non invasifs dans le diagnostic de l’insuffisance cardiaque à fraction d’éjection préservée et dans la stratification du risque apparaît intéressante dans ce contexte. L’indice E/e’ en Doppler tissulaire spectral a été validé dans l’estimation des pressions de remplissage du ventricule gauche indépendamment du rythme cardiaque. Une valeur de E/e’ septal > 11 est rapportée comme prédictive d’une pression diastolique ventriculaire gauche > 15 mmHg chez les patients en fibrillation auriculaire. De plus, plusieurs études ont rapporté la pertinence clinique de sa mesure au repos comme à l’effort dans le diagnostic et le pronostic de l’insuffisance cardiaque à fraction d’éjection préservée chez les patients en arythmie. Cet indice offre parallèlement une information pronostique essentielle chez les patients en fibrillation auriculaire. Enfin, une valeur pathologique de E/e’ est prédictive de récidive de la fibrillation auriculaire après cardioversion ou procédure d’ablation. En conclusion, nous recommandons la mesure de E/e’ chez tous les patients en fibrillation auriculaire bénéficiant de la réalisation d’une échocardiographie Doppler transthoracique. Atrial fibrillation is the most common cardiac rhythm disorder encountered in daily clinical practice. It carries high morbidity and mortality rates, mainly related to sudden death, heart failure and stroke. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is therefore attractive in this clinical setting. The spectral tissue Doppler-derived E/e’ ratio is a simple and user-friendly index which has been validated in the assessment of left ventricular diastolic pressures, regardless of rhythm. A septal E/e’ > 11 is associated with invasive left ventricular diastolic pressures > 15 mmHg in patients with atrial fibrillation. Several studies have reported the clinical relevance of abnormal values of E/e’ at rest and during exercise in the diagnosis and risk stratification of heart failure with preserved ejection fraction in patients with atrial fibrillation. There is now convincing evidence that increased E/e’ is associated with adverse outcome in patients with atrial fibrillation and predicts the recurrence of arrhythmia after cardioversion or catheter ablation. In conclusion, we recommend the measurement of E/e’ in each patient with atrial fibrillation referred for clinically indicated transthoracic Doppler echocardiography. [ABSTRACT FROM AUTHOR]

In the wake of demographic change in Western countries, atrial fibrillation has reached an epidemiological scale, yet current strategies for drug treatment of the arrhythmia lack sufficient efficacy and safety. In search of novel medications, atrial-selective drugs that specifically target atrial over other cardiac functions have been developed. Here, I will address drugs acting on potassium (K+) channels that are either predominantly expressed in atria or possess electrophysiological properties distinct in atria from ventricles. These channels include the ultra-rapidly activating, delayed outward-rectifying Kv1.5 channel conducting IKur, the acetylcholine-activated inward-rectifying Kir3.1/Kir3.4 channel conducting IK,ACh, the Ca2+-activated K+ channels of small conductance (SK) conducting ISK, and the two-pore domain K+ (K2P) channels (tandem of P domains, weak inward-rectifying K+ channels (TWIK-1), TWIK-related acid-sensitive K+ channels (TASK-1 and TASK-3)) that are responsible for voltage-independent background currents ITWIK-1, ITASK-1, and ITASK-3. Direct drug effects on these channels are described and their putative value in treatment of atrial fibrillation is discussed. Although many potential drug targets have emerged in the process of unravelling details of the pathophysiological mechanisms responsible for atrial fibrillation, we do not know whether novel antiarrhythmic drugs will be more successful when modulating many targets or a single specific one. The answer to this riddle can only be solved in a clinical context. [ABSTRACT FROM AUTHOR]

The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation ( P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group ( P < 0.05). In summary, atorvastatin could improve left atrial function and shorten the duration of atrial stunning after radiofrequency ablation of atrial fibrillation. [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]

Résumé La mortalité cardiovasculaire des patients hémodialysés reste un problème majeur. La prévalence et l’incidence de la fibrillation auriculaire dans cette population sont également plus importantes que dans la population générale. L’indication d’un traitement par antivitamine K (AVK) dans ce contexte de fibrillation auriculaire est à mettre en balance avec le risque hémorragique, déjà majoré dans cette population. Malheureusement, et contrairement à la population générale, l’indication de l’anticoagulation basée sur des scores de risque embolique ou hémorragique n’est pas aussi clairement établie dans la population de patients hémodialysés. Aucune étude prospective randomisée n’a analysé la balance bénéfice/risque d’un traitement anticoagulant chez le sujet hémodialysé. Cet article fait l’état des lieux actuel de la littérature, témoignant de la prévalence des événements thromboemboliques, mais également hémorragiques, dans la population de patients hémodialysés. L’impact du traitement par AVK dans cette population spécifique est également revu. À ce stade de nos connaissances, la prise en charge des patients reste à individualiser en fonction de leurs caractéristiques. Cardiovascular mortality of hemodialysis patients remains a major problem. The prevalence and incidence of atrial fibrillation in this population are more important than in the general population. The indication of antivitamin K therapy (AVK) in this context of atrial fibrillation must be weighted against the increased risk of bleeding. Unfortunately, and contrary to the general population, an indication of anticoagulation based on embolic or hemorrhagic risk scores is not as clearly established in the hemodialysis population. No prospective randomized study has investigated the benefit/risk balance of anticoagulant treatment in hemodialysis subjects. This article is a review of the current literature on this topic, showing the prevalence of thromboembolic but also bleeding events in the hemodialysis population. The impact of AVK treatment in this specific population is also reviewed. To the best of our knowledge, the indication of treatment must be individualized. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD. [ABSTRACT FROM AUTHOR]

Résumé Une femme âgée de 83 ans présente depuis trois ans une fibrillation auriculaire traitée par amiodarone et, depuis peu, par un anticoagulant oral direct afin de prévenir la formation de caillots. Elle est également prise en charge pour une hypothyroïdie et une hernie hiatale. Summary An 83-year-old woman is suffering from atrial fibrillation for three years. She has been taking amiodarone and, recently, a direct oral anticoagulant in order to prevent the formation of clots. She is also being treated for an underactive thyroid and a hiatal hernia. [ABSTRACT FROM AUTHOR]

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Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Stroke can be prevented with treatments targeted at hypertension, diabetes mellitus, hyperlipidemia and atrial fibrillation, but this is often hampered by under-diagnosis and under-treatment of those risk factors. The magnitude of this problem is not well-studied in sub-Saharan Africa. Materials and Methods: We conducted a cross-sectional survey of stroke patients at a tertiary hospital during January 2010 to July 2013 to determine patient awareness of a pre-existing stroke risk factor and prior use of antihypertensive, anti-diabetic, antiplatelet and lipid-lowering agents. We also investigated whether gender and school education influenced patient awareness and treatment of a stroke risk factor prior to stroke. Results: Three hundred and sixty nine stroke patients presented during the study period, of which 344 eligible subjects were studied. Mean age at presentation (±SD) was 55.8 ± 13.7 years, and was not different for men and women. Hypertension, hyperlipidemia, diabetes and atrial fibrillation were prevalent among 83.7%, 26.5%, 25.6% and 9.6% patients respectively. Awareness was high for pre-existing diabetes (81.8%) and hypertension (76.7%), but not for hyperlipidemia (26.4%) and atrial fibrillation (15.2%). Men were better educated than women (p = 0.002), and had better awareness for hyperlipidemia (37.3% versus 13.5%; p = 0.009). Men were also more likely to take drug treatments for a stroke risk factor, but the differences were significant. Conclusions: A high rate of under-diagnosis and under-treatment of hypertension, hyperlipidemia and atrial fibrillation contributes to the stroke burden in sub-Saharan Africa, especially among women. Public health measures including mass media campaigns could help reduce the burden of stroke. [ABSTRACT FROM AUTHOR]