Early rhythm control therapy in patients recently diagnosed with atrial fibrillation reduces the risk of cardiovascular events compared against the usual treatment of frequency control. These data come from the EAST-AFNET 4 trial recently presented at ESC 2020, simultaneously published in NEJM. These data suggest that we should offer patients early rhythm control therapy to...
Alcohol and Atrial Fibrillation: More Reasons for Moderate Consumption
Reducing alcohol consumption should be included in the “package” of secondary prevention recommendations, not only for its impact on arteries, but also because it reduces atrial fibrillation (AF). Alcohol abstinence might improve arrhythmia symptoms and reduce the chances of recurrence in patients who have already had an episode of AF. Regular alcohol consumers who were...
Benefit of Anticoagulation in the Elderly with Atrial Fibrillation
Guidelines recommend oral anticoagulation for all ≥ 75-year-old patients with atrial fibrillation. However, there is little evidence as to its net clinical benefit in the elderly population. This study looked at the life net clinical benefit in atrial fibrillation patients over 75 years of age treated with warfarin or apixaban vs. no treatment. Researchers observed...
Net Benefit of Left Atrial Appendage Closure vs. Anticoagulation in Atrial Fibrillation
This analysis shows that the long-term clinical benefit of left atrial appendage closure with Watchman is superior to warfarin in patients with atrial fibrillation (AF). The initial peri-procedural risks of device implantation are counterbalanced over time, with reduced risk of bleeding and death. The PROTECT-AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in...
ESC 2019 | AFIRE: Monotherapy with Rivaroxaban in Atrial Fibrillation and Stable CAD
In patients with atrial fibrillation and stable coronary artery disease who have not had revascularization procedures in the last 12 months, monotherapy with rivaroxaban seems the best treatment strategy compared to rivaroxaban plus antiplatelet antiaggregation. This is what resulted from the AFIRE study, presented during the ESC 2019 in Paris and published in NEJM. Monotherapy...
Permanent Carotid Coil Filters in Patients with Atrial Fibrillation
This new strategy to reduce the risk of stroke in patients with atrial fibrillation is technically feasible and safe, even though long-term outcomes are yet to be seen and despite the evidence available, for instance, left atrial appendage closure devices. It is true that they could be used simultaneously, but its synergy and cost have...
Heart and Brain: Risk Factors, Atrial Fibrillation and Dementia
For decades, physiologists have known what cardiologists often forget: heart and brain communicate intensely in a healthy person, and in a wide range of cardiovascular diseases they could damage one another. Multiple actions and immediate reactions in the brain adequately adapt heart function to bodily needs, such as anxiety and frustration, which might impair adequate...
Antithrombotic Strategies in Atrial Fibrillation and Angioplasty
What is the most appropriate antithrombotic strategy for a patient with atrial fibrillation and coronary artery disease, particularly when admitted with acute coronary syndrome or undergoing coronary angioplasty? This is a question whose answer is still in the works and that literature is addressing dynamically. Whatever we read yesterday may already be out of date...
New Percutaneous Devices to Prevent Embolism in Atrial Fibrillation
Patients with atrial fibrillation (AF) unsuitable for anticoagulation because of bleeding risk, require other strategies to prevent stroke. For some years, there have been in the market (limited to some places; not as part of the regular agenda of cardiologists and hematologists) devices to occlude the atrium that have been proved safe and effective. These...
ACC 2019 | AUGUSTUS: Apixaban Plus P2Y12 Inhibitor Is the Best Combination in Atrial Fibrillation and Angioplasty
Aspirin increases bleeding with no ischemic benefit, but a trend toward more stent thrombosis with placebo warrants further studies. Patients with atrial fibrillation who receive an anticoagulant agent and coronary angioplasty with a stent, and then continue with aspirin, experience an increased risk of bleeding without any ischemic benefit whatsoever. The use of a...