scholarly journals Long-term ECG monitoring. Significance for primary and secondary prevention of thromboembolic events in atrial fibrillation

2019 ◽  
Vol 7 (4S) ◽  
pp. 94-100
Author(s):  
T. Y. Chichkova ◽  
I. E. Mamchur ◽  
E. A. Khomenko ◽  
O. M. Polikutina
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Thromboembolic Events ◽  
Ecg Monitoring ◽  
Primary And Secondary Prevention ◽  
Prevention Of Thromboembolic Events

scholarly journals Current approaches to diagnosis and prevention of ishemic stroke.

2018 ◽  
Vol 96 (5) ◽  
pp. 389-396
Author(s):  
M. A. Kutlubaev ◽  
E. N. Khasanova
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Small Vessel Disease ◽  
Malignant Tumors ◽  
Cerebral Arteries ◽  
Cerebral Embolism ◽  
Ecg Monitoring ◽  
Prevention Measures ◽  
Vessel Disease

Etiology ofembolic stroke is very heterogeneous. It could be related to large vessel disease, small vessel disease, thromboembolism of cardiac origin. Clarification of etiology of stroke is important prerequisite for adequate selection of its secondary prevention measures. Standard work-up allows identification of its etiology in 60-90% of cases. 1n the rest 10-40% of cases stroke is considered cryptogenic. The majority of cryptogenic strokes are embolic. In keeping with this, a concept of embolic stroke of undetermined source (ESUS) was suggested. 1n the paper authors review most sigificant causes of ESUS. Occult atrial fibrillation is one of the common cause of ESUS. 1t could be detected only by means of long term ECG monitoring. Standard 24-hour ECG monitoring after stroke detects around 5% of cases ofpreviously unknown paroxysmal atrial fibrillation, while long-term monitoring of ECG allows detection ofparoxysmal atrial fibrillation in 15% of cases. Patent foramen ovale could lead to stroke in patients with deep vein thrombosis in the legs and pelvis due to paradoxical embolism. Atherosclerosis of aortic arch is observed in the half ofpeople older than 45 years. Large, ulcerated, non-calcified or floating atheromas could cause a stroke. Malignant tumors could lead to cerebral embolism through non-bacterial thrombotic endocarditis. Tumor embolism into cerebral arteries could also be seen in rare cases. The rate of cerebral embolism is high in mixomas. Approaches to diagnosis and secondary prevention of ESUS are discussed in the paper.

scholarly journals A long-term analysis in the primary and secondary prevention in Atrial Fibrillation

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Christian Tanislav ◽  
Damir Erkapic ◽  
Dursun Guenduez ◽  
Marco Meyer ◽  
Marin Herceg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Primary And Secondary Prevention ◽  
Term Analysis

Prevention of Thromboembolic Events in Atrial Fibrillation

1997 ◽  
Vol 78 (01) ◽  
pp. 377-381 ◽  
Author(s):  
Birgitte Gade Koefoed ◽  
Annette Lemche Gulløv ◽  
Palle Petersen
Keyword(s):  
Atrial Fibrillation ◽  
Thromboembolic Events ◽  
Prevention Of Thromboembolic Events

Relevance of supraventricular runs detected after cerebral ischemia

Neurology ◽  
2017 ◽  
Vol 89 (15) ◽  
pp. 1545-1552 ◽  
Author(s):  
Mark Weber-Krüger ◽  
Constanze Lutz ◽  
Antonia Zapf ◽  
Raoul Stahrenberg ◽  
Joachim Seegers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cerebral Ischemia ◽  
Ecg Monitoring ◽  
Holter Ecg ◽  
Acute Cerebral Ischemia ◽  
Temporal Phenomenon ◽  
Long Term Follow Up ◽  
Recurrent Strokes

Objective:Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up.Methods:Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence.Results:A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent).Conclusions:Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.

scholarly journals Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population / Kardioemboliska Cerebrāla Infarkta Primārās un Sekundārās Profilakses Problēmas Latvijā

2015 ◽  
Vol 69 (5) ◽  
pp. 199-204
Author(s):  
Kristaps Jurjāns ◽  
Santa Sabeļnikova ◽  
Evija Miglāne ◽  
Baiba Luriņa ◽  
Oskars Kalējs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Patient Group ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Cardioembolic Stroke ◽  
University Hospital ◽  
Primary And Secondary Prevention ◽  
Stroke Patients ◽  
Very High

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

scholarly journals The role of the accessory pathway radiofrequency catheter ablation in the secondary prevention of the malignant tachyarrhythmias in patients with Wolff-Parkinson-White syndrome

2010 ◽  
Vol 67 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Nebojsa Mujovic ◽  
Miodrag Grujic ◽  
Stevan Mrdja ◽  
Aleksandar Kocijancic ◽  
Tatjana Potpara ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Secondary Prevention ◽  
Emotional Stress ◽  
Drug Administration ◽  
Clinical Manifestation ◽  
Accessory Pathway

Background/Aim. The occurrence of atrial fibrillation (AF) in the presence of an accessory pathway (AP) that conducts rapidly is potentially lethal because the rapid ventricular response may lead to ventricular fibrillation (VF). The aim of the study was to determine long-term efficacy of AP catheter-ablation using radiofrequency (RF) current in secondary prevention of VF in WPW patients. Methods. Study included a total of 192 symptomatic WPW patients who underwent RF catheter-ablation of AP in our institution from 1994 to 2007 and were available for clinical follow-up for more than 3 months after procedure. Results. Before ablation, VF was recorded in total of 27 patients (14.1%). In 14 of patients (51.9%) VF was the first clinical manifestation of WPW syndrome. A total of 35 VF episodes were identified in 27 patients. The occurrence of VF was preceded by physical activity or emotional stress in 17.1% of cases, by alcohol abuse in 2.9% and by inappropriate intravenous drug administration in 28.6%. In addition, no clear precipitating factor was identified in 40% of VF cases, while informations about activities preceding 11.4% of VF episodes were not available. The follow-up of 5.7 ? 3.3 years was obtained in all of 27 VF patients. Of the 20 patients who underwent successful AP ablation, all were alive, without syncope or ventricular tachyarrhythmias during long-term follow-up. In 4 of 7 unsuccessfully treated patients, recurrence of supraventricular tachycardia and/or preexcited atrial fibrillation were recorded; one of these patients suddenly died of VF, 6 years after procedure. Conclusion. In significant proportion of WPW patients, VF was the first clinical manifestation of WPW syndrome, often precipitated by physical activity, emotional stress or inappropriate drug administration. Successful elimination of AP by percutaneous RF catheter-ablation is highly effective in secondary prevention of life-threatening tachyarrhythmias in patients with ventricular preexcitation.

Abstract 14575: Implantable Cardiac Defibrillator in the Setting of Tetralogy of Fallot: Long-Term Follow-Up of a French National Multicenter Retrospective Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Abdeslam Bouzeman ◽  
Maxime De Guillebon ◽  
Guillaume Duthoit ◽  
Magalie Ladouceur ◽  
Raphael Martins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Tetralogy Of Fallot ◽  
Primary And Secondary Prevention ◽  
Long Term Follow Up ◽  
Appropriate Therapy

Background: Tetralogy of Fallot (TOF) is the most frequent form of congenital heart disease managed by EP physicians for potential ICD. However, few studies have reported long-term outcomes of TOF patients with ICD. Methods: Between 2005 and 2014, all TOF patients with ICD in 17 French centers were enrolled in a specific evaluation aiming to determine characteristics at implantation as well as outcomes (overall mortality, appropriate ICD therapies, and device-related complications). Results: Overall 78 patients (45±13 years, 64% males) were enrolled. A majority of patients were implanted in the setting of secondary prevention (73%), whereas the remaining (27%) in primary prevention. Among the latest group, known risk factors for sudden cardiac death were: severe pulmonary regurgitation (30%,) prior palliative shunt (50%), syncope with unknown origin (25%), inducible ventricular tachycardia (45%), QRS duration ≥180ms (18%), non-sustained ventricular tachycardia (25%), and documented sustained supra ventricular tachycardia (45%).Overall, patients implanted in the setting of primary prevention presented with a mean of 3.1±1.4 risk factors. After a mean follow-up of 4.9±3.8 years, 35 patients (45%) experienced at least one appropriate therapy (25% in the primary prevention group compared to 53% in the secondary prevention group), giving annual-incidences of 6.9% (95%CI 0.14-13.7) and 21.3% (12.4-30.3) respectively (P=0,01). The mean time between ICD implantation and the first appropriate therapy was 2.2±3.2 years, without significant differences between primary and secondary prevention. Overall, ≥one ICD-related complication occurred in 30 patients (38%), including inappropriate shock (n=9), major pocket hematoma (n=1), lead dysfunction (n=12), infection (n=4), shoulder algodystrophia (n=2), device failure or dislodgement needing reintervention (n=2). Eventually, four patients were transplanted (5%), and six patients (8%) died during the course of follow-up. Conclusions: Considering relatively long-term follow-up, patients with TOF and ICDs experience high rates of appropriate ICD therapies, in both primary and secondary prevention. Major ICD-related complications remain, however, high.

scholarly journals Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant—Danish nationwide cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028468 ◽  
Author(s):  
A Gundlund ◽  
Thomas Kümler ◽  
Anders Nissen Bonde ◽  
Jawad Haider Butt ◽  
Gunnar Hilmar Gislason ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Alcohol Intoxication ◽  
Thromboembolic Events ◽  
Thromboembolic Risk ◽  
Cox Regression Analysis ◽  
Number Of Patients ◽  
Secondary Outcomes

ObjectivesWe compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant.Design and settingRetrospective cohort study based on Danish nationwide registries.ParticipantsPatients with AF with and without secondary precipitants (1996–2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.Primary and secondary outcomesThe primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.ResultsThe most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.ConclusionsIn general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.

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