Article

Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)

www.escardio.org/guidelines
Europace (Impact Factor: 3.05). 10/2010; 12(10):1360-420. DOI: 10.1093/europace/euq350
4 Followers
 · 
107 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Most atrial fibrillation (AF) epidemiology described Western populations; there is a paucity of data from Chinese ethnicity. This study presented differences in patient characteristics and management strategies, and assessed the quality of life (QoL) and AF control in Taiwanese patients from RealiseAF. Methods RealiseAF enrolled 10,523 patients internationally, in which Taiwanese cohort accounts for 7.1%. Physicians were randomly selected from a global list. Patient characteristics, management and therapeutic strategies of AF, QoL measured by the EQ-5D questionnaire, and the control of AF (in sinus rhythm, or AF with a ventricular rate ≤80 beats per minute) evaluated by electrocardiography were assessed. Results Taiwanese patients were mostly outpatients (93.9%), older (70.2 ± 11.8 years), accompanied by more comorbidities, more frequently (51.7%) in permanent AF, and symptomatic (European Heart Rhythm Association score ≥II: 81.5%) compared with the non-Taiwanese cohort. A rhythm-control strategy was less preferable to rate-control than in non-Taiwanese cohort as well as the use of class I and III antiarrhythmic drugs (AADs); 85.2% of Taiwanese patients received AADs, among which beta-blockers were the most common (46.9%). QoL was compromised (Visual Analogue Scale: 70.3 ± 14.4; single index utility score: 0.81 ± 0.25) and only 48.6% of the Taiwanese patients had AF controlled. Conclusions AF complexity in the Taiwanese cohort was similar to or even greater than that in the non-Taiwanese cohort. The Taiwanese patients were highly symptomatic; QoL was impaired despite the widespread use of medications and AF control was unsatisfactory. There is an apparent unmet need in AF treatment in Chinese ethnicity.
    Journal of Cardiology 09/2014; 64(3-4). DOI:10.1016/j.jjcc.2014.01.010 · 2.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Sedation with propofol should be administered by personnel trained in advanced airway management. To overcome this limitation, the use of short acting benzodiazepines by cardiologists spread widely, causing concerns about the safety of this procedure in the absence of anesthesiology assistance. The aim of the study was to compare feasibility of a cardiologist-only approach with an anesthesiologist-assisted sedation protocol during elective direct-current cardioversion (DCC) of persistent atrial fibrillation (AF).
    International Journal of Cardiology 08/2014; 176:930-935. DOI:10.1016/j.ijcard.2014.08.050 · 6.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Silent atrial fibrillation (AF) has been suggested to be frequent after acute myocardial infarction (MI). Continuous ECG monitoring (CEM) has been shown to improve AF screening in patients at risk of stroke. We aimed to assess the incidence and prognosis of silent AF in patients with acute MI. All the consecutive patients with acute MI were prospectively analyzed by CEM≥48h after admission. Silent AF was defined as asymptomatic episodes lasting at least 30s. The population was divided into three groups: no-AF, silent AF and symptomatic AF. Among the 849 patients, 135 (16%) developed silent AF and 45 (5%) symptomatic AF. Compared with the no-AF group, patients with silent AF were markedly older (80 vs. 62y, p<0.001), more frequently women (43% vs. 30%, p=0.006) and less likely to be smokers (20% vs. 36%, p<0.001). They had impaired left ventricular ejection fraction (LVEF) and left atrial (LA) enlargement. By multivariate analysis, age, history of AF, indexed LA area and LVEF were identified as independent predictors of silent AF. In-hospital heart failure and death rates were markedly higher in silent AF group when compared with no-AF patients (41.8% vs 21.0% and 10.4% vs. 1.3%, respectively). Our large prospective study showed for the first time that silent AF is more frequent than symptomatic AF after MI. Our work suggests that indexed LA area could help to predict the risk of developing silent AF. Moreover, the onset of silent AF is associated with worse hospital prognosis.
    International journal of cardiology 04/2014; 174(3). DOI:10.1016/j.ijcard.2014.04.158 · 6.18 Impact Factor