Heart rhythm : the official journal of the Heart Rhythm Society
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Ablation (ABL) is a second-line therapy for the management of atrial fibrillation (AF). Single-center studies have demonstrated the safety and efficacy of ABL; however, the low event rates render it difficult to assess predictors of major adverse events. ⋯ In our large population-based study, we found higher procedure-related mortality but comparable stroke rate after AF ABL than previously reported. Age ≥80 years and heart failure was each independently associated with >8-fold increase in odds of death. The only significant predictor of stroke was prior stroke/transient ischemic attack. These findings may aid in patient selection for AF ABL.
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J wave/QRS slurring (early repolarization) on 12-lead ECG has been associated with increased risk for ventricular fibrillation in the absence of cardiovascular (CV) disease. ⋯ In athletes, early repolarization pattern usually is associated with other ECG changes, such as increased QRS voltages and ST-segment elevation, as well as LV remodeling, suggesting that it likely represents another benign expression of the physiologic athlete's heart. J wave (early repolarization) is common in highly trained athletes and does not convey risk for adverse cardiac events, including sudden death or tachyarrhythmias.
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Preparticipation screening programs have been suggested to reduce the numbers of sports-related sudden cardiac deaths (SrSCD). ⋯ The incidence rates of SrSCD in noncompetitive and competitive athletes are not different. The study showed an increase in the incidence rate of SrSCD in persons aged 36-49 years in both noncompetitive and competitive athletes compared to those aged 12-35 years. Importantly, SCD in the general population is much more prevalent than is SrSCD in all age groups.
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Multicenter Study
Incidence and prediction of ischemic stroke among atrial fibrillation patients with end-stage renal disease requiring dialysis.
Renal dysfunction is a significant risk factor for ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence among AF patients with end-stage renal disease (ESRD) are unclear. ⋯ The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis and was superior to the CHADS2 score. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high-risk patients remains to be defined.