Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Nov 2014
Meta AnalysisPerioperative anticoagulation management in patients on chronic oral anticoagulant therapy undergoing cardiac devices implantation: a meta-analysis.
The perioperative anticoagulation strategy during cardiac implantable electronic devices (CIEDs) implantation is highly variable without consensus among implanting physicians. A systematic literature search was performed in MEDLINE, EMBASE, and the Cochrane Library to identify clinical trials in patients on chronic oral anticoagulant (OAC) therapy undergoing CIEDs implantation. Bleeding and thromboembolic events were compared among heparin bridging, continued OAC, and interrupted OAC groups. ⋯ There was no significant difference between OAC continuation and OAC interruption group in bleeding (RR 0.90, 95% CI, 0.65-1.24, P = 0.52) and thromboembolic (RR 0.57, 95% CI, 0.16-2.01, P = 0.38) complications. The OAC interruption group had an obviously lower incidence of bleeding in comparison with the heparin bridging group and no statistical significance was observed in thrombus occurrence. Implantation of CIEDs with continuous OAC therapy may offer the best option by combining the lower risk of bleeding with rare thromboembolism compared with heparin bridging and OAC interruption therapy.
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Pacing Clin Electrophysiol · Nov 2014
Meta AnalysisRelationship between brain natriuretic peptides and recurrence of atrial fibrillation after successful direct current cardioversion: a meta-analysis.
Atrial fibrillation (AF) recurrence is common after successful direct current cardioversion (DCCV), with a 40% rate of recurrence within the first month. Several studies have investigated the potential association between brain natriuretic peptide (BNP) or N-terminal (NT)-proBNP levels before DCCV and the risk of AF recurrence, but results have been inconsistent. We, therefore, conducted a systematic review and meta-analysis of all available data to determine whether sinus rhythm (SR) maintenance after successful DCCV may be determined by preprocedural BNP and NT-proBNP levels. ⋯ Our analysis suggests that low preprocedural BNP/NT-proBNP levels are associated with SR maintenance. The use of BNP or NT-proBNP for prediction of long-term response to DCCV appears to be useful and should be further evaluated.
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Pacing Clin Electrophysiol · Oct 2014
Observational StudyLeft ventricular hypertrophy and antiarrhythmic drugs in atrial fibrillation: impact on mortality.
Despite sparse clinical data, current atrial fibrillation (AF) guidelines favor amiodarone as a drug of choice for patients with left ventricular hypertrophy (LVH). ⋯ Patients with persistent AF and LVH on non-AADs do not have higher mortality compared to patients on amiodarone. Importantly, these findings do not support amiodarone as a superior choice in patients with LVH.
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Pacing Clin Electrophysiol · Oct 2014
Safety and outcomes of magnetic resonance imaging in patients with abandoned pacemaker and defibrillator leads.
Abandoned cardiovascular implantable electronic device (CIED) leads remain a contraindication to magnetic resonance imaging (MRI) studies, largely due to in vitro data showing endocardial heating secondary to the radiofrequency field. We tested the hypothesis that abandoned CIED leads do not pose an increased risk of clinical harm for patients undergoing MRI. ⋯ The use of MRI in patients with abandoned cardiac device leads appears feasible when performed under careful monitoring, with no adverse events, although the experience is small. MRI did not affect the function of leads that were subsequently reconnected to a cardiac device.
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Pacing Clin Electrophysiol · Sep 2014
Randomized Controlled Trial Multicenter StudyRandomized controlled trial of perioperative ICD management: magnet application versus reprogramming.
There are insufficient data to guide perioperative implantable cardioverter-defibrillator (ICD) management for patients undergoing surgical procedures using electrocautery. ⋯ A magnet protocol simplifies perioperative ICD management for procedures using electrocautery more than 6 inches from the ICD. This protocol results in significantly shorter time with ICD therapy off, fewer provider handoffs, no risk of inadvertently discharging patients home with ICD therapies off, and no device reset.