Nihon rinsho. Japanese journal of clinical medicine
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Dabigatran is an oral, direct, and competitive inhibitor of thrombin, which is administered to patients with non-valvular atrial fibrillation for prevention of stroke at a dose of 110 mg twice daily or 150 mg twice daily. Anticoagulation by dabigatran is "hybrid anticoagulation", consisting of action of both dabigatran and physiological coagulation inhibitors because warfarin inhibits production of protein C and protein S but dabigatran does not. ⋯ The RE-LY trial confirmed effectiveness and safety of both doses of dabigatran for prevention of stroke and both doses of dabigatran had much lower risks of intracranial bleeding compared with warfarin. Compliance to guidance of dabigatran treatment is essential for avoidance of severe hemorrhagic complications.
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Electrophysiological study should be done in patients who suppose to undergo the treatment including pulmonary vein isolation using catheter ablation for atrial fibrillation. The purpose of the electrophysiological study consist with confirmation of the induction and the origin of atrial fibrillation, and with recognition of electrical potential and arrhythmogenic substrate for maintenance of atrial fibrillation. ⋯ Moreover, the complex fractionated atrial electrograms(CFAE) and ganglionated plexus(GP) play an important role in maintenance of atrial fibrillation. As it is indispensable to record and distinguish the electrical potential of atrium and pulmonary vein for the ablation of atrial fibrillation, every physician who is concerned in the catheter ablation requires accustoming to these potentials.