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Romero JE, Goldhaber SZ. Uninterrupted Oral Anticoagulation During Catheter Ablation of Ventricular Tachycardia: Is the Riskier Option the Safest? JACC Clin Electrophysiol 2022; 8:749-753. [PMID: 35738851 DOI: 10.1016/j.jacep.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Jorge E Romero
- Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Samuel Z Goldhaber
- Thrombosis Research Group and Section of Vascular Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lakkireddy D, Shenthar J, Garg J, Padmanabhan D, Gopinathannair R, Di Biase L, Romero J, Mohanty S, Burkhardt DJ, Al-Ahmad A, Atkins D, Bommana S, Natale A. SafeTy and Efficacy of Direct Oral Anticoagulant versus Aspirin for Reduction Of RisK of CErebrovascular Events in Patients Undergoing Ventricular Tachycardia Ablation (STROKE-VT). JACC Clin Electrophysiol 2021; 7:1493-1501. [PMID: 34393085 DOI: 10.1016/j.jacep.2021.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The STROKE-VT is a multicenter, randomized controlled trial that studied the differences in cerebrovascular events (CVE) between direct oral anticoagulant (DOAC) vs. ASA use post-procedurally in patients undergoing left ventricular arrhythmia (LVA) ablation [ventricular tachycardia (VT) or premature ventricular contraction (PVC)] using radiofrequency ablation (RFA). METHODS 246 patients scheduled for LVA-RFA were randomized 1:1 post-procedurally to receive DOAC or ASA. The study's primary endpoint was the incidence of stroke or TIA, or MRI detected asymptomatic cerebrovascular events (ACE) at 24 hours and 30 days follow-up. The secondary endpoints included procedure-related complications (composite of any vascular complication, pericardial complication, heart block, thromboembolic event excluding stroke or TIA) and in-hospital mortality. RESULTS There were no differences between groups regarding baseline and ablation characteristics (except the percentage of patients undergoing VT ablation, rate of amiodarone use, and total RFA time). Post-procedure cerebrovascular events (stroke and TIA) were lower in the DOAC arm versus ASA arm (0% vs. 6.5%, p<0.001 and 4.9% vs. 18%, p < 0.001; respectively). Patients in the ASA group had higher MRI detected ACE compared to the DOAC group both at 24 hours (23% vs. 12%, p = 0.03) and 30 days (18% vs. 6.5%, p = 0.006) follow-up. The acute procedure-related complication and in-hospital mortality were similar between the two groups. CONCLUSION DOAC utilization following endocardial/epicardial ablation for LVA-RFA was associated with reduced risk of transient ischemic attack or stroke, and asymptomatic MRI-detected cerebrovascular event.
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Affiliation(s)
- Dhanunjaya Lakkireddy
- Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS.
| | - Jayaprakash Shenthar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, 9th Block Jayanagar, Bannerghatta Road, Bengaluru, India
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda University Health, Loma Linda, CA
| | - Deepak Padmanabhan
- Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India
| | - Rakesh Gopinathannair
- Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - David J Burkhardt
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - Donita Atkins
- Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Sudha Bommana
- Division of Cardiology, Cardiac Arrhythmia Service, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
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Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3973924. [PMID: 34136565 PMCID: PMC8175165 DOI: 10.1155/2021/3973924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: "aortic valve stenosis," "aortic valve operation," and "transcatheter aortic valve therapy." Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 353] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 837] [Impact Index Per Article: 279.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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