Impact of atrial fibrillation on clinical outcomes among patients with coronary artery disease undergoing revascularisation with drug-eluting stents

Coronary artery disease (CAD) and atrial fibrillation (AF) are major determinants of morbidity and mortality. A combined treatment with antiplatelet agents and vitamin K antagonists limits the risk of stent thrombosis and stroke while increasing the rate of bleeding. The objective of this study was to investigate the impact of atrial fibrillation (AF) on long-term clinical outcomes in patients with CAD undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES)

Severe renal impairment and stroke prevention in atrial fibrillation implications for thromboprophylaxis and bleeding risk.

The prevalence of atrial fibrillation (AF) in end-stage renal failure is high, with an increased risk of stroke among these patients with AF compared with the AF population without severe renal impairment. Many trials have shown the net clinical benefit of oral anticoagulation therapy for primary and secondary prevention of stroke in patient populations with AF. However, current stroke risk stratification schemes are based on studies that have deliberately excluded patients with severe renal impairment. Indeed, there are no large randomized controlled trials that assess the real risk/benefit of full intensity anticoagulation in patients with severe renal impairment. Also, rates of major bleeding episodes in anticoagulated hemodialysis patients with AF are high. These data are influenced by the lack of appropriate monitoring, the difficulties in maintaining the international normalized ratio target (variable between the studies), and an inaccurate bleeding classification. Thus, the limited available data may be difficult to apply to such a heterogeneous patient population, characterized by both an increased risk of bleeding and a hypercoagulability state, as seen in the patient population with severe renal impairment

Are hospitalizations for invasive procedures missed opportunities for teaching rules of secondary prevention?

4nonenoneP M Fioretti; R Marinigh; C Fresco; S BrusaferroP. M., Fioretti; R., Marinigh; C., Fresco; Brusaferro, Silvi

Recurrent arrhythmic storms and unsuccessful catheter ablation in chronic ischemic heart disease

The prototypical substrate for reentrant ventricular tachycardia (VT) is post-myocardial infarction (MI) scar. Catheter ablation is an important therapeutic option for recurrent VT but sometimes it is not effective despite the technical advances. Here we describe the case of a 60-year-old man who suffered a MI in 1998 and presented with recurrent arrhythmic storms during his long-term follow-up. Twenty years later, he underwent two catheter ablations with bipolar electroanatomic voltage mapping (EVM) demonstrating only an area of low voltages in the lateral left ventricular free wall. Both procedures were unsuccessful and the patient eventually underwent cardiac transplantation in 2019. Pathology examination revealed circumferential subendocardial scar with hypertrabeculation, so that the reentry substrate was unreachable by ablation with the use of standard techniques. The comparison of EVM findings with the morphologic ones in patients with chronic ischemic heart disease can help to better understand the feasibility and effectiveness of VT substrate ablation