Distribution of Cardioembolic Stroke: A Cohort Study

Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In thi

Rhythm control as treatment for patients with medication-resistant atrial fibrillation: Maze surgery and percutaneous pulmonary vein isolation by catheter ablation

In patients with atrial fibrillation, a decision must be made whether to accept the arrhythmia (rate control) or to pursue maintenance of sinus rhythm (rhythm control). Randomized trials have shown no difference between these strategies with respect to morbidity, mortality, and quality of life. In these studies, morbidity and mortality appeared to be related predominantly to the underlying heart disease rather than to the arrhythmia itself. However, other analyses suggest that long-term sinus rhythm may improve prognosis. At any rate, complaints caused by the arrhythmia may definitely be a reason to strive for rhythm control. If pharmacological rhythm control fails, maze surgery, both in patients with lone atrial fibrillation and as concomitant surgery, is highly successful. This, however, necessitates cardiac surgery. New techniques have now emerged, including pulmonary vein isolation by means of percutaneous catheter ablation. This is less invasive and therefore nowadays the treatment of first choice if pharmacological rhythm control has faile