Updates 29 Feb 2016

Outcomes in Arrhythmogenic Right Ventricular Dysplasia
In the March issue of Heart Lung and Circulation, Martin et al report the outcomes in a 7 year follow-up of 30 patients with ARVD. Among 26 patients with an implantable cardioverter defibrillator, 13 (50%) received appropriate shock therapy within 12 months and 4 (15%) had inappropriate shocks. Male gender was associated with increased risk of arrhythmia. The authors noted that asymptomatic individuals with a family history of sudden death had a low rate of arrhythmia, raising question of need for cardioverter-defbrillators in this group.

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Anticoagulation in Atrial Fibrillation
A detailed review of choice of anticoagulant agents for individuals with atrial fibrillation has been published by Diener et al in the February 4 issue of the European Heart Journal. Among key points identified for specific patients groups are:

  1. Monotherapy with a NOAC is preferable for most stable patients with non-valvular AF and CAD – aspirin may be added as clinically indicated
  2. Vitamin K antagonists remain the standard of care for NVAF patients undergoing cardioversion
  3. Patients with a single stroke risk factor, other than gender, should be considered for oral anticoagulant therapy
  4. Oral anticoagulant therapy should be considered after even a single episode of paroxysmal AF, given likelihood of recurrence

See: http://dx.doi.org/10.1093/eurheartj/ehv643
See: http://dx.doi.org/10.1093/eurheartj/ehw069

Walking Speed Predicts Outcomes After TAVR
In the February 26 2016 online issue of Circulation, Alfredsson et al of the Duke Clinical Research Unit describe the 30 day outcomes after TAVR in 8039 patients. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for slowest, slow, and normal walkers, respectively (p<0.001). Each 0.2 m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio 1.11, 95% confidence interval 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio 1.35, 95% confidence interval 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home.

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Aspirin has Neutral Effect at Time of Coronary Artery Surgery
In this week’s NEJM, Myles et al of the ANZCA Clinical Trials Network report on the efficacy of aspirin in preventing adverse events at time of coronary artery surgery. In a randomized trial of 2100 patients undergoing coronary surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo.

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Coronary Calcium Scores A Better Predictor of Significant Stenoses than Conventional Risk Factors is Symptomatic Patients
A study of 5515 symptomatic patients reported by Nicolle et al in the March issue of the International Journal of Cardiology compares coronary calcium scoring with usual clinical risk factors for prediction of significant stenoses. The log calcium score was a more significant predictor of >50% stenosis than was male gender, diabetes, smoking or family history. The authors did note, however, that 5.5% of patients with a calcium score of zero still had a significant stenosis.

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