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The Impact of Proton Pump Inhibition on Dabigatran Levels in Patients With Atrial Fibrillation
Background: nucleon pump inhibition (PPI) administrated along with dabigatran reduces the danger of channel hemorrhage. However, there’s a discussion concerning attainable PPI–dabigatran interaction which will scale back the effectivity of this medical care.
Study Question: to see the impact of concomitant PPI on dabigatran plasma levels in patients with nonvalvular fibrillation (NV-AF).
Study Design: A pilot prospective study in patients with NV-AF on dabigatran medical care was performed; thirty one patients were listed. PPI with either antiacid or pantoprazole was administrated in nineteen patients.
Measures and Outcomes: Blood samples were taken for the assessment of the dabigatran trough and peak levels. Dabigatran concentration was measured with the Hemoclot coagulase matter Assay.
Results: there have been vital variations in dabigatran trough level scrutiny patients treated with PPI and patients while not PPI (58.86 ± 36.76 ng/mL vs. 110.72 ± 88.47 ng/mL, P < 0.05). Similarly, there have been vital variations in dabigatran peak level between compared teams (88.0 ± 20.5 ng/mL vs. 174.4 ± 139.64 ng/mL, P < 0.05).
Conclusions: This pilot study incontestable the interaction between PPI and dabigatran levels in patients with NV-AF. [1]
A deep learning approach for real-time detection of atrial fibrillation
Goal: To develop a strong and period approach for automatic detection of fibrillation (AF) in long graph (ECG) recordings victimisation deep learning (DL). Method: associate end-to-end model combining the Convolutional- and Recurrent-Neural Networks (CNN and RNN) was projected to extract high level options from segments of RR intervals (RRIs) so as to classify them as AF or traditional sinus rhythm (NSR). Results: The model was trained and valid on 3 completely different databases together with a complete of eighty nine subjects. It achieved a sensitivity and specificity of ninety eight.98% and 96.95%, severally, valid through a 5-fold cross-validation. in addition, the projected model was found to be computationally economical and it had been capable of analyzing twenty four h of ECG recordings in but one second. The projected algorithmic rule was additionally tested on the unseen datasets to look at its hardiness in police work AF for brand spanking new recordings that resulted in ninety eight.96% and 86.04% for specificity and sensitivity, severally. Conclusion: Compared to the progressive models evaluated on commonplace benchmark ECG datasets, the projected model created higher performance in police work AF. in addition, since the model learns options directly from the info, it avoids the necessity for clever/cumbersome feature engineering. [2]
Cardioversion of atrial fibrillation in obese patients: Results from the Cardioversion‐BMI randomized controlled trial
Aims
Obesity is related to higher electrical cardioversion (ECV) failure in persistent arrhythmia (PeAF). For ease‐of‐use, several centers like patches over paddles. we have a tendency to assessed the optimum modality and shock vector, similarly because the safety and effectuality of the Manual Pressure Augmentation (MPA) technique.
Methods
Patients with fleshiness (BMI ≥ 30) and PeAF undergoing ECV employing a biphasic electronic device were irregular into one in every of four arms by modality (adhesive patches or hand-held paddles) and shock vector (anteroposterior [AP] or anteroapical [AA]). If the primary 2 shocks (100 and 200 J) unsuccessful, then patients received a 200‐J shock mistreatment the choice modality (patch or paddle). Shock vector remained unchanged. In Associate in Nursing empiric substudy, twenty patients with BMI of thirty five or additional, and UN agency unsuccessful ECV at 200 J mistreatment each patches/paddles underwent an effort of MPA.
Results
In total, one hundred twenty five patients were irregular between Gregorian calendar month 2016 and March 2018. initial or second shock success was forty three of sixty three (68.2%) for patches and fifty six of sixty two (90.3%) for paddles (P = 0.002). there have been twenty crossovers from patches to paddles (12 of 20 third shock success with paddles) and 6 crossovers from paddles to patches (three of six third shock success with patches). Paddles with success cardioverted sixty eight of eighty two patients compared with forty six of sixty nine mistreatment patches (82.9% vs 66.7%; P = 0.02). Shock vector failed to influence initial or second shock success rates (82.0% AP vs seventy six.6% AA; P = 0.46). MPA was self-made in sixteen of twenty (80%) UN agency unsuccessful in each (patches/paddles), with 360 J needed in six of seven cases.
Conclusion
Routine use of adhesive patches at 200 J is insufficient in fleshiness. methods that improve success embrace the employment of paddles, MPA, and step-up to 360 J. [3]
Biobank-driven genomic discovery yields new insight into atrial fibrillation biology
To identify genetic variation underlying arrhythmia, the foremost common cardiopathy, we have a tendency to performed a genome-wide association study of >1,000,000 people, as well as sixty,620 arrhythmia cases and 970,216 controls. we have a tendency to known 142 freelance risk variants at 111 loci and prioritized 151 useful candidate genes doubtless to be concerned in arrhythmia. several of the known risk variants fall close to genes wherever additional hurtful mutations are reportable to cause serious heart defects in humans (GATA4, MYH6, NKX2-5, PITX2, TBX5)1, or close to genes necessary for skeletal muscle perform and integrity (for example, CFL2, MYH7, PKP2, RBM20, SGCG, SSPN). Pathway and useful enrichment analyses additionally recommended that a lot of of the reputed arrhythmia genes act via viscus structural reworking, doubtless within the variety of associate ‘atrial cardiomyopathy’2, either throughout vertebrate heart development or as a response to fret within the adult heart. [4]
Dronedarone after Catheter Ablation of Atrial Fibrillation: A New Option in Hybrid Therapy
Background and Aim: tubing ablation has become the medical aid of selection in patients with symptomatic, recurrent, drug-refractory fibrillation (AF). However, frequent AF recurrences typically necessitate Associate in Nursing connected antiarrhythmic (AAD) medical aid. Dronedarone may be a new category III AAD with modest aspect effects. we have a tendency to compared a standard AAD medical aid (CAAT) with category I/III AADs to a completely unique therapy with dronedarone (NAAT)in respect to AF recurrences and improvement of symptoms.
Methodology: 100 twenty 5 consecutive patients (84 men; mean age sixty two.1±12.4 years) with symptomatic attack (n=70) or persistent (n=55) drug refractory AF were listed in Associate in Nursing open-label randomised study. Following productive vena isolation (PVI) patients were randomised to receive CAAT (n=50), NAAT (n=50) or no AAD medical aid (=control; n=25). Follow-up visits were regular at three, 6, 9, and twelve months post ablation. Seven-day-Holter observance and patients’ histories served as indicators of treatment success. Bar signs of AF repetition AADs were interrupted half-dozen months post ablation.
Results: The pre-ablation European cardiac rhythm Association (EHRA)-score minimized from a pair of.8±0.4 to 1.4±0.6 (NAAT) and one.5±0.7 (CAAT) half-dozen months when PVI (1.7±0.7 within the management group). Fifty patients full-fledged an heart condition repetition inside three months. when half-dozen months, each hybrid medical aid teams showed a big advantage over the management cluster affirmative sinus rhythm (SR).Whereas CAAT might retain its significant profit at nine months NAAT lost its relative benefits with solely a positive trend remaining over the management cluster however a big disadvantage compared to CAAT patients. At now AF recurrences were found in thirty four of NAAT patients, twenty six of CAAT patients, and fortieth of management patients. At twelve months, however, no cluster might preserve a big lead over either of the others.
Conclusion: Dronedarone when PVI is safe and effective. Compared to a CAAT, NAAT reveals similar enhancements of EHRA-scores and non-significantly totally different AF repetition rates from nine months on. Despite this, CAAT keeps considerably a lot of patients in SR nine months when PVI. [5]
Reference
[1] Bolek, T., Samoš, M., Stanciaková, L., Ivanková, J., Škornová, I., Staško, J., Galajda, P., Kubisz, P. nd Mokán, M., 2019. The impact of proton pumpa inhibition on dabigatran levels in patients with atrial fibrillation. American journal of therapeutics, 26(3), pp.e308-e313. (Web Link)
[2] Andersen, R.S., Peimankar, A. and Puthusserypady, S., 2019. A deep learning approach for real-time detection of atrial fibrillation. Expert Systems with Applications, 115, pp.465-473. (Web Link)
[3] Voskoboinik, A., Moskovitch, J., Plunkett, G., Bloom, J., Wong, G., Nalliah, C., Prabhu, S., Sugumar, H., Paramasweran, R., McLellan, A. and Ling, L.H., 2019. Cardioversion of atrial fibrillation in obese patients: Results from the Cardioversion‐BMI randomized controlled trial. Journal of cardiovascular electrophysiology, 30(2), pp.155-161. (Web Link)
[4] Biobank-driven genomic discovery yields new insight into atrial fibrillation biology
Jonas B. Nielsen, Rosa B. Thorolfsdottir, Cristen J. Willer
Nature Geneticsvolume 50, pages1234–1239 (2018) (Web Link)
[5] Gramley, F., Vogt, F., Natour, M., Koellensperger, E. and Kettering, K. (2017) “Dronedarone after Catheter Ablation of Atrial Fibrillation: A New Option in Hybrid Therapy”, Cardiology and Angiology: An International Journal, 6(2), pp. 1-10. doi: 10.9734/CA/2017/32001. (Web Link)