Funding Acknowledgements Type of funding sources: None. Background/Introduction Proton pump inhibitor is commonly used for gastroprotective effect in patients with a combination of antiplatelets and anticoagulants. However, data quantifying the concomitant proton pump inhibitor for clinical adverse outcomes other than gastrointestinal bleedings of oral anticoagulant is lacking. Purpose We aimed to explore the effect of concomitant proton pump inhibitor on the effectiveness and safety of oral anticoagulant in patients with atrial fibrillation. Methods The medical records were retrospectively reviewed from four tertiary referral hospitals between January 1, 2012, and December 31, 2020. Concomitant use of drug was quantified as the overlapping proportion over the duration of oral anticoagulant therapy. Primary endpoint was the time to occurrence of ischemic stroke, systemic embolism, intracardiac thrombus, major bleeding events, or death. Results Data were analyzed for 20,750 episodes with oral anticoagulant and atrial fibrillation (median [IQR] age, 71 [63-78] years; female, 42.5%; warfarin, 37.3%; median [IQR] CHA2DS2-VASc score, 3 [2-5]). The risk of primary endpoint was greatest in the group of persistent use (80% or more of overlapping proportion) of proton pump inhibitor among the other groups with less overlapping proportion (adjusted hazard ratio, 1.88; 95% confidence interval, 1.63–2.16; P for groups, <0.001). Concomitant proton pump inhibitor was not associated with the risk of major bleeding from the gastrointestinal tract. Conclusion Among patients with atrial fibrillation receiving oral anticoagulant, concomitant use of proton pump inhibitor increased the rate of thromboembolism, major bleeding, or death in proportion of overlapping period.

Funding Acknowledgements Type of funding sources: None. Backgrounds Novel oral anticoagulants (NOACs) are effective to prevent stroke in patients with atrial fibrillation. Real world long-term data on the efficacy and safety of NOACs compared to warfarin in Asians are lacking. Purpose We aimed to explore the effectiveness and safety of NOAC in Asian patients with atrial fibrillation. Methods The medical records were reviewed in registry of four tertiary referral hospitals between January 1, 2012, and December 31, 2020. The primary outcome was the composite of thromboembolism, major bleeding and all caused mortality. Results Data were analyzed for 19,994 participants with oral anticoagulant and atrial fibrillation (median age, 72 years; female, 41.5%; warfarin, 35.5%; median CHA2DS2-VASc score, 3). The rate of the primary outcome was 5.5% per year in the NOAC group, as compared with 6.0% per year in the warfarin group (HR with NOAC, 0.70; 95% confidence interval [CI], 0.63 to 0.77; P<0.001 for superiority). The rate of ischemic event was 2.2% per year in the NOAC group, as compared with 2.8% per year in the warfarin group (HR, 0.56; 95% CI, 0.48 to 0.65; P<0.001). The rate of major bleeding was 1.9% per year in the NOAC group, as compared with 2.2% per year in the warfarin group (HR, 0.69; 95% CI, 0.58 to 0.82; P<0.001), and the rates of all caused death were 1.9% and 3.2%, respectively (HR, 0.85; 95% CI, 0.71 to 1.02; P=0.08). conclusion In Asian patients with atrial fibrillation, NOAC was effective and safe to prevent thromboembolic events with less bleeding compared to warfarin.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Korea University Introduction Implantable loop recorder (ILR) is useful to reveal hidden arrhythmia. The real-world using trend of ILR implantation and indication were studied using nationwide database. Purpose To assess the indication of ILR and diagnostic rate of meaningful arrhythmia Method We analyzed the 1,460 patients who underwent ILR implantation (male 62%, mean age 62±16) from 2008 to 2019 using Korea Health Insurance review and assessment service database. Result The embolic stroke of undetermined source (ESUS) group, syncope group and palpitation group were 619 (42.3%), 765 (52.3%), 76 (5.2%) as implantation indication, respectively. From 2016 to 2019, the ESUS group increased by 14 times and the syncope group by 4 times. Among patients with ESUS, 191 patients (31%) were diagnosed with atrial fibrillation within 1 year. Bradycardia needed pacing therapy was revealed in 28%, tachycardia in 6% and atrial fibrillation in 24% in syncope group. The predictors of atrial fibrillation in ESUS group were age (OR: 1.024 per year, CI: 1.006-1.042, p=0.0072) and heart failure (OR: 2.215, CI:1.357-3.615, p=0.0015). The mean time from ILR to pacing therapy was 3±2 months in syncope group and that to anticoagulation in ESUS group was 6±3 months. Discussion The use of ILR for evaluation of ESUS is increasing, with atrial fibrillation diagnostic rate of 30%. The time to treatment differed by group.

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