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Unlike vitamin K antagonists (VKAs), the new oral anticoagulants (NOACs)—direct thrombin inhibitor, dabigatran, and direct activated factor X inhibitors, rivaroxaban, and apixaban—do not require routine INR monitoring. Compared to VKAs, they possess relatively rapid onset of action and short halflives, but vary in relative degrees of renal excretion as well as interaction with p-glycoprotein membrane transporters and liver cytochrome P450 metabolic enzymes. Recent completed phase III trials comparing NOACs with VKAs for stroke prevention in atrial fibrillation (AF)—the RE-LY, ROCKET AF, and ARISTOTLE trials—demonstrated at least noninferior efficacy, largely driven by significant reductions in haemorrhagic stroke. Major and nonmajor clinically relevant bleeding rates were acceptable compared to VKAs. Of note, the NOACs caused significantly less intracranial haemorrhagic events compared to VKAs, the mechanisms of which are not completely clear. With convenient fixed-dose administration, the NOACs facilitate anticoagulant management in AF in the community, which has hitherto been grossly underutilised. Guidelines should evolve towards simplicity in anticipation of greater use of NOACs among primary care physicians. At the same time, the need for caution with their use in patients with severely impaired renal function should be emphasised.

Fifteen patients of different ventricular tachycardias (VTs) underwent mapping and radiofrequency ablation (RFA) in National Heart Centre Singapore, Jakarta and Lab AID cardiac hospital, Dhaka, Bangladesh. Mapping by conventional catheter technique and by 3D Electroanatomic Voltage showed VT originating from right & left ventricular outfl ow tracts, posterior fascicle, mitral annulus and also from ischemic old myocardial scar. Among the 15 VT patients, fascicular VTs were 4 (27%), Right ventricular outflow tract (RVOT) VTs were 5 (33.3%), Left ventricular outfl ow tract (LVOT) VTs were 2 (13.3%), Mitral annular (MAVT) VT was1 (7%), and ischemic VT with implanted ICD were 3 (20%). One of the ischemic VT had Epicardial origin. Ablation was not attempted in MAVT due to polymorphic, hemodynamic altered VT. Stereotaxis (CARTO with remote magnetic Navigation) was used for diagnosis & RFA of ischemic Epicardial VT. Ablation were unsuccessful in 2 RVOT VTs. In other cases, RFA resulted successful and partial successful outcome. There was no death or remarkable complication during the procedure or during short term followup.