The changing circumstance of atrial fibrillation ‐ progress towards precision medicine

Savelieva, Irina; Potpara, Tatjana; Hindriks, Gerhardt; Pison, Laurent; Blomström‐Lundqvist, Carina

doi:10.1111/joim.12478

Cited by 29 publications

(13 citation statements)

References 129 publications

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“…83,84 However, to date, none have been found to be sufficiently useful and practical to warrant adoption in influencing clinical decision-making. 85 In patients with a history AF, the combination of AF duration and CHADS 2 score was predictive of ischaemic TEs. 86,87 …”

Section: Implications Of Study Findings On Atrial High-rate Episodes mentioning

confidence: 96%

Atrial high-rate episodes and stroke prevention

et al. 2016

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While the benefit of oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation (AF) is well established, it is not known whether oral anticoagulation is indicated in patients with atrial high-rate episodes (AHRE) recorded on a cardiac implantable electronic device, sometimes also called subclinical AF, and lasting for at least 6 min in the absence of clinically diagnosed AF. Clinical evidence has shown that short episodes of rapid atrial tachycarrhythmias are often detected in patients presenting with stroke and transient ischaemic attack. Patients with AHRE have a higher likelihood of suffering from subsequent strokes, but their stroke rate seems lower than in patients with diagnosed AF, and not all AHRE episodes correspond to AF. The prognostic and pathological significance of AHRE is not yet fully understood. Clinical trials of OAC therapy are being conducted to determine whether therapeutic intervention would be beneficial to patients experiencing AHRE in terms of reducing the risk of stroke.

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Section: Implications Of Study Findings On Atrial High-rate Episodes mentioning

confidence: 96%

Atrial high-rate episodes and stroke prevention

et al. 2016

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“…The risk of stroke is independent of the type of AF (paroxysmal, persistent, or permanent). 30 For patients with haemorrhagic diathesis or receiving anticoagulants for preexisting cardiovascular disease, evaluation of the haemorrhagic risk can be assessed by using HAS-BLED, ATRIA, or HEMOR 2 RHAGES scores despite their limitations. 31 There is no formal justification to avoid anticoagulation according to HAS-BLED score ( Table 2).…”

Section: Clinical Evaluation At Baselinementioning

confidence: 99%

Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding

Boriani

Corradini

Cuneo

et al. 2018

Hematological Oncology

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The Bruton tyrosine kinase inhibitor ibrutinib (IB) has attained an important role in the treatment of patients with chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström macroglobulinemia, significantly improving clinical outcomes. However, IB therapy has been associated with an increased risk of atrial fibrillation (AF) and bleeding. We report on the expert opinion that a group of Italian haematologists, cardiologists, and pharmacologists jointly released to improve the practical management of patients at risk for AF and bleeding during treatment with IB. A proper pretreatment assessment to identify patients who are at a higher risk, careful choice of concomitant drugs, regular monitoring, and multispecialist approach were characterized as the main principles of clinical management of these patients. For patients developing AF, anticoagulant and antiarrhythmic therapy must be guided by considerations about efficacy, safety, and risk of pharmacokinetic interactions with IB. For patients experiencing bleeding or requiring procedures that increase the risk of bleeding, considerations about platelet turnover, IB-related platelet dysfunctions, and bleeding worsening by concomitant anticoagulants or antiplatelet agents provide clues to manage bleeding. Overall, AF and bleeding are manageable clinical events in patients receiving IB, not requiring drug interruption in most cases. Preexisting AF should not represent an absolute contraindication to IB therapy. For each patient candidate for IB, strategies of risk assessment and mitigation may allow to exploit the life-saving effects of in chronic lymphocytic leukaemia and mantle cell lymphoma.

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“…The tremendous development of AF ablation widened this gap even more and created a hypothetical competition between interventional and pharmacological rhythm control strategies. However, it is more than obvious that catheter ablation alone cannot be applied to the 33 million patients with AF expected in the next ten years [ 6 , 7 ], if we take into account the limited availability of specialized human resources, the very large costs, eminent procedure limitations, and contraindications or patient's preferences. Also, as demonstrated by a contemporary European registry, the ablation success is increased by AAD reinforcement therapy [ 8 ] from 63% to 83% and the residual AF risk remains high after ablation.…”

Section: Introductionmentioning

confidence: 99%

Antiarrhythmic drugs for atrial fibrillation: Imminent impulses are emerging

Dan

Dobrev

2018

IJC Heart & Vasculature

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Rhythm and rate strategies are considered equivalent for the management of atrial fibrillation (AF). Moreover, both strategies are intended for improving symptoms and quality of life. Despite the clinical availability of several antiarrhythmic drugs (AAD) the alternatives for the patient with comorbidities are significantly fewer because of the concern regarding many adverse effects, including proarrhythmias. The impetuous development of AF ablation gave rise to a false impression that AAD are a second line therapy. All these statements reflect, in fact, the weakness of the classical paradigm and classification regarding AAD and the gap between the current knowledge of AF mechanism and determinants and the "classical" AAD non-discriminatory action. A new paradigm in development of effective and safe AAD is based on modern knowledge of vulnerable parameters involved in the genesis and perpetuation of AF. New AAD will target specific triggers of AF and ion currents which are expressed preferentially in fibrillatory atrium. Such targets will include repolarizing currents and channels, as ultrarapid potassium current, two pore potassium current, the acetylcholine-gated potassium current, small-conductance calcium-dependent potassium channels, but, also, molecular targets involved in intracellular calcium kinetics, as Ca2+-calmodulin–dependent protein kinase, ryanodine receptors and non-coding miRNA. New mechanistic discoveries link AF to inflammation and modern anti-cytokine drugs. There is still a long way to win between basic research and clinical practice, but, without any doubt, antiarrhythmic drug therapy will remain and develop as a cornerstone therapy for AF not in conflict, but complementary and alternative to interventional therapy.

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The changing circumstance of atrial fibrillation ‐ progress towards precision medicine

Cited by 29 publications

References 129 publications

Atrial high-rate episodes and stroke prevention

Atrial high-rate episodes and stroke prevention

Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding

Antiarrhythmic drugs for atrial fibrillation: Imminent impulses are emerging

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