Dôsledný prístup lekára k antikoagulačnej liečbe je zásadným faktorom ovplyvňujúcim úspešnosť primárnej a sekundárnej prevencie ischemickej cievnej mozgovej príhody. V klinickej praxi neurológ rieši otázku antikoagulačnej liečby predovšetkým u pacientov s cievnou mozgovou príhodou, či už došlo k jej vzniku na liečbe antikoagulanciami, alebo vznikla u pacienta bez antikoagulačnej terapie, no diagnostický proces odhalil etiologický faktor vyžadujúci takýto typ liečby. Obzvlášť náročné je rozhodovanie o načasovaní antikoagulačnej liečby po príhode. Dôležitý je aj výber konkrétneho preparátu, jeho dávkovanie a zváženie individuálnych rizikových faktorov.

A consistent approach to anticoagulant therapy is a crucial factor influencing the success of primary and secondary prevention of ischaemic stroke. In clinical practice, neurologists deal with anticoagulant treatment mainly in patients who have experienced a stroke, whether it occurred during anticoagulant therapy or in those without such treatment but an etiological factor requiring anticoagulation was identified during the diagnostic process. Deciding on the timing of anticoagulant therapy after stroke is particularly challenging. Equally important is the choice of a drug, its dosage, and consideration of individual risk factors.

• MeSH
• antikoagulační přemostění klasifikace   metody   MeSH
• antikoagulancia * farmakologie   klasifikace   terapeutické užití   MeSH
• dabigatran farmakologie   terapeutické užití   MeSH
• fibrilace síní diagnóza   farmakoterapie   MeSH
• ischemická cévní mozková příhoda * diagnóza   farmakoterapie   prevence a kontrola   MeSH
• rivaroxaban farmakologie   terapeutické užití   MeSH
• warfarin farmakologie   terapeutické užití   MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. METHODS: We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). RESULTS: We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P = 0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P = 0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. CONCLUSIONS: Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.).

• MeSH
• antikoagulancia * škodlivé účinky   terapeutické užití   MeSH
• Aspirin * škodlivé účinky   terapeutické užití   MeSH
• cévní mozková příhoda * etiologie   prevence a kontrola   MeSH
• dvojitá slepá metoda MeSH
• embolie * etiologie   prevence a kontrola   MeSH
• fibrilace síní * komplikace   diagnóza   MeSH
• inhibitory faktoru Xa škodlivé účinky   terapeutické užití   MeSH
• krvácení chemicky indukované   MeSH
• lidé MeSH
• pyridony škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Kanada MeSH

This study aimed to evaluate the ability of selected microRNAs as biomarkers of atrial fibrillation (AF) in ischemic stroke patients in comparison with other established biochemical biomarkers. A prospective case-control study of consecutive ischemic stroke patients with AF admitted to a comprehensive stroke center was conducted. The control group consisted of patients with ischemic stroke with no AF detected on prolonged (at least 3 weeks) Holter ECG monitoring. As potential biomarkers of AF, we analyzed the plasma levels of microRNAs (miR-21, miR-29b, miR-133b, miR-142-5p, miR-150, miR-499, and miR-223-3p) and 13 biochemical biomarkers at admission. The predictive accuracy of biomarkers was assessed by calculating the area under the receiver operating characteristic curve. The data of 117 patients were analyzed (61 with AF, 56 with no AF, 46% men, median age 73 years, median National Institutes of Health Stroke Scale 6). Biochemical biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity cardiac troponin I, fibrinogen, C-reactive protein, eGFR, and total triglycerides) were significantly associated with AF. NT-proBNP had the best diagnostic performance for AF with area under the receiver operating characteristic curve 0.92 (95%, CI 0.86-0.98); a cutoff value of >528 ng/L had a sensitivity of 79% and a specificity of 97%. None of the other biomarkers, including microRNAs, was associated with AF. Conventional biochemical biomarkers (NT-proBNP, high-sensitivity cardiac troponin I, fibrinogen, C-reactive protein, eGFR, and triglycerides), but not microRNAs (miR-21, miR-29b, miR-133b, miR-142-5p, miR-150, miR-499, and miR-223-3p) were significantly associated with AF in our ischemic stroke cohort.

• MeSH
• biologické markery * krev   MeSH
• C-reaktivní protein analýza   MeSH
• fibrilace síní * krev   diagnóza   genetika   MeSH
• ischemická cévní mozková příhoda * krev   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikro RNA * krev   MeSH
• natriuretický peptid typu B krev   MeSH
• peptidové fragmenty krev   MeSH
• prospektivní studie MeSH
• ROC křivka MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

INTRODUCTION: Pulsed electric field (PEF) has emerged as a promising energy source for catheter ablation of atrial fibrillation (AF). However, data regarding the in-vivo effect of PEF energy on erythrocytes during AF ablation procedures are scarce. This study aimed to quantify the impact of PEF energy on erythrocyte damage during AF ablation by assessing specific hemolytic biomarkers. METHODS: A total of 60 patients (age: 68 years, males: 72%, serum creatinine: 91 μmol/L) with AF underwent catheter ablation of AF using PEF energy delivered by a multipolar pentaspline Farawave catheter (Farapulse, Boston Scientific, Inc.). Ablation beyond pulmonary vein isolation was performed at the operator's discretion. Peripheral venous blood was sampled for assessing the plasma levels of free hemoglobin (fHb), direct (conjugated) bilirubin, lactate dehydrogenase (LDH), and creatinine before, immediately after the ablation, and on the next day. RESULTS: Following the PEF ablation with duration of [median (interquartile range)] 75 (58, 95) min, with 74 (52, 92) applications and PVI only in 27% of patients, fHb, LDH, and direct bilirubin significantly increased, from 40 (18, 65) to 493 (327, 848) mg/L, from 3.1 (2.6, 3.6) to 6.8 (5.0, 7.9) μkat/L, and from 12 (9, 17) to 28 (16, 44) μmol/L, respectively (all p < .0001). A strong linear correlation was found between the peak fHb and the number of PEF applications (R = 0.81, p < .001). The major hemolysis (defined as fHb >500 mg/L) was predicted by the number of PEF applications with the corresponding area under the receiver operating characteristic curve of 0.934. The optimum cut-off value of >74 PEF applications predicted the major hemolysis with 89% sensitivity and 87% specificity. CONCLUSION: Catheter ablation of AF using PEF energy delivered from a pentaspline catheter is associated with significant intravascular hemolysis. More than 74 PEF applications frequently resulted in major hemolysis. However, the critical amount of PEF energy that may cause kidney injury in susceptible patients remains to be investigated.

• MeSH
• bilirubin krev   MeSH
• biologické markery * krev   MeSH
• časové faktory MeSH
• design vybavení MeSH
• erytrocyty MeSH
• fibrilace síní * chirurgie   diagnóza   patofyziologie   krev   MeSH
• hemoglobiny metabolismus   MeSH
• hemolýza * MeSH
• katetrizační ablace * škodlivé účinky   přístrojové vybavení   MeSH
• kreatinin krev   MeSH
• L-laktátdehydrogenasa krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční katétry MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• antiarytmika terapeutické užití   MeSH
• antikoagulancia terapeutické užití   MeSH
• fibrilace síní * diagnóza   patofyziologie   terapie   MeSH
• katetrizační ablace metody   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Fibrilace síní je nejčastější setrvalou arytmií u pacientů s hypertrofickou kardiomyopatií. Souhrnný článek se zabývá komplexními mechanismy vedoucími k rozvoji fibrilace síní u této skupiny pacientů a specifickými aspekty její terapie (zejména antikoagulační terapie a přístupy k udržení sinusového rytmu). Závěrečná část je věnována vlivu arytmie na klinickou symptomatologii a prognózu pacientů s hypertrofickou kardiomyopatií.

Atrial fibrillation is the most common sustained arrhythmia in patients with hypertrophic cardiomyopathy. The review article focuses on the complex mechanisms of development of atrial fibrillation in this subgroup of patients and on specific aspects of treatment (anticoagulation therapy and rhythm control). The final part focuses on the arrhythmia's effect on clinical symptomatology and prognosis of patients with hypertrophic cardiomyopathy.

• MeSH
• antiarytmika farmakologie   terapeutické užití   MeSH
• antikoagulancia farmakologie   terapeutické užití   MeSH
• dilatace patologická etiologie   komplikace   MeSH
• elektrokardiografie metody   MeSH
• fibrilace síní * diagnóza   etiologie   farmakoterapie   MeSH
• hodnocení rizik metody   MeSH
• hypertrofická kardiomyopatie * komplikace   MeSH
• lidé MeSH
• tromboembolie prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Akutní končetinová ischemie (acute limb ischemia, ALI) představuje zásadní hrozbu pro životaschopnost končetin vyžadující urgentní revaskularizační intervence. V této kazuistice popisujeme případ 47leté Asiatky s bilaterální ALI v důsledku těžké mitrální stenózy (MS) revmatické etiologie a fibrilace síní (FS) se zanedbanou úpravou mezinárodního normalizačního poměru (INR). Pacientka byla přivezena do nemocnice s náhlou klidovou bolestí obou dolních končetin, již namodralých a naprosto bez čití. Echokardiografické vyšetření prokázalo těžkou MS revmatické etiologie spolu s trombem v oušku levé síně. CT angiogram odhalil téměř úplně obturující trombus v místě odstupu horní břišní aorty. Okamžitě byla provedena bilaterální tromboembolektomie, po níž došlo ke zlepšení stavu, a pacientka byla nakonec propuštěna z nemocnice ve stabilizovaném stavu. Pro optimální výsledek v případě ALI zahrnujících současně MS a FS jsou absolutně nezbytné vhodná antikoagulační terapie, důsledné monitorování INR a použití vhodné strategie k náhradě chlopně.

Acute limb ischemia (ALI) poses a critical threat to limb viability, necessitating urgent revascularization interventions. This case report discusses a 47-year-old Asian woman with bilateral ALI due to severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), with neglected international normalized ratio (INR) control. The patient presented with sudden bilateral leg pain at rest, accompanied by bluish discoloration and sensory loss. Echocardiographic findings indicated severe rheumatic MS along with a thrombus in the left atrial appendage. The computed tomography angiogram revealed a near-total thrombus originating from the upper abdominal aorta. Immediate bilateral thromboembolectomy was performed. Subsequent improvements were observed, and the patient was eventually discharged in stable condition. Proper anticoagulant therapy, vigilant INR monitoring, and a strategic approach to valve replacement are crucial for optimizing outcomes in cases of ALI involving concurrent MS and AF.

• MeSH
• akutní nemoc terapie   MeSH
• antikoagulancia farmakologie   terapeutické užití   MeSH
• diagnostické zobrazování metody   MeSH
• dolní končetina * patologie   MeSH
• fibrilace síní diagnóza   etiologie   farmakoterapie   MeSH
• INR metody   normy   MeSH
• ischemie * chirurgie   etiologie   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální stenóza etiologie   komplikace   MeSH
• revmatická karditida * komplikace   MeSH
• trombektomie metody   MeSH
• trombotická příhoda chirurgie   farmakoterapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear. METHODS AND RESULTS: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients). CONCLUSIONS: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.

• MeSH
• antikoagulancia * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• aplikace orální MeSH
• časové faktory MeSH
• cévní mozková příhoda * prevence a kontrola   etiologie   MeSH
• dvojitá slepá metoda MeSH
• fibrilace síní * farmakoterapie   komplikace   diagnóza   MeSH
• kardiostimulátor MeSH
• krvácení chemicky indukované   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tranzitorní ischemická ataka * prevence a kontrola   etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Cryoballoon ablation for treatment of atrial fibrillation (AF) reduces procedure times, but limited data is available about its impact on electrophysiology (EP) lab efficiency in Central and Eastern Europe (CEE). Using CEE-specific procedure data, the present study modeled cryoballoon ablation procedures on EP lab resource consumption to improve efficiency. METHODS: A discrete event simulation model was developed to assess EP efficiency with cryoballoon ablation. Model inputs were taken from CEE sites within the Cryo Global Registry, namely Czech Republic, Hungary, Poland, Serbia, and Slovakia. The main endpoints were percentage of days that resulted in overtime and percentage of days with time for one extra simple EP procedure. Use of the 'figure of 8' (Fo8) closure technique to reduce procedure time was also examined. RESULTS: The mean lab occupancy time across all CEE sites was 133 ± 47 minutes (min: 104 minutes, max:181 minutes). Cryoballoon ablation in the base-case scenario resulted in 14.6% of days with overtime and 64.8% of days with time for an extra simple EP procedure. Use of the Fo8 closure technique enhanced these values to 5.5% and 85.3%, respectively. Model endpoints were most sensitive to changes in lab occupancy times and overtime start time. CONCLUSIONS: In this CEE-specific analysis of EP lab efficiency it was found that 3 cryoballoon ablation procedures could be performed in 1 lab day, leaving time for a 4th simple EP procedure on most days. As such, use cryoballoon ablation for PVI is an effective way to improve EP lab efficiency.

• MeSH
• časové faktory MeSH
• délka operace MeSH
• elektrofyziologické techniky kardiologické MeSH
• fibrilace síní * chirurgie   patofyziologie   diagnóza   MeSH
• kryochirurgie * MeSH
• lidé MeSH
• registrace * MeSH
• venae pulmonales * chirurgie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• východní Evropa MeSH

BACKGROUND: Aficamten, a novel cardiac myosin inhibitor, reversibly reduces cardiac hypercontractility in obstructive hypertrophic cardiomyopathy. We present a prespecified analysis of the pharmacokinetics, pharmacodynamics, and safety of aficamten in SEQUOIA-HCM (Safety, Efficacy, and Quantitative Understanding of Obstruction Impact of Aficamten in HCM). METHODS AND RESULTS: A total of 282 patients with obstructive hypertrophic cardiomyopathy were randomized 1:1 to daily aficamten (5-20 mg) or placebo between February 1, 2022, and May 15, 2023. Aficamten dosing targeted the lowest effective dose for achieving site-interpreted Valsalva left ventricular outflow tract gradient <30 mm Hg with left ventricular ejection fraction (LVEF) ≥50%. End points were evaluated during titration (day 1 to week 8), maintenance (weeks 8-24), and washout (weeks 24-28), and included major adverse cardiac events, new-onset atrial fibrillation, implantable cardioverter-defibrillator discharges, LVEF <50%, and treatment-emergent adverse events. At week 8, 3.6%, 12.9%, 35%, and 48.6% of patients achieved 5-, 10-, 15-, and 20-mg doses, respectively. Baseline characteristics were similar across groups. Aficamten concentration increased by dose and remained stable during maintenance. During the treatment period, LVEF decreased by -0.9% (95% CI, -1.3 to -0.6) per 100 ng/mL aficamten exposure. Seven (4.9%) patients taking aficamten underwent per-protocol dose reduction for site-interpreted LVEF <50%. There were no treatment interruptions or heart failure worsening for LVEF <50%. No major adverse cardiovascular events were associated with aficamten, and treatment-emergent adverse events were similar between treatment groups, including atrial fibrillation. CONCLUSIONS: A site-based dosing algorithm targeting the lowest effective aficamten dose reduced left ventricular outflow tract gradient with a favorable safety profile throughout SEQUOIA-HCM. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05186818.

• MeSH
• benzylaminy MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• fibrilace síní farmakoterapie   diagnóza   patofyziologie   MeSH
• funkce levé komory srdeční * účinky léků   MeSH
• hypertrofická kardiomyopatie * patofyziologie   farmakoterapie   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• tepový objem * účinky léků   MeSH
• uracil analogy a deriváty   MeSH
• výsledek terapie MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH