Heart rhythm : the official journal of the Heart Rhythm Society
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Randomized Controlled Trial Comparative Study
Continuation of warfarin during pacemaker or implantable cardioverter-defibrillator implantation: a randomized clinical trial.
Management of oral anticoagulation in patients undergoing pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) implantation remains controversial. Prior studies demonstrate that continuation of warfarin may be safer when compared with strategies requiring interruption and/or heparin bridging. Limited data from randomized trials exist. ⋯ While the results were not statistically significant, there was a trend toward reduced complications in patients randomized to warfarin continuation. This strategy should be considered in patients undergoing PPM or ICD implantation.
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Randomized Controlled Trial Comparative Study
General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study.
Radiofrequency catheter ablation of atrial fibrillation can be performed under general anesthesia or conscious sedation at the physician's preference. ⋯ The use of general anesthesia is associated with higher cure rate with a single procedure, and it seems to reduce the prevalence of PV reconnection observed at the time of repeat ablation.
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Atrial fibrillation is associated with an increased risk of embolic events. The left atrial appendage (LAA) is believed to be an incubator for thrombus formation. LAA exclusion has been advocated to potentially reduce embolic events arising from the LAA. ⋯ Catheter-based surgical suture ligation of the LAA is feasible in humans. This novel catheter approach may be appropriate for patients with atrial fibrillation who are ineligible for anticoagulation therapy. Further investigation is needed to demonstrate the long-term safety and efficacy of LAA closure.
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Comparative Study
Value of the signal-averaged electrocardiogram in arrhythmogenic right ventricular cardiomyopathy/dysplasia.
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited disease that causes structural and functional abnormalities of the right ventricle (RV). The presence of late potentials as assessed by the signal-averaged electrocardiogram (SAECG) is a minor task force criterion. ⋯ Using 1 of 3 SAECG criteria contributed to increased sensitivity and specificity for the diagnosis of ARVC/D. This finding is incorporated in the recent modification of the task force criteria.