Antithrombotic treatment in chronic heart failure and sinus rhythm: Systematic review

AIM: To assess the efficacy and safety of antithrombotic drugs(antiplatelet or anticoagulant drugs) compared to no antithrombotic treatment or placebo in patients with heart failure(HF) and sinus rhythm. METHODS: We searched Medline and Cochrane Library for randomized controlled trials evaluating antithrombotic treatment and no antithrombotic treatment in patients with HF and sinus rhythm. Risk ratio(RR) and 95%CIs were estimated performing meta-analysis with random effects method. RESULTS: Two studies met the inclusion criteria: Heart failure Long-term Antithrombotic Study and Warfarin/Aspirin Study in Heart failure, with 336 patients and mean follow-up 1.8-2.25 years. Stroke risk was not reduced by acetylsalicylic acid(RR = 1.18, 95%CI: 0.17-8.15), oral anticoagulation(RR = 0.30, 95%CI: 0.03-2.65) or overall antithrombotic drugs(RR = 0.52, 95%CI: 0.10-2.74). Acetylsalicylic acid showed a significant increased risk of worsening HF(RR = 1.78, 95%CI: 1.08-2.92), while oral anticoagulation had no impact in this outcome(RR = 1.03, 95%CI: 0.61-1.75). Overall antithrombotic drugs showed a significant risk increase of major bleeding(RR = 6.99, 95%CI: 0.89-54.64). CONCLUSION: Best available evidence does not support the routine use of antithrombotic drugs in patients with HF and sinus rhythm. These drugs, particularly oral anti-coagulation has the hazard of increase significantly major bleeding risk.

Serum carbohydrate antigen-125 is elevated in patients with chronic atrial fibrillation

Objective： To determine whether CA-125 is elevated in medically stable patients with chronic atrial fibrillation （AF） compared with patients without AF and to examine whether levels of CA-125 are associated with demographic and clinical variables in a sample of patients under study. Methods： 55 patients with chronic AF and 58 control patients in sinus rhythm were included into the study. Patients with acute heart failure （HF）, chronic inflammatory or neoplastic disease were excluded from the study. Circulating levels of CA-125 were assessed; all patients underwent clinical examination, assessment and medical records including demographic data, history of comorbid conditions, current use of cardiac medications, and the results of cardiac tests including electrocardiograms. Results： The mean age of the study sample was 53.2±6.5 years and 48% were men. Patients with sinus rhythm were significantly more likely to have lower heart rates, smaller dimensions of left atrium, and to be treated with aspirin. Coumadin, coumadin and digoxin were more often prescribed in patients with chronic AF. The CA-125 levels were significantly higher in patients with chronic AF than in patients in sinus rhythm （48.5±7.65 U/ml and 28.43±5.48 U/ml, P〈0.005）. An inverse relation was found between CA-125 levels and left ventricular ejection fraction （LVEF） （r=-0.48, P〈0.001）. CA-125 was significantly related to the left atrium （LA） diameter, left ventricular end-diastolic diameter （LVEDD）, left ventricular end-systolic diameter （LVESD） and brain natriuretic peptide （BNP）. There was no significant correlation between CA-125 and age. Conelusion： In subjects with chronic AF, CA-125 levels are increased; CA-125 was significantly related to the LA diameter, LVEDD, LVESD and BNP.

Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation

Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.