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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 5 | Issue 2
Page Nos. 19-32

Online since Thursday, January 28, 2021

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ORIGINAL ARTICLES  

Real-world experience with percutaneous left atrial appendage closure in patients with atrial fibrillation in China (English version) p. 19
Shaobo Shi, Tao Liu, Bin Kong, Bo Cui, Yu Liu, Gang Wu, Qinyan Zhao, Bo Yang, Congxin Huang, He Huang
DOI:10.4103/ijhr.ijhr_11_20  
Background: This study aimed to display the real-world application of percutaneous left atrial appendage closure (LAAC) in patients with atrial fibrillation (AF) through analyzing the clinical data and operation information. Materials and Methods: AF patients who had received LAAC were selected from the database of China AF Center from November 2018 to November 2019. The clinical characteristics, surgical parameters, surgical complications, and end-of-operation rhythm were collected and analyzed. Comparisons of clinical characteristics, rate of success, and complications were performed between the simple LAAC group and the LACC combined with catheter ablation group. The study was approved by the Expert Committee of the Chinese AF Center in 2019. The study trial was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR1900021250) on February 3, 2019. Results: A total of 2001 eligible patients from 175 hospitals were included in the final analysis in this real-world study, with 1178 males (58.9%). The mean age was 69.4 years (29–91 years). The proportion of paroxysmal AF was 44.6% (892 patients). The mean of CHA2DS2-VASC score congestive heart failure, hypertension, age ≥75 [doubled], diabetes mellitus, prior stroke or transient ischemic attack [doubled], vascular disease, age 65–74, female) and HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [>65 years], and drugs/alcohol concomitantly) was 3.7 and 3.9, respectively. The main occluder was Watchman (1,276/2,001, 63.8%), surgical complications were 9.5% (190 patients), residual peri-device flow was 5.1% (102 patients), success rate was 98.9% (1979 patients), and final sinus rhythm was 63.4% (1269 patients). Compared with the simple LAAC group (1,075 patients, 53.7%), the LACC combined with catheter ablation group (926 patients, 46.3%) was younger, with a higher proportion of paroxysmal AF (624 [67.4%] vs. 268 [24.9%], P < 0.001), higher CHA2DS2-VASC score (4.0 ± 1.5 vs. 3.7 ± 1.4, P < 0.001), lower HAS-BLED score (3.6 ± 1.6 vs. 3.9 ± 1.2, P < 0.001), lower residual peri-device flow (26 [2.8%] vs. 76 [7.1%], P < 0.001), and higher sinus rhythm after surgery (96.7% vs. 34.8%, P < 0.001). However, the rates of success (99.2% vs. 98.7%, P = 0.275) and complications (9.7% vs. 9.3%, P = 0.670) were similar. Conclusion: There is a high success rate and low incidence of severe complications in the real-world use of LAAC in patients with AF. LAAC combined with catheter ablation is also safe and effective due to lower complications and higher proportion of sinus rhythm.
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Comprehensive management workflow of atrial fibrillation raises the compliance of patients: An observational cross-sectional study p. 25
Weizhuo Liu, Jian Li, Bangwei Wu, Nanqing Xiong, Peng Zhou, Liwen Bao, Kun Xie, Xiufang Gao, Yutao Wang, Haiming Shi, Xinping Luo
DOI:10.4103/ijhr.ijhr_12_20  
Background: Low compliance works as a significant limitation to the treatment effect of patients with atrial fibrillation (AF) during clinical practice. This study aimed to evaluate the influence of a recently established AF management platform on AF workflow, including diagnosis, treatment, and follow-up. Participants and Methods: Patients diagnosed with AF from January 2015 to February 2019 in Huashan Hospital, Fudan University, were enrolled and classified into two groups depending on their hospital visits before (Group 1) or after (Group 2) platform establishment in this observational cross-sectional study. Clinical characteristics, including clinical comorbidities, medications, and clinical events, were compared before and after the establishment of AF management platform. This study was approved by the Institutional Review Board of Huashan Hospital, Fudan University (approval No. KY2019-552), in May 2019. Results: In this study, 8343 hospital visits by patients were involved in Group 1 and 13,294 records in Group 2, from which several key points could be shown: (1) a downward trend in various comorbidities; (2) the follow-up frequency distinctly increased, especially among outpatients with low CHA2DS2-VASc scores; (3) a significant increase in anticoagulant use in patients with different stroke risks; and (4) the main indicators that affected anticoagulant use differed between the two groups. Conclusion: This comprehensive management platform can raise the compliance of AF patients, which shows superiority to conventional workflow in overall effect.
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CASE REPORT Top

Acute decompensated heart failure increases the anticoagulation effect of dabigatran: A case report p. 30
Le Geng, Jiaojiao Shi, Mingfang Li, Minglong Chen
DOI:10.4103/ijhr.ijhr_8_20  
Dabigatran is a widely used non-Vitamin K antagonist oral anticoagulant and has demonstrated a better efficacy and safety profile compared to Vitamin K antagonists. However, in some specific situations, the bleeding risk of dabigatran will be much increased. A 76-year-old female atrial fibrillation patient with concomitant nonrheumatic mitral valve regurgitation and chronic heart failure was described. She was on dabigatran 110 mg twice a day. On day 2 after admission, the patient presented with acute decompensated heart failure, the creatinine clearance level markedly decreased from 40.9 mL/min to 23.1 mL/min, and the trough-activated partial thromboplastin time exceeded the detection range. In this clinical context, renal and coagulation function should be monitored closely to avoid severe adverse events, especially major bleeding. Low-molecular-weight heparin might be considered to be applied temporarily, and rivaroxaban may be prescribed in this condition. The ethical approval was waived by the institutional review board of our hospital owing to the retrospective nature of the study.
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