Notes

Electrophysiological and medicinal characterization associated with dispersing depolarization from the mature zebrafish tectum.
It has been shown that gout is associated with left atrium remodeling and a pro-inflammatory state leading to the development of atrial fibrillation (AF). There is limited evidence whether gout increases the risk of stroke in patients with AF. We assessed the incidence of gout and the risk of stroke in patients with AF.

This is a retrospective cohort study using the 2016 US National Inpatient Sample (NIS) based on ICD-10 codes. The outcomes of the study were the risk and severity of new stroke in patients with pre-existing AF and gout.

In 2016, we identified 3844057 patients admitted to the hospitals in NIS with history of AF, of which 240875 had history of gout. STM2457 price Patients with AF and gout have higher risk of new stroke (OR 2.07 [1.97-2.19],
<.001), and this risk remains significantly elevated after adjusting for CHADS2VASC score variables, chronic kidney disease, dyslipidemia, obesity, and race (OR 1.10 [1.01-1.11],
=.041). However, presence of gout in patients with AF was not associated with all-cause in-hospital mortality, need for mechanical ventilation, percutaneous gastrostomy tube insertion, or discharge to skilled nursing facility.

Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Subjects with AF and gout compared to AF alone had an increased risk of new stroke, but presence of gout was not associated with stroke severity. There is a potential role of gout as a risk factor or a risk marker for stroke in subjects with AF.
Studies indicate that uninterrupted anticoagulation (UA) is superior to interrupted anticoagulation (IA) in the periprocedural period during catheter ablation of atrial fibrillation. Still IA is followed in many centers considering the bleeding risk. This meta-analysis compares interrupted and uninterrupted direct oral anticoagulation during catheter ablation of atrial fibrillation.

A systematic search into PubMed, EMBASE, and the Cochrane databases was performed and five studies were selected that directly compared IA vs UA before ablation and reported procedural outcomes, embolic, and bleeding events. The primary outcome of the study was major adverse cerebro-cardiovascular events.

The meta-analysis included 840 patients with UA and 938 patients with IA. Median follow-up was 30days. Activated clotting time (ACT) before first heparin bolus was significantly longer with UA (
=.006), whereas mean ACT was similar between the two groups (
=.19). Total heparin dose needed was significantly higher with IA (mean, ‒1.61; 95% CI, ‒2.67 to ‒0.55;
=.003). Mean procedure time did not vary between groups (
=.81). Overall complication rates were low, with similar major adverse cerebro-cardiovascular event (
=.40) and total bleeding (
=.55) rates between groups. Silent cerebral events (SCEs) were significantly more frequent with IA (log odds ratio, ‒0.90; 95% CI, ‒1.59 to ‒0.22;
<.01;

, 33%). Rates of major bleeding, minor bleeding, pericardial effusion, cardiac tamponade, and puncture complications were similar between groups.

UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.
UA during atrial fibrillation ablation has similar bleeding event rates, procedural times, and mean ACTs as IA, with fewer SCEs.
Direct oral anticoagulants (DOACs) are the recommended first-line therapy for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the safety and effectiveness of edoxaban for this indication requires monitoring over the long term in real-world settings.

ETNA-AF-Japan (trial no. UMIN000017011) was a prospective, multicenter observational study (part of postmarketing surveillance in Japan). NVAF patients due to receive edoxaban to prevent ischemic stroke were enrolled between 13 April 2015 and 30 September 2017.

A total of 11569 patients were enrolled. For the 11111 patients (female, 40.6%) whose data comprised the safety analysis set, age, body weight, creatinine clearance (CLcr), and CHADS
score were 74.2±10.0years, 60.0±12.7kg, 63.9±25.8mL/min, and 2.2±1.3, respectively (mean±SD). The majority (86.3%) received edoxaban in accordance with package insert information. The mean duration of treatment was 561.9±261.2days. The annual incidence (95% confidence interval) of all bleeding events and major bleeding events was 5.60% (5.25%-5.98%) and 1.02% (0.88%-1.18%), respectively. The annual incidence of ischemic stroke (excluding transient ischemic attack, TIA) or systemic embolism was 1.08% (0.93%-1.25%). Multivariate analysis showed low body weight, low CLcr, history of gastrointestinal bleeding, anemia, and use of an antiplatelet agent to be associated with major bleeding, and history of ischemic stroke or TIA, vascular disease, and antiplatelet agent use to be associated with ischemic stroke (excluding TIA) or systemic embolism.

These results provide real-world evidence for the long-term good safety and effectiveness profile of edoxaban in Japanese NVAF patients under clinical practice.
These results provide real-world evidence for the long-term good safety and effectiveness profile of edoxaban in Japanese NVAF patients under clinical practice.Prior to ventricular tachycardia ablation, this patient's cardiac implantable electronic device (CIED) was temporarily programmed to backup pacing mode with tachycardia therapies disabled. During radiofrequency energy delivery, the patient developed ventricular fibrillation requiring emergent cardioversion. Electrogram interrogation showed that the CIED switched to noise reversion mode during ablation. The consequent asynchronous pacing resulted in a paced QRS landing on an intrinsic T wave, inducing ventricular fibrillation. This serves as an important reminder that asynchronous pacing consequent to CIED oversensing could occur in any procedure that could cause electromagnetic interference such as radiofrequency cathteter ablation.
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