The aim of this pilot study is to determine the pattern of oral anticoagulant and antiplatelet use in patients with permanent atrial fibrillation (AF) in Irish general practice.

Worldwide, AF is the most common sustained cardiac arrhythmia in adults and poses a significant burden to patients, physicians and healthcare systems. There is a five-fold increased risk of stroke with AF, and AF-related strokes are associated with higher levels of both morbidity and mortality compared to other stroke subtypes. Thankfully, appropriate use of oral anticoagulation (OAC) for AF can reduce the risk of stroke by up to 64%. However, we know that patients are commonly undertreated with OAC, prescribed inappropriate doses of OAC and have prolonged use of an antiplatelet agent in addition to OAC without indication.

A descriptive, cross-sectional observational study was undertaken. Proportionate sampling was used across 11 practices from the Ireland East practice-based research network. The general practitioners completed a report form on each patient provided by the research team by undertaking a retrospective chart review.

Eleven practices participated with a total number of 1855 patients with AF. We received data on 153 patients.

The main findings from this pilot project are that:

1. 1. 11% of patients were undertreated with OAC

2. 2. 20 % of patients were on an incorrect non-vitamin K antagonist oral anticoagulant dose

3. 3. 28 patients (18%) were inappropriately prescribed combination antithrombotic therapy

Undertreatment and underdosing of OAC expose patients to higher risk of thromboembolic events, bleeding and all-cause mortality. Prolonged combination antithrombotic therapy is associated with serious increased risk of bleeding with no additional stroke protection. This pilot project highlights several gaps between guidelines and clinical practice. By identifying these areas, we hope to develop a targeted quality improvement intervention using the electronic health records in general practice to improve the care that those with AF receive.

There are no comprehensive studies on sexual dysfunctions among people with paroxysmal and persistent atrial fibrillation after excluding concomitant somatic and mental disorders, even though their presence has a significant impact on observed changes in sexual activity and behaviour. Most of the available studies among males are focused on erectile dysfunction due to well established relationship of it with the occurrence of cardiovascular disorders in the future.

The aim of the study was to assess the prevalence of sexual disorders among male patients treated for paroxysmal and persistent atrial fibrillation.

The study group included 54 men diagnosed with paroxysmal and persistent atrial fibrillation, qualified for electrical cardioversion and/or ablation of circumferential pulmonary vein, not burdened with additional somatic diseases. The control group consisted of 55 men matched in terms of sex, age and health condition. The study used standard CSFQ-14 sexuality assessment questionnaires, and the WHOQoL-BREF quality of life survey. Mental status examination was performed to exclude those with mental disorders, currently or in the past receiving psychiatric and/or addiction treatment.

The analysis of the survey studies showed that among the surveyed men with paroxysmal and persistent atrial fibrillation, the prevalence of sexual problems is high (61.1% study group vs 47.3% control group). There were significant differences between the study group with lower sexual function scores in pleasure, desire/interest, arousal/erection, orgasm/ejaculation, and in the overall CSFQ-14’s score. The desire/frequency ratio did not differ between the groups.

Comprehensive care requires the assessment of sexual satisfaction and the presence of possible dysfunctions using standardized tools.

No significant relationships.

Various electrocardiogram (ECG)-based devices are available for home monitoring, but the reliability in adults with CHD is unknown. Therefore, we determined the accuracy of different ECG-based devices compared to the standard 12-lead ECG in adult CHD.

This is a single-centre, prospective, cross-sectional study in 176 consecutive adults with CHD (54% male, age 40 ± 16.6 years, 24% severe CHD, 84% previous surgery, 3% atrial fibrillation (AF), 24% right bundle branch block). Diagnostic accuracy of the Withings Scanwatch (lead I), Eko DUO (precordial lead), and Kardia 6L (six leads) was determined in comparison to the standard 12-lead ECG on several tasks: 1) AF classification (percentage correct), 2) QRS-morphology classification (percentage correct), and 3) ECG intervals calculation (QTc time ≤ 40 ms difference). Both tested AF algorithms had high accuracy (Withings: 100%, Kardia 6L: 97%) in ECGs that were classified. However, the Withings algorithm classified fewer ECGs as inconclusive (5%) compared to 31% of Kardia (p < 0.001). Physician evaluation of Kardia correctly classified QRS morphology more frequently (90% accuracy) compared to Eko DUO (84% accuracy) (p = 0.03). QTc was underestimated on all ECG-based devices (p < 0.01). QTc duration accuracy was acceptable in only 51% of Withings versus 70% Eko and 74% Kardia (p < 0.001 for both comparisons).

Although all devices demonstrated high accuracy in AF detection, the Withings automatic algorithm had fewest uninterpretable results. Kardia 6L was most accurate in overall evaluation such as QRS morphology and QTc duration. These findings can inform both patients and caregivers for optimal choice of home monitoring.

Atrial fibrillation (AF) is the most important cause of embolic stroke of undetermined source (ESUS). Implantable loop recorder (ILR) demonstrated the highest sensitivity for detecting it. This register was created to confirm the high prevalence of AF in patients after ESUS and to verify possible benefits on clinical outcomes such as TIA (Transient Ischaemic Attack)/stroke recurrence and death using ILR.

A total of 278 patients admitted to “Molinette” Hospital in Stroke Unit department between 2011 and 2016, diagnosed with ESUS, underwent ILR implantation if they had at least one risk factor for AF. A total of 165 patients admitted to other departments in the same center for the same pathology, without ILR, represent the control group. We used propensity score to select 132 patients from each group (matching age, sex, CHADS-VASC, and HAS-BLEED baseline characteristics).

The detection rate of AF episodes was significantly higher in the ILR group (p < 0.001). No significant protective role of ILR for clinical endpoints was found on univariate analysis, although a trend towards significance has been pointed for the composite outcome of death and ischemic events recurrence (OR 0.52, CI 0.26–1.04, p = 0.06). A protective role of ILR was found for deaths (OR 0.4, CI 0.17–0.94, p 0.03) and for the composite outcome (OR 0.41, CI 0.19–0.87, p 0.02) on multivariate analysis in the best subsets.

With our statistical models, we identified a significant clinical benefit from ILR monitoring, evidenced by a trend of less death and TIA/stroke recurrence and relevant ILR protection for prediction of TIA/stroke recurrence.

Annually, 15% of patients who receive oral anticoagulation require interruption for surgery or an invasive procedure. This study evaluates the adherence of patients with atrial fibrillation with a history of stroke or transient ischemic attack to the Thrombosis Canada Perioperative guidelines for the discontinuation and reinitiation of anticoagulation treatment.

We collected data from a prospective patient survey at the Stroke Prevention Clinic in the University of Alberta hospital. Patients’ charts were reviewed from the electronic medical records, and adherence was looked at according to the Thrombosis Canada Perioperative guidelines for the interruption of anticoagulants.

During the study period (2016–2019), there were 509 patients surveyed. Anticoagulation treatment was interrupted in 150 patients with 98 interrupted for surgical or invasive procedures. The interruption was adherent to guidelines in only 29 (29.6%) of patients and inappropriate or nonadherent in 69 (70.4%) patients. There were seven ischemic strokes recorded during the period of interruption. The proportion of strokes was higher in patients whose anticoagulation interruption was longer than what the guidelines recommended (6/61 or 9.8%) when compared to those who adhered to recommended perioperative anticoagulation guidelines (1/29 or 3.4%).

Our results indicate that significant discrepancy with following the recommended perioperative anticoagulation guidelines is common in real-life practice. Delay in re-anticoagulation may increase the risk of complications.

A one-channel electrocardiogram (ECG) channel is recommended during electroencephalogram (EEG) recordings principally to help establish ECG or pulse wave contamination of the ECG EEG. However, the ECG recording, in itself, provides useful clinical information, principally the detection of arrhythmias, especially atrial fibrillation (AF), which indicates heart disease that can predispose to embolic stroke and systemic embolism. We sought to determine the prevalence of AF routine recordings in our EEG laboratory in a general hospital.

We reviewed the consecutive EEG reports for the past 7 years to determine how often AF was detected in various age groups.

We found AF in 0–0.2% per decade of life until age 60–69 years, 2.7% for 70–79 years, 5% for 80–89 years, and 8% for 90–99 years.

We suggest that the ECG trace should be carefully analyzed for AF, especially in patients over 60 years of age. When detected, it should be brought to the referring doctor’s attention.

The use of selectiveserotonin reuptake inhibitors (SSRIs) is an independent risk factor for bleeding events. Antidepressants and oral anticoagulants (OACs) are often prescribed together as depression and anxiety often coexist with cardiovascular diseases, atrial fibrillation and thromboembolic disorders. Serotonin is released from platelets in response to vascular injury, promoting aggregation. Inhibition of serotonin transporter (responsible for the uptake of serotonin into platelets) can lead into a reduced ability to form clots and a subsequent increase in the risk of bleeding. Direct oral aticoagulants (DOACs), rivaroxaban, apixaban and edoxaban are primarily metabolized via CYP3A4. The co-administration of antidepressants with inhibitory effects on CYP3A4 may theoretically interact with them.

Presentation of a case of upper gastrointestinal bleeding after initiation of Apixaban in a patient taking Sertraline and literature review.

We carried out a literature review in Pubmed electing those articles focused on bleeding risk between newer direct oral antigulants and selective serotinin reuptake inhibitors.

A 66-year-old woman sought medical assistance for generalized ecchymosis and melena. She was diagnosed with atrial fibrillation treated with apixaban 7 days ago. Concomitant treatment between apixaban and sertraline was the possible cause of upper gastrointestinal bleeding and ecchymosis. We had to switch sertraline into vortioxetine (with less dregree of serotonin reuptake inhibition) and add proton-pump inhibitor (Omeprazole) in order to decrease the risk of bleeding.

SSRIs increase the risk of gastrointestinal bleeding, much more in case of concomitant use of oral anticoagulants. If SSRI use cannot be avoided, monitor closely and prescribe proton pump inhibitors.

Psychosis itself may be associated with an increased risk of atrial fibrillation. Moreover, antipscyhotic treatment increases this risk. Recently D’Urso et al. reported aripiprazole-induced atrial fibrillation in a patient with concomitant risk factors.

To the best of author’s knowledge no data has been published about the safety and the efficacy of lurasidone treatment in psychotic patient with comorbid atrial fibrillation.

A 68 years old patient with persistent atrial fibrillation and hypertension in treatment with amiodarone 100 mg/day, lurasidone 25 mg/day, rivaroxaban 15 mg/day, clopidogrel 75 mg/day, bisoprolol 1,25 mg/day, tamsulosin 0,4 mg/day presented delusional ideas of jealousy for not real betrayal by his wife, social withdrawal, reduced sleep. Blood pressure 130/80 mmHg, heart rate 70 bpm, Qtc 420 msec. The patient was drug-naïve for any psychotropic treatment. The authors decided to start lurasidone treatment at the dosage of 18,5 mg/day.

After the first administration of lurasidone treatment sleep was resolved. After two weeks delusional ideas and social withdrawal were markedly improved. After one month of treatment, blood pressure, heart rate and Qtc remained almost stable. The authors decided not to increase the dosage of lurasidone because of the age of the patient and the comorbid cardiovascular pathologies.

Lurasidone has showed safety and efficacy in the treatment of this patient with delusional disorder and comorbid atrial fibrillation. This is a preliminary data that requires follow up and further studies to confirm the usefulness of lurasidone in psychotic patients with atrial fibrillation and cardiovascular risks.

No significant relationships.