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2% and 1.5%, according to age group (<65 or 65 to 74 years of age), and number of non-sex comorbidities of the CHA

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-VASc score (0 or 1). Interestingly, in patients with EHRA Type 2 VHD<65 years of age with 0 or 1 comorbidity, the risk was 1.5% (95% confidence interval 0.7% to 2.8%) and 1.5% (95% confidence interval 0.6% to 3.4%) at 1 year after the atrial fibrillation diagnosis.

These observations suggest that in atrial fibrillation patients with EHRA Type 2 VHD, who are not currently recommended oral anticoagulant therapy according to guidelines, the risk of thromboembolism may exceed the level above which oral anticoagulation is considered beneficial.

These observations suggest that in atrial fibrillation patients with EHRA Type 2 VHD, who are not currently recommended oral anticoagulant therapy according to guidelines, the risk of thromboembolism may exceed the level above which oral anticoagulation is considered beneficial.

The aim of this study was to examine the efficacy and safety of warfarin initiation following the diagnosis of atrial fibrillation (AF) in patients with late-stage chronic kidney disease (CKD) who transitioned to dialysis.

The clinical benefit of warfarin therapy for thromboprophylaxis after incident AF diagnosis in patients with late-stage CKD who are transitioning to dialysis is unknown.

In this retrospective cohort analysis, the study population was a national cohort of 22,771 U.S. veterans with incident end-stage renal disease who developed incident AF before initiating renal replacement therapy. This study examined the association of warfarin therapy following the diagnosis of incident AF with ischemic cerebrovascular accidents (CVAs) (ischemic stroke or transient ischemic attack), ischemic CVA-related hospitalization, major bleeding events (gastrointestinal or intracranial bleeding), bleeding event-related hospitalizations, and post-dialysis, all-cause mortality in multivariable adjusted Cox regrein patients with advanced CKD with incident AF.

In patients with late-stage CKD who transitioned to dialysis, warfarin use was associated with higher risk of ischemic and bleeding events but a lower risk of mortality. Apatinib mw Future studies such as those comparing warfarin with newer oral anticoagulant agents are needed to granularly define the net clinical benefit of anticoagulation therapy in patients with advanced CKD with incident AF.

This study sought to isolate arrhythmogenic Marshall bundles (MBs) by radiofrequency (RF) catheter ablation.

The vein of Marshall (VOM) is surrounded by a muscular bundle called the MB. The MB is 1 of the arrhythmogenic sources of atrial fibrillation (AF) and electrically connects to either the left atrial (LA) myocardium or coronary sinus (CS) musculature. link2 By eliminating such electric connections using RF catheter ablation, the MB might be electrically isolated.

This retrospective study included 20 patients (64 ± 10 years old, 5 women) who underwent an MB isolation for nonparoxysmal AF. After pulmonary vein isolation, we performed venography of the VOM and inserted a 2-F electrode catheter into the VOM. RF applications were delivered to eliminate the MB electrograms from both the LA and CS when the MB was considered arrhythmogenic.

MB isolation was achieved in 14 patients (70%). Of them, complete or partial MB isolation was accomplished in 7 patients (35%) each. The average number of RF applications in the LA (35 W, 30 s) and CS (25 W, 30 s) was 15 ± 14 and 4 ± 3, respectively. No severe adverse events were observed. During a follow-up of 23 ± 11months, 18 patients (90%) maintained sinus rhythm.

RF applications targeting recordings from an electrode catheter in the VOM were feasible, and the MB could be electrically isolated. Elimination of the MB potentials would be a clear endpoint for patients with an arrhythmogenic MB.

RF applications targeting recordings from an electrode catheter in the VOM were feasible, and the MB could be electrically isolated. Elimination of the MB potentials would be a clear endpoint for patients with an arrhythmogenic MB.

The aim of this study was to investigate the procedural efficacy and safety of the novel Watchman FLX (Boston Scientific, Marlborough, Massachusetts) device for left atrial appendage occlusion (LAAO) and to assess the feasibility of intracardiac echocardiography (ICE) to guide implantation.

The Watchman FLX device for transcatheter LAAO was introduced for a simplified implantation in a wider range of LAA anatomies.

This single-center study included consecutive patients undergoing LAAO with the Watchman FLX between March 2019 and January 2020 (N=91). Patients underwent cardiac computed tomography (CT) imaging for pre-procedural planning. Initial procedures were guided by transesophageal echocardiography (TEE; n=8) and thereafter by ICE (n=83) from the left atrium. TEE and cardiac CT imaging were performed at 8weeks' follow-up.

Technical success was achieved in 90 (99%) patients, with the first device implanted in 86 (96%) procedures. Procedural success was 93.4%. Peri-procedural complications occurred in 5 (5.5%), with pericardial effusion being the most common (2.2%). Only 3.3% had a peri-device leak on TEE follow-up. No device-related thrombosis occurred. The mean device compression rate at end of procedure was 18.3 ± 7.7%, compared with 12.2 ± 7.8% by TEE at 8weeks' follow-up (p<0.001) and 5.8 ± 8.8% by cardiac CT imaging at follow-up (p<0.001).

The Watchman FLX device was suitable for closure of a wide range of LAA anatomies, including shallow appendages. The follow-up closure rate was higher than previously reported with other devices. ICE from the left atrium was used, with high procedural success and a low complication rate, comparable to previous studies on LAAO.

The Watchman FLX device was suitable for closure of a wide range of LAA anatomies, including shallow appendages. The follow-up closure rate was higher than previously reported with other devices. ICE from the left atrium was used, with high procedural success and a low complication rate, comparable to previous studies on LAAO.

This study sought to study the relation between outcomes of modified stepwise atrial fibrillation (AF) substrate ablation and dynamic electrogram characteristics in the coronary sinus (CS) and right atrium (RA).

Identifying patients with persistent AF who will benefit from limited lesion sets versus those requiring extensive substrate modification is challenging.

We studied 70 patients undergoing persistent AF ablation, 43 with acute success (successful ablation [sABL], AF termination, or noninducibility) and 27 with failure (failed ablation [fABL], no termination, or induced AF of >5minutes). Dominant frequency (DF) and sample entropy (SampEn, increasing with signal complexity) were measured on 30-second recordings of wide-coverage simultaneous RA and CS electrograms during baseline AF and induced AF post-pulmonary vein isolation and after left-sided electrogram-guided ablation steps (on the CS with or without the left atrium [LA]).

At baseline AF, patients with sABL exhibited lower RA SampEn (p=0 baseline or developing during ablation are associated with unfavorable acute and long-term outcomes of persistent AF ablation. These parameters allow monitoring of the effects of left-sided substrate ablation and, therefore, a rational choice of additional RA substrate modification.

The aim of this study was to assess the safety and efficacy of a new subxiphoid hybrid epicardial-endocardial atrial fibrillation (AF) ablation and left atrial appendage (LAA) ligation approach for the treatment of persistent AF.

Surgical hybrid ablation procedures have shown promise for maintaining sinus rhythm versus catheter ablation but are associated with increased periprocedural adverse events.

Patients with symptomatic persistent AF (n=33, mean age 64 ± 9 years, 25 men) who had antiarrhythmic drug therapy or prior catheter ablation was unsuccessful were referred for hybrid epicardial-endocardial AF ablation and LAA exclusion. LAA closure was confirmed by transesophageal echocardiographic Doppler flow and/or computed tomographic angiography 1 to 3months post-ligation. The incidence of atrial tachycardia or AF recurrence, LAA closure, thromboembolic events, and post-operative complications were assessed.

All 33 patients underwent successful LAA ligation with epicardial ablation of the posterior left atrial wall, as well as endocardial pulmonary vein isolation and cavotricuspid isthmus ablation. Freedom from atrial tachycardia or AF was 91% (20 of 22 patients) at 6months, 90% (18 of 20 patients) at 12months, 92% (11 of 12 patients) at 18months, and 92% (11 of 12) at 24months. There were no acute periprocedural complications (<7days). Thirty-day adverse events included 2 patients with pericardial effusion requiring pericardiocentesis and 1 incisional hernia repair. There were no long-term complications, strokes, or deaths. LAA ligation was complete in 27 of 33 subjects (82%), with 6 subjects having leaks of<5mm.

Subxiphoid hybrid epicardial-endocardial ablation with LAA ligation is feasible, safe, and effective. Future prospective studies are needed to validate these initial findings.

Subxiphoid hybrid epicardial-endocardial ablation with LAA ligation is feasible, safe, and effective. Future prospective studies are needed to validate these initial findings.Adolescence is a period of dramatic developmental transitions-from puberty-related changes in hormones, bodies, and brains to an increasingly complex social world. The concurrent increase in the onset of many mental disorders has prompted the search for key developmental processes that drive changes in risk for psychopathology during this period of life. Hormonal surges and consequent physical maturation linked to pubertal development in adolescence are thought to affect multiple aspects of brain development, social cognition, and peer relations, each of which have also demonstrated associations with risk for mood and anxiety disorders. These puberty-related effects may combine with other nonpubertal influences on brain maturation to transform adolescents' social perception and experiences, which in turn continue to shape both mental health and brain development through transactional processes. In this review, we focus on pubertal, neural, and social changes across the duration of adolescence that are known or thought to be related to adolescent-emergent disorders, specifically depression, anxiety, and deliberate self-harm (nonsuicidal self-injury). We propose a theoretical model in which social processes (both social cognition and peer relations) are critical to understanding the way in which pubertal development drives neural and psychological changes that produce potential mental health vulnerabilities, particularly (but not exclusively) in adolescent girls.Accumulating evidence suggests that the use of cannabis and nicotine and tobacco-related products (NTPs) during the adolescent years has harmful effects on the developing brain. Yet, few studies have focused on the developing brain as it relates to the co-administration of cannabis and NTPs, despite the high prevalence rates of co-use in adolescence. link3 This review aims to synthesize the existing literature on neurocognitive, structural neuroimaging, and functional neuroimaging outcomes associated with cannabis and NTP co-use. A systematic search of peer-reviewed articles resulted in a pool of 1107 articles. Inclusion criteria were 1) data-based study; 2) age range of 13 to 35 years or, for preclinical studies, nonadult subjects; 3) cannabis and NTP group jointly considered; and 4) neurocognitive, structural neuroimaging, or functional neuroimaging as an outcome measure. Twelve studies met inclusion criteria. Consistent with the literature, cannabis and nicotine were found to have independent effects on cognition.