Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with bioprosthetic valves.

The non-vitamin K antagonist oral anticoagulants (NOACs), which include dabigatran, apixaban, edoxaban and rivaroxaban, are preferred over vitamin K antagonists for stoke prevention in most patients with non-valvular atrial fibrillation. The NOACs are contraindicated in atrial fibrillation patients with rheumatic mitral stenosis or mechanical heart valves. There is evidence that bioprosthetic heart valves are less thrombogenic than mechanical heart valves, but it is unknown whether the risk of thromboembolism in atrial fibrillation patients with bioprosthetic valves differs from that in patients without such valves.

Real-life experience with a new anticoagulation regimen for patients undergoing left-sided ablation procedures.

Background: Current guidelines for anticoagulation during left-sided procedures recommend the administration of unfractionated heparin (UFH) with an initial bolus of 50-100 U/kg, followed by continuous infusion to maintain an activated clotting time (ACT) ≥ 300 s. Our objective was to compare the effectiveness of this standard regimen (100 U/kg bolus) to a more aggressive approach (200 U/kg bolus).

Methods: We collected data on a series of consecutive patients undergoing left sided ablation procedures.

Intracardiac echo-facilitated 3D electroanatomical mapping of ventricular arrhythmias from the papillary muscles: assessing the 'fourth dimension' during ablation.

Aims: Ventricular arrhythmias (VA) originating from a papillary muscle (PM) have recently been described as a distinct clinical entity with peculiar features that make its treatment with catheter ablation challenging. Here, we report our experience using an intracardiac echo-facilitated 3D electroanatomical mapping approach in a case series of patients undergoing ablation for PM VA.

Methods And Results: Sixteen patients who underwent catheter ablation for ventricular tachycardia (VT) or symptomatic premature ventricular contractions originating from left ventricular PMs were included in the study.

Electrocardiographic monitoring for detecting atrial fibrillation after ischemic stroke or transient ischemic attack: systematic review and meta-analysis.

Background: Atrial fibrillation (AF) is a major cause of stroke. Although standard investigations after an event include electrocardiographic monitoring, the optimal duration to detect AF is unclear. We performed a systematic review and meta-analysis to determine whether the duration of electrocardiographic monitoring after an ischemic event is related to the detection of AF.

16-hour call duty schedules: the Quebec experience.

Since 1 July 2012, as a result of a labour arbitration ruling in the province of Quebec and the subsequent agreement negotiated by the Fédération des médecins résidents du Québec, all 3,400 medical residents training in Quebec have been on a 16-hour duty schedule for in-house calls. This is a major change within medical teaching sites, as well as a professional and educational challenge for physicians-in-training and their supervisors. The Quebec ruling now raises similar issues for all medical residents in Canada because of its legal basis, namely the Canadian Charter of Rights and Freedoms.