Lesions typical of atheroembolism are apparent on the feet (Panel A) of a 65-year-old man who had undergone left heart catheterization through the femoral approach four weeks earlier. Nonoliguric renal failure developed (serum creatinine, 5.5 mg per deciliter [490 m mol per liter]), and livedo reticularis and cutaneous infarcts were present on both feet, with preserved distal pulses. A transesophageal echocardiogram of the descending thoracic aorta showed multiple complex, pedunculated, mobile, protruding lesions presumed to be atheromas (arrows in Panel B), the probable source of embolism.
Atrial fibrillation (AF) is associated with increases in the risk of mortality, congestive heart failure, and stroke. Medical treatment is aimed at preventing thrombo-embolic complications and reducing symptoms and consequences related to the arrhythmia. In the first section of this review, we discuss the principles of mainstream oral anticoagulant therapy and the possible advantages of the new oral anticoagulants. In the second section, we review the catheter ablation approaches to paroxysmal and persistent/long-standing AF, their results, and the current application of new catheters.
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