BackgroundAtrial fibrillation (AF) is the most common clinical arrhythmia and one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. Despite substantial advances in (interventional) rhythm control treatment during the last decade, anticoagulation for stroke prevention remains a major component of AF treatment.HypothesisThere are important sex‐specific differences in AF‐related stroke, resulting from sex‐specific mechanisms and therapeutic differences.MethodsThis review summarizes available data on sex differences in risk assessment and prevention of stroke and highlights current knowledge gaps in AF‐related stroke mechanisms, prevention and management that warrant further research.ResultsIncreased thrombotic risk in women is multifactorial, involving hormonal changes after menopause, structural, endocrine and lifestyle/social factors and their interactions. It is clear from randomized studies that women benefit from anticoagulant treatment and that their bleeding risk is similar to men. Women should therefore receive equivalent treatment to men, based on the validated criteria for anticoagulation therapy. However, women are not represented equally in the large randomized studies and sex‐related information in many fields is lacking.ConclusionsFemale sex is an established risk factor for stroke in AF patients. The evidence for sex‐specific differences in stroke risk assessment and stroke prevention is accumulating. However, the underlying biological mechanisms remain incompletely understood and further studies are required in order to decrease AF‐related morbidity and mortality.
Nowadays the standard care for patients at high risk of sudden cardiac death (SCD) or life-threatening ventricular arrhythmias is the implantable cardioverter-defibrillator (ICD) and its variants (S-ICD, CRT-D). Although in the past ICD implantation was associated with routine defibrillation threshold (DFT) testing, recently more and more centers worldwide are abandoning DFT testing, considering the balance between the clinical benefit and increased procedural risks. In spite of this new approach, the usefulness/ suitability of DFT testing -the "to test or not to test" debate -still remains a matter of intense dispute among cardiologists. We present a brief history of ICDs and DFT testing along with the results of key/compelling studies on DFT testing and the management of patients with a high defibrillation threshold.
CRT represents the transition from the heart rhythm therapy, started more than 60 years ago with the first pacemakers, to the optimization therapy of myocardial contractility in heart failure. It is estimated that about a quarter of the population of patients with heart failure have electrical and mechanical criteria for cardiac asynchrony. They are the target of resynchronization therapy. The current indications for resynchronization therapy use basic selection criteria, without having high predictive power in terms of response to treatment. About one-third of patients undergoing resynchronization are found to be non-responsive to therapy. In this study we tested a new direction in our effort to increase the number of post-resynchronization beneficiaries, using markers of oxidative stress in patients with heart failure, assessed before and after intervention, with promising results.
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