We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group ( P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.
In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.
Late restored cardiac function after successful resynchronization by right posterior accessory pathway ablation in Wolff-Parkinson-White syndrome associated dilated cardiomyopathy.
ObjectivesAlthough drug eluting stents (DES) have documented convenience in bifurcation lesions, possible unfavorable effects on small side branch ostium (SBO) remain a question. We aimed to explore the effects of DES on small jailed SBs (1.5–2.25 mm) which originated from the lesion on the main vessel and were not treated with either stenting or balloon dilatation.MethodsAngiographic data of 107 consecutive patients (129 SB) with Medina 1,1,1 or 1,1,0 lesions were evaluated at the time of procedure and at the follow-up.ResultsOf all DES used, 70 (54.7%) was sirolimus-eluting, 39 (30.5%) was paclitaxel-eluting and 20 (14.8%) was zotarolimus-eluting. The diameter of SBs was 1.84 ± 0.41 mm with a stenosis of 20.7 ± 26.6% at SBO at baseline. The lesion at the SBO had progressed after the procedure when the pre vs postprocedure values and follow-up vs pre-procedure values are compared (20.7 ± 26.6% vs 29.4 ± 27.4%; p < 0.0001 and 25.4 ± 25.1 vs 20.7 ± 26.6%; p = 0.004 respectively). A significant reduction in stenosis was revealed over the follow-up (29.4 ± 27.4 vs 25.4 ± 25.1 respectively; p = 0.013). The severity of the disease at the SBO at baseline was the only parameter that affected the severity of SB stenosis in acute, longterm and follow-up. Additional parameters with influence on SB patency at different times were female gender, stent deployment with low pressure, cTFC of the main lesion, age, cTFC of the lesion, late loss index and the preprocedure TIMI flow grade of the SB.ConclusionsAlthough there was a significant deterioration of SBO immediately after stenting, follow-up data showed that the lesion at SBO improved but remained worse than baseline.
Sener et al in their letter entitled "Predicting Recurrent Thromboembolism in Atrial Fibrillation" 1 raise some queries regarding our article. 2 We report in our article, that sinus rhythm restoration was a better strategy than rate control to reduce recurrent ischemic stroke/transient ischemic attack rates in patients with atrial fibrillation (AF). 2 Renal dysfunction causes increased tendency to thrombosis, and therefore, the R2-CHADS2 (Renal dysfunction, Congestive heart failure, Hypertension, Age, Diabetes, Stroke) score was developed to take the glomerular filtration rate into account when estimating the embolic risk in patients with AF. 3 In our study, renal function was within normal limits.Cancer and anticancer drugs may affect the risk of thrombosis in patients with AF. 4 In our study, patients with cancer and patients using anticancer drugs were excluded. 2 Sener et al 1 mention missing information in our study regarding the use of anticoagulants. We want to point that anticoagulant drug doses and time in therapeutic range in the patients, as expected, were within therapeutic range and the international normalized ratio was between 2 and 3.
ORCID iDMurat Ugurlucan https://orcid.org/0000-0001-6643-9364
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