Real World Usage of Oral Anticoagulants in Patients Undergoing Electrical Cardioversion for Atrial Tachyarrhythmias

Abstract

BACKGROUND: Dysautonomia is thought to affect up to 1% of teenagers and is associated with significant impairments in quality of life (QoL). There are limited therapeutic options for physicians managing adolescents with dysautonomia. Typically, advice is given about fluid and salt balance, as well as physical counter pressure movements. In this pilot study, we sought to determine whether adolescents with dysautonomia improve their QoL following a prescribed body weight resistance training program. METHODS: Participants were referred with symptoms of dysautonomia and underwent a full cardiac assessment including an exercise test. QoL questionnaires (Peds QL) were completed by participants and their parents prior to starting the home-based exercise program. Exercises consisted of: squats, squat holds, lunges, planks, hip bridges, and step ups. Participants were asked to perform 3 sets of 15 repetitions, 5 days per week. Isometric exercises were held longer over the course of the program. Participants were asked to keep a log of the days they completed the exercises as well as their symptoms. Contact was made over the course of the program to ensure compliance and to ensure that the family felt supported. After 8-weeks, participants returned for a repeat exercise test and QoL questionnaires. RESULTS: We enrolled 11 participants, 7 completed the study protocol (Age: 15.1 yrs (13.1-15.5); Height: 164 cm (157-181); Weight: 59.0 kg (51.6-68.0)). Two were excluded due to other medical issues, one did not complete the exercise program, and one was lost to follow-up. All participants completed the exercises at least 3 times per week, up to the prescribed 5 days per week. QoL scores were significantly higher in the participants post intervention [41.67 (32.61-80.43) vs 72.21 (40.22-95.65); p¼0.027]. Parent proxy reports for the QoL of their teens also improved [45.0 (28.26-79.34) vs 73.8 (41.3-100.0); p¼0.046]. The Cohen's d¼0.85 suggests a large clinically relevant effect size. There was no significant change in treadmill time [600 seconds (300-779) vs 591 (480-840); p¼0.138]. CONCLUSION: This is the first study to demonstrate that an 8week body weight resistance training program can improve QoL in adolescents with dysautonomia.

Prevalence of Left Atrial Appendage Thrombus in Patients Anticoagulated With Direct Oral Anticoagulants: Systematic Review and Meta-analysis

“…Although it is true that patients enrolled in RCTs are likely different in regard to medication compliance and baseline characteristics, real-life data examining the safety of withholding TEE in patients appropriately anticoagulated on DOAC confirm RCT data. 24,25 Kaplan et al 25 reviewed more than 600 patients who underwent cardioversion after 3 weeks of DOAC therapy and observed a low stroke rate at 30 days (2/600). It is important to note, however, that the safety of using DOAC in cardioversion is based on the low incidence of thromboembolic events rather than LAAT.…”