American Heart Association

Monthly Archives: January 2022

Article Commentary: “Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure”

Meghana Srinivas, MD
@SrinivasMeghana

Lusk JB, Xu H, Peterson ED, Bhatt DL, Fonarow GC, Smith EE, Matsouaka R, Schwamm LH, Xian Y. Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke. 2021;52:e777–e781.

When aspirin fails, what’s next? The use of aspirin for cardiovascular disease dates back to the 1950s to 1960s. It is only until very recently that studies have shown its lack of benefit in primary prevention of cardio and cerebrovascular diseases. In the United States, more than 40% of adults over the age of 70 years take aspirin for primary prevention of cardiovascular diseases, and more than 70% of patients of any age with a history of cardiovascular disease take daily aspirin. What’s next if patients who are taking aspirin for stroke prevention experience an ischemic stroke?

What can be tried? Increasing the dose of aspirin, adding a second drug, or switching to an alternate antiplatelet agent are often considered, but there is no evidence of superiority of one over the other. This study by Jay B. Lusk et al. used data from the American Heart Association Get with the Guidelines (GWTG) Stroke Registry to study the prevalence of aspirin failure in older patients who present with acute ischemic stroke and describe their discharge prescription pattern of antithrombotic therapy for secondary prevention of stroke.

By |January 5th, 2022|clinical|Comments Off on Article Commentary: “Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure”
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Delaying the Progression of AF: What is the Role of Catheter Ablation?

Wern Yew Ding, MBChB

Kuck KH, Lebedev DS, Mikhaylov EN, Romanov A, Gellér L, Kalējs O, Neumann T, Davtyan K, On YK, Popov S, et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). Europace. 2021;23:362-369.

Atrial fibrillation (AF) is closely linked to atrial cardiomyopathy and associated with structural and electrical remodelling that develops as the condition progresses. Currently, AF is classified based on a crude assessment of the estimated duration of each episode. Progression of AF is often signalled by an increase in AF burden, which is related to poorer outcomes, including excess thromboembolism. Therefore, halting (or even reversing) AF progression is of clinical importance.

In this study by Kuck and colleagues, the authors investigated whether catheter AF ablation could delay the progression of AF compared with drug therapy. To this end, they performed a study among patients aged equal or over 60 years old with symptomatic paroxysmal AF who were randomized to either radio frequency catheter ablation (RFCA) or anti-arrhythmic drug (AAD) therapy. The study was terminated prematurely due to slow enrolment; at the time of termination, 255 (79%) of the planned 322 patients were enrolled. Over a follow-up period of 3 years, the primary endpoint for the rate of persistent AF or atrial tachycardia was significantly lower with RFCA compared to AAD therapy (2.4% vs. 17.5%). The rate of any recurrent AF or atrial tachycardia was also significantly lower with RFCA over AAD therapy (49.2% vs. 84.8%). Serious adverse events occurred in 12 (11.8%) patients in the radiofrequency ablation arm.

By |January 3rd, 2022|clinical|Comments Off on Delaying the Progression of AF: What is the Role of Catheter Ablation?
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