Medicine and Health Sciences Commons^™

Sociodemographic Determinants Of Oral Anticoagulant Prescription In Patients With Atrial Fibrillations: Findings From The Pinnacle Registry Using Machine Learning, Zahra Azizi, Andrew T. Ward, Donghyun J. Lee, Sanchit S. Gad, Kanchan Bhasin, Robert J. Beetel, Tiago Ferreira, Sushant Shankar, John S. Rumsfeld, Salim S. Virani

Office of the Provost

Background: Current risk scores that are solely based on clinical factors have shown modest predictive ability for understanding of factors associated with gaps in real-world prescription of oral anticoagulation (OAC) in patients with atrial fibrillation (AF).
Objective: In this study, we sought to identify the role of social and geographic determinants, beyond clinical factors associated with variation in OAC prescriptions using a large national registry of ambulatory patients with AF.
Methods: Between January 2017 and June 2018, we identified patients with AF from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) Registry. We examined associations between patient …

Clinical Characteristics And Prognostic Factors Of Atrial Fibrillation At A Tertiary Center Of Pakistan – From A South-Asian Perspective – A Cross-Sectional Study, Intisar Ahmed, Aiysha Nasir, Pirbhat Shams, Hunaina Shahab, Muhammad Hassan, Faryal Subhani, Ghurfan Adnan, Awais Farhad, Aamir Hameed, Yawer Saeed

Section of Cardiology

Background: There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward.
Objectives: To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan.
Methods: This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July-December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or …

Switching Warfarin To Direct Oral Anticoagulants In Atrial Fibrillation: Insights From The Ncdr Pinnacle Registry, Christopher T. Sciria, Thomas M. Maddox, Lucas Marzec, Benjamin Rodwin, Salim S. Virani, Amarnath Annapureddy, James V. Freeman, Ali O'Hare, Yuyin Liu

Office of the Provost

Background: Previous studies examining the use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) have largely focused on patients newly initiating therapy. Little is known about the prevalence/patterns of switching to DOACs among AF patients initially treated with warfarin.
Hypothesis: To examine patterns of anticoagulation among patients chronically managed with warfarin upon the availability of DOACs and identify patient/practice-level factors associated with switching from chronic warfarin therapy to a DOAC.
Methods: Prospective cohort study of AF patients in the NCDR PINNACLE registry prescribed warfarin between May 1, 2008 and May 1, 2015. Patients were followed at least 1 year …

Increase In Organization Index Predicts Atrial Fibrillation Termination With Flecainide Post-Ablation: Spectral Analysis Of Intracardiac Electrograms, Jiun Tuan, Faizel Osman, Jeilan Mohamed, Suman Kundu, Rajkumar Mantravadi, Peter J. Stafford, G. André Ng

Internal Medicine, East Africa

Aims: The mechanism of the action of flecainide in the termination of human atrial fibrillation (AF) is not fully understood. We studied the acute effects of flecainide on AF electrograms in the time and frequency domain to identify factors associated with AF termination.

Methods and results: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. Dominant frequency (DF) and organization index (OI) were obtained by fast Fourier transform of electrograms from the coronary sinus catheter over 10 s in AF, before and after flecainide infusion. Mean AF cycle length (CL) was …

Ganglionic Plexus Ablation During Pulmonary Vein Isolation--Predisposing To Ventricular Arrhythmias?, Faizel Osman, Suman Kundu, Jiun Tuan, Jeilan Mohamed, Peter J. Stafford, G. Andre' Ng

Internal Medicine, East Africa

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation. Reduced vagal modulation is known to predispose to ventricular arrhythmias and vagal denervation following AF ablation may predispose to ventricular arrhythmias and requires further study.