- Original ArticleAug 28, 202210.1056/NEJMoa2206485
In a prospective global study, extravascular implantable cardioverter–defibrillators with a substernal lead were implanted safely and were able to detect and terminate induced ventricular arrhythmias at the time of implantation.
- EditorialAug 28, 202210.1056/NEJMe2210187
The landscape for stroke prevention in atrial fibrillation has been changed by the availability of the direct oral anticoagulants (DOACs) that have been tested in large, prospective, randomized trials for stroke prevention in patients with so-called nonvalvular atrial fibrillation. However, the definition of what is valvular or nonvalvular atrial fibrillation...
- Original ArticleAug 28, 202210.1056/NEJMoa2209051
Among patients with rheumatic heart disease and atrial fibrillation who received a vitamin K antagonist or rivaroxaban, the rate of stroke, systemic embolism, MI, or death from vascular or unknown causes was lower with a VKA, without increased bleeding.
- N Engl J Med 2022; 387:565-567
This interactive feature about screening for atrial fibrillation in asymptomatic older adults offers a case vignette accompanied by two essays, one supporting screening and the other supporting deferral of screening.
- N Engl J Med 2022; 386:1953-1954
This case report describes a patient in Sweden who had an out-of-hospital cardiac arrest and received defibrillation with an automated external defibrillator delivered by a drone (shown in a video).
- N Engl J Med 2022; 386:1647-1657
A 56-year-old man presented in early autumn with a 1-month history of myalgias and fever. His heart rate was 48 beats per minute. An electrocardiogram showed sinus bradycardia and complete heart block; cardiac imaging showed inflammatory changes in the epicardial fat abutting the noncoronary sinus of the aortic valve. A...
- N Engl J Med 2021; 385:2150-2160
In a randomized trial involving patients who had atrial fibrillation after TAVR, edoxaban was noninferior to vitamin K antagonists with respect to a composite outcome of death, MI, stroke, thromboembolism, valve thrombosis, or major bleeding but was associated with a higher incidence of major bleeding.
- N Engl J Med 2021; 385:466-468
This interactive feature about management of atrial fibrillation offers a case vignette accompanied by two essays supporting different approaches to the use of anticoagulants after ablation for atrial fibrillation.
- N Engl J Med 2021; 385:65-65
An 83-year-old woman presented with swelling and discoloration of the right side of the tongue. An electrocardiogram revealed atrial fibrillation. CT angiography was performed, and a diagnosis of right lingual-artery thromboembolism was made.
- N Engl J Med 2021; 384:2306-2316
In a postmortem study, HIV-positive persons were found to have higher rates of presumed sudden cardiac death and myocardial fibrosis than persons without known HIV infection. Approximately one third of apparent sudden cardiac deaths in HIV-positive persons were due to occult drug overdose.
- N Engl J Med 2021; 384:e83
A 58-year-old man presented with dizziness and palpitations that occurred only while speaking. Continuous electrocardiographic monitoring (shown in a video) revealed atrial premature beats while the patient was speaking isolated words and sustained atrial tachycardia when he was speaking full sentences.
- N Engl J Med 2021; 384:2081-2091
In a randomized trial, 4811 patients with atrial fibrillation were assigned to undergo or not undergo left atrial appendage occlusion during cardiac surgery for another indication. At 3 years, 77% of the patients continued to receive oral anticoagulation. At 3.8 years, the risk of ischemic stroke or systemic embolism was...
- N Engl J Med 2021; 384:2154-2155
It is widely accepted that the increased risk of stroke among patients with atrial fibrillation is substantially due to embolization of thrombi that develop in the left atrial appendage. On the basis of multiple randomized trials showing that the risk of stroke is reduced with oral anticoagulation therapy among high-risk...
- N Engl J Med 2021; 384:e63
A 75-year-old man presented with dizziness and swelling of the face and arms. CT of the chest showed occlusion of the superior vena cava resulting from thrombus encasement of pacemaker leads.
- N Engl J Med 2021; 384:374-375
Catheter ablation of atrial fibrillation by means of pulmonary vein isolation has undergone substantial improvements in efficacy and safety since it was introduced 20 years ago, and it has become an established treatment for patients with symptomatic atrial fibrillation.1 Although clinical practice guidelines have generally recommended at least...
- N Engl J Med 2021; 384:305-315
Patients with symptomatic, paroxysmal, untreated atrial fibrillation were randomly assigned to antiarrhythmic drug therapy or cryoablation. At 1 year, there was a significantly lower rate of recurrence of atrial fibrillation with cryoablation than with drug therapy.
- N Engl J Med 2021; 384:316-324
In this multicenter trial involving patients with paroxysmal atrial fibrillation who had not previously received rhythm-control treatment, cryoballoon ablation resulted in a significantly higher percentage of patients with treatment success at 1 year than antiarrhythmic drug therapy, with a low incidence of procedure-related adverse events.
- N Engl J Med 2021; 384:353-361
Management of atrial fibrillation includes therapy for treatable risk factors, anticoagulation based on estimated stroke risk, rate control, and in appropriate circumstances, catheter ablation or antiarrhythmic drugs to maintain sinus rhythm.
- N Engl J Med 2020; 383:2117-2126
In this randomized trial comparing rivaroxaban with dose-adjusted warfarin in patients with atrial fibrillation and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin with respect to the mean time until the primary outcome of death, major cardiovascular events, or major bleeding at 12 months.
- N Engl J Med 2020; 383:1735-1745
Elderly patients with atrial fibrillation who were not appropriate candidates for standard doses of oral anticoagulants because of a high risk of bleeding were assigned to receive 15 mg of edoxaban or placebo once daily. Edoxaban was superior to placebo in preventing stroke or systemic embolism.