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Latest Developments in Cardiology This Week
For the week ending February 14, 2025, John Mandrola, MD, discusses significant topics including silent cerebral embolism after left atrial appendage closure (LAAC), the role of artificial intelligence in ECG rhythm analysis, anti-thrombotic strategies for patients with atrial fibrillation and coronary artery disease, and guidelines for treating subclinical atrial fibrillation.
Silent Cerebral Embolism after LAAC
A recent study from Nanjing, China, explored the incidence of silent cerebral embolism (SCE) following left atrial appendage closure (LAAC). The study involved 75 patients who underwent LAAC, with pre- and post-procedure MRI scans as well as neurocognitive tests conducted at various intervals post-procedure.
Key findings include:
- 39% of patients experienced SCE post-procedure, with most resolving by 45 days.
- Those with late SCE also showed significant cognitive decline.
- Neurocognitive tests using the Mini-Mental State Examination and Montreal Cognitive Assessment revealed these effects.
Dr. Mandrola emphasizes that cognitive decline is particularly concerning in elderly patients and highlights the need for more extensive research on the long-term neurological impact of LAAC.
AI in ECG Rhythm Monitoring
Researchers have published a study in Nature Medicine evaluating the effectiveness of DeepRhythm AI ECG rhythm monitoring system compared to traditional ECG technicians. This randomized controlled trial involved 5200 rhythm events read by 167 ECG technicians and a DeepRhythm AI system.
Findings show:
- The AI model detected critical arrhythmias with a sensitivity of 98.6%, compared to 80.3% by ECG technicians.
- AI reduced false-negative findings by 14 times, though it had a higher rate of false positives.
Dr. Mandrola praises the study for validating the AI’s accuracy and outlines potential benefits, such as improved access to care and cost reduction in ambulatory ECG monitoring.
Optimizing Anticoagulation in Patients with CAD and Atrial Fibrillation
A meta-analysis in JACC examines the effectiveness of oral anticoagulation (OAC) alone versus OAC combined with single antiplatelet therapy (SAPT) in patients with both atrial fibrillation (AF) and stable coronary artery disease (CAD).
Main takeaways:
- No significant difference was found in efficacy outcomes between OAC monotherapy and OAC plus SAPT.
- Bleeding outcomes were better for patients receiving OAC alone.
Dr. Mandrola advocates for more frequent use of OAC monotherapy, particularly in patients with diabetes or men. However, he acknowledges racial differences in thrombotic and bleeding risks remain a consideration.
Anticoagulants for Subclinical Atrial Fibrillation: A Closer Look
ARTESIA, a large trial comparing apixaban to aspirin in patients with subclinical AF, demonstrated a reduction in stroke and systemic embolism risk but also increased major bleeding risk.
A recent subgroup analysis in Lancet Neurology finds benefits of apixaban in reducing stroke risk among patients with a history of stroke or transient ischemic attack (TIA). However, the analysis faced limitations, including small sample size and unadjusted multiplicity issues.
Dr. Mandrola suggests caution in interpreting subgroup findings and advocates for further research to validate these observations.
Conclusion
Recent research presents both advancements and challenges in the management of cardiac conditions. Studies on LAAC, AI in ECG analysis, anticoagulation strategies, and subclinical AF treatment provide valuable insights that could transform patient care.
Continued innovation and research are vital to improving clinical outcomes and patient safety. For the latest updates and in-depth commentary, subscribe to the This Week in Cardiology podcast on Apple Podcasts, Spotify, or your preferred podcast provider.
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