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Cited by 6,418Atrial Fibrillation Management and OutcomesClinical practice guidelines implementationAcute Ischemic Stroke Management

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Open access
Kirchhof, Paulus, Benussi, Stefano, Kotecha, Dipak, Ahlsson, Anders, Atar, Dan, Casadei, Barbara, Castella, Manuel, Diener, Hans-Christoph +117 more·2016·European Heart Journal
DOI 10.1093/eurheartj/ehw210
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Abstract

The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO) ... ... Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate. A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) and by the European Association for Cardio-Thoracic Surgery (EACTS), as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/Guidelines-development/Writing-ESC-Guidelines). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

AI snapshot

Written from a shortened version of the paper’s full text (it is longer than we read).

TL;DR

This 2016 ESC/EACTS guideline synthesizes evidence and expert consensus for diagnosis, stroke prevention, rate/rhythm control, and integrated care in atrial fibrillation. It recommends oral anticoagulation by CHA₂DS₂-VASc score, NOACs in preference to VKAs when eligible, and symptom-directed rhythm control including catheter or surgical ablation in selected patients.

Key findings

  • AF burden is large: in 2010 an estimated 20.9 million men and 12.6 million women had AF worldwide; one in four middle-aged adults in Europe and the US will develop AF; by 2030, 14–17 million AF patients are anticipated in the European Union; 20–30% of ischaemic strokes have AF diagnosed before, during, or after the event.
  • Stroke prevention: VKA therapy reduces stroke by two-thirds and mortality by one-quarter versus control; a NOAC meta-analysis (42,411 NOAC and 29,272 warfarin patients) reduced stroke/systemic embolism by 19% (RR 0.81; 95% CI 0.73–0.91), lowered mortality by 10% (RR 0.90; 95% CI 0.85–0.95), halved intracranial haemorrhage (RR 0.48; 95% CI 0.39–0.59), and increased gastrointestinal bleeding (RR 1.25; 95% CI 1.01–1.55). OAC is recommended for men with CHA₂DS₂-VASc ≥2 and women ≥3; NOACs are preferred over VKAs when eligible; antiplatelet monotherapy is not recommended.
  • Integrated AF care in an RCT reduced the composite of cardiovascular hospitalization and cardiovascular death over a mean 22 months (14.3% vs 20.8%; HR 0.65; 95% CI 0.45–0.93; P=0.017).
  • Catheter ablation is more effective than antiarrhythmic drugs for maintaining sinus rhythm; sinus rhythm without severely symptomatic recurrences is found in up to 70% of paroxysmal AF and around 50% of persistent AF, with severe complications in 5–7%, life-threatening complications in 2–3%, and intraprocedural death <0.2%. Concomitant AF surgery increased freedom from AF/flutter/tachycardia (RR 1.94; 95% CI 1.51–2.49) but also pacemaker implantation (RR 1.69; 95% CI 1.12–2.54).

Methods

  • Guideline development by an ESC Task Force including EHRA, EACTS, and ESO representation, based on comprehensive review of published evidence; three PICOT questions were answered by commissioned external systematic reviews, and recommendations were graded by class and level of evidence.
  • Draft recommendations were discussed in web-based conference calls, modified by consensus, and voted on online; only recommendations supported by at least 75% of task force members were included.
  • Not a primary study: no single sample or dataset; the document is an evidence synthesis and expert consensus guideline reflecting evidence available at the time of writing.

Limitations

  • Stated: gaps in evidence include rate control, which is “in dire need of better studies”; rhythm control, integrated AF management, and lifestyle modification are still developing evidence; trials are needed for LAA occlusion, severe CKD/dialysis, anticoagulation for atrial high-rate episodes, OAC after bleeding or stroke, catheter ablation in persistent/long-standing persistent AF, and other areas.
  • Stated: some recommendations are based on consensus rather than prospective data, including initiation/continuation of anticoagulation after stroke/TIA and initiation/resumption after intracranial haemorrhage.
  • Evident from the text: many recommendations are Class IIa/IIb with Level B/C evidence, and the guideline notes ongoing trials (e.g., EAST, CABANA, AXAFA, RE-CIRCUIT, ARTESiA, NOAH, LAAOS III) that will inform future practice.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/eurheartj/ehw210

Cites

1040 of 1040 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 814 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The median length of hospital stay in atrial fibrillation patients undergoing their first ablation as part of the EURObservational Research Programme was 3 days (interquartile range 2-4 days), based on data from 1391 patients from hospitals performing at least 50 ablations per year.

    “The median length of hospital stay in AF patients undergoing their first ablation as part of the EURObservational Research Programme (EORP) was 3 days (interquartile range 2-4 days), based on data from 1391 patients from hospitals performing at least 50 ablations per year.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    In a systematic review commissioned for these guidelines, concomitant atrial fibrillation surgery resulted in greater freedom from atrial fibrillation, atrial flutter, and atrial tachycardia (RR 1.94, 95% CI 1.51-2.49; n=554 from seven randomized controlled trials).

    “In a systematic review commissioned for these guidelines, concomitant AF surgery resulted in greater freedom from AF, atrial flutter, and atrial tachycardia (RR 1.94, 95% CI 1.51-2.49;n = 554 from seven RCTs) (Web Addenda Figure 3).1040”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1040]

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  • Premisecitation

    Oral anticoagulation with vitamin K antagonists or non-vitamin K antagonist oral anticoagulants markedly reduces stroke and mortality in AF patients.

    “Oral anticoagulation (OAC) with vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) markedly reduces stroke and mortality in AF patients.38,39”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Hart, 2007, Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation, Ann Intern Med source

      Not checked in the free run.

    • cites [39] Ruff, 2014, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, Lancet source

      Not checked in the free run.

  • Premisecitation

    In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women.

    “In both developed and developing countries, the age-adjusted incidence and prevalence of AF are lower in women, while the risk of death in women with AF is similar to or higher than that in men with AF. 1,46,47”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Chugh, 2014, Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study, Circulation source

      Not checked in the free run.

    • cites [46] Emdin, 2016, Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies, BMJ source

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    • cites [47] Ko, 2016, Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis, Nat Rev Cardiol source

      Not checked in the free run.

  • Premisecitation

    Activation of fibroblasts, enhanced connective tissue deposition, and fibrosis are the hallmarks of structural remodelling in AF.

    “Activation of fibroblasts, enhanced connective tissue deposition, and fibrosis are the hallmarks of this process.[78][79][80]”
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    • cites [78][79][80]

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  • May combine two claims. 143
  • Classified as probably not a substantial claim. 40

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    Findingcitation

    Patients undergoing the Cox maze procedure required pacemaker implantation more often (RR 1.69, 95% CI 1.12-2.54; n=1631 from 17 randomized controlled trials), without a detectable difference in other outcomes or complications.

    “Patients undergoing the Cox maze procedure required pacemaker implantation more often (RR 1.69, 95% CI 1.12-2.54;n = 1631 from 17 RCTs), without a detectable difference in other outcomes or complications.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1040]

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  • May combine two claims.

    Premisecitation

    Rhythm control and rate control improve AF-related symptoms.

    “Other interventions such as rhythm control and rate control improve AF-related symptoms and may preserve cardiac function, but have not demonstrated a reduction in long-term morbidity or mortality.40,41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

      Not checked in the free run.

    • cites [41] Al-Khatib, 2014, Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rhythm control and rate control have not demonstrated a reduction in long-term morbidity or mortality.

    “Other interventions such as rhythm control and rate control improve AF-related symptoms and may preserve cardiac function, but have not demonstrated a reduction in long-term morbidity or mortality.40,41”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

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    • cites [41] Al-Khatib, 2014, Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review, Ann Intern Med source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In contemporary, well-controlled, randomized clinical trials in AF, the average annual stroke rate is about 1.5%.

    “In contemporary, well-controlled, randomized clinical trials in AF, the average annual stroke rate is about 1.5% and the annualized death rate is around 3%. 40”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rhythm control and rate control may preserve cardiac function.

    “Other interventions such as rhythm control and rate control improve AF-related symptoms and may preserve cardiac function, but have not demonstrated a reduction in long-term morbidity or mortality.40,41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

      Not checked in the free run.

    • cites [41] Al-Khatib, 2014, Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    AF is independently associated with a twofold increased risk of all-cause mortality in women and a 1.5-fold increase in men.

    “AF is independently associated with a twofold increased risk of all-cause mortality in women and a 1.5-fold increase in men [20][21][22] (Table 3).”
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    • cites [20][21][22]

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    Premisecitation

    Between 10% and 40% of AF patients are hospitalized each year.

    “between 10% and 40% of AF patients are hospitalized each year.23,34,35”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [23] Kotecha, 2014, Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis, Lancet source

      Not checked in the free run.

    • cites [34] Steinberg, 2014, Drivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), Am Heart J source

      Not checked in the free run.

    • cites [35] Kirchhof, 2014, Management of patients wtih atrial fibrillation by primary care physicians in Germany: 1-year results of the ATRIUM registry, Clin Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A minority of deaths in AF are related to stroke, while sudden cardiac death and death from progressive heart failure are more frequent.

    “A minority of these deaths are related to stroke, while sudden cardiac death and death from progressive heart failure are more frequent, emphasizing the need for interventions beyond anticoagulation.43,44”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [43] Marijon, 2013, Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study, Circulation source

      Not checked in the free run.

    • cites [44] Senoo, 2015, Residual risk of stroke and death in anticoagulated patients according to the type of atrial fibrillation: AMADEUS Trial, Stroke source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In contemporary, well-controlled, randomized clinical trials in AF, the annualized death rate is around 3%.

    “In contemporary, well-controlled, randomized clinical trials in AF, the average annual stroke rate is about 1.5% and the annualized death rate is around 3%. 40”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    20-30% of patients with an ischaemic stroke have AF diagnosed before, during, or after the initial event.

    “Contemporary studies show that 20-30% of patients with an ischaemic stroke have AF diagnosed before, during, or after the initial event.17,26,27”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [17] Kishore, 2014, Detection of atrial fibrillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis, Stroke source

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    • cites [26] Henriksson, 2012, Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke, Int J Stroke source

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    • cites [27] Grond, 2013, Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study, Stroke source

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  • May combine two claims.

    Premisecitation

    Structural remodelling results in electrical dissociation between muscle bundles and local conduction heterogeneities, favouring reentry and perpetuation of the arrhythmia.

    “Structural remodelling results in electrical dissociation between muscle bundles and local conduction heterogeneities, 85 favouring reentry and perpetuation of the arrhythmia.86”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [85] Allessie, 2010, Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease: longitudinal dissociation, Circ Arrhythm Electrophysiol source

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    • cites [86] Spach, 1994, Initiating reentry: the role of nonuniform anisotropy in small circuits, J Cardiovasc Electrophysiol source

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  • May combine two claims.

    Premisecitation

    Women with AF appear less likely to receive specialist care and rhythm control therapy.

    “Bleeding risk on anticoagulation is similar in both sexes, 49,50,53 but women appear less likely to receive specialist care and rhythm control therapy, 54 while the outcomes of catheter ablation or AF surgery are comparable to those in men.55,56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Roten, 2009, Gender differences in patients referred for atrial fibrillation management to a tertiary center, Pacing Clin Electrophysiol source

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    Premisecitation

    Even short episodes of AF lead to myocardial damage and expression of prothrombotic factors on the atrial endothelial surface, and activation of platelets and inflammatory cells, and contribute to a generalized prothrombotic state.

    “Furthermore, even short episodes of AF lead to myocardial damage and expression of prothrombotic factors on the atrial endothelial surface, and activation of platelets and inflammatory cells, and contribute to a generalized prothrombotic state.88,89”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [88] Lim, 2013, Effect of atrial fibrillation on atrial thrombogenesis in humans: impact of rate and rhythm, J Am Coll Cardiol source

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    • cites [89] Hijazi, 2013, Biomarkers in atrial fibrillation: a clinical review, Eur Heart J source

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  • May combine two claims.

    Premisecitation

    Previously undiagnosed AF was found in 1.4% of those aged >65 years, suggesting a number needed to screen of 70.

    “Previously undiagnosed AF was found in 1.4% of those aged > 65 years, suggesting a number needed to screen of 70.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [134] Lowres, 2013, Screening to identify unknown atrial fibrillation, A systematic review. Thromb Haemost source

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    Premisecitation

    There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, for even longer periods, or by daily short-term ECG recording in patients over 75 years of age.

    “There is good evidence that prolonged ECG monitoring enhances the detection of undiagnosed AF, for 72 hours after a stroke, 27,127 for even longer periods, 18,128 or by daily short-term ECG recording in patients over 75 years of age 129 (Web Addenda Figure 1).”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [27] Grond, 2013, Improved detection of silent atrial fibrillation using 72-hour Holter ECG in patients with ischemic stroke: a prospective multicenter cohort study, Stroke source

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    • cites [127] Rizos, 2012, Continuous stroke unit electrocardiographic monitoring versus 24-hour Holter electrocardiography for detection of paroxysmal atrial fibrillation after stroke, Stroke source

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    • cites [18] Sanna, 2014, Cryptogenic stroke and underlying atrial fibrillation, N Engl J Med source

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    • cites [128] Gladstone, 2014, Atrial fibrillation in patients with cryptogenic stroke, N Engl J Med source

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    • cites [129] Friberg, 2013, Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP), Europace source

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  • May combine two claims.

    Premisecitation

    Right atrial isthmus-dependent flutter has a typical ECG pattern and ventricular rate.

    “Right atrial isthmus-dependent flutter has a typical ECG pattern and ventricular rate.158”
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    • cites [158] Bun, 2015, Atrial flutter: more than just one of a kind, Eur Heart J source

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  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is unclear whether AHRE imply the same therapeutic requirements as overt AF.

    “Consequently, it is unclear whether AHRE imply the same therapeutic requirements as overt AF, 148 and the benefit of OAC in patients with AHRE is being evaluation in ongoing clinical trials (e.g.ARTESiA [NCT01938248] and NOAH [NCT02618577]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [148] Lamas, 2012, How much atrial fibrillation is too much atrial fibrillation?, N Engl J Med source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of atrial flutter is less than one-tenth of the prevalence of AF.

    “The prevalence of atrial flutter is less than one-tenth of the prevalence of AF. 159”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [159] Granada, 2000, Incidence and predictors of atrial flutter in the general population, J Am Coll Cardiol source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a small proportion of patients, AF will remain paroxysmal over several decades (2-3% of AF patients).

    “In a small proportion of patients, AF will remain paroxysmal over several decades (2-3% of AF patients).161”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [161] Jahangir, 2007, Long-term progression and outcomes with aging in patients with lone atrial fibrillation: a 30-year follow-up study, Circulation source

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  • May combine two claims.

    Premisecitation

    The EHRA scale has been used and validated.

    “The EHRA scale has been used and validated.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [194] Kirchhof, 2014, Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF), Europace source

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    • cites [195] Lip, 2015, Improved outcomes with European Society of Cardiology guideline-adherent antithrombotic treatment in high-risk patients with atrial fibrillation: a report from the EORP-AF General Pilot Registry, Europace source

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    • cites [196] Freeman, 2015, Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), Circ Cardiovasc Qual Outcomes source

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  • May combine two claims.

    Premisecitation

    Genetic predisposition is independently associated with AF, with HR range 0.4-3.2.

    “Genetic predisposition (based on multiple common gene variants associated with AF) 64 HR range 0.4-3.2”
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    • cites [64] Lubitz, 2014, Novel genetic markers associate with atrial fibrillation risk in Europeans and Japanese, J Am Coll Cardiol source

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    Premisecitation

    A modification was proposed in 2014, subdividing EHRA class 2 into mild (2a) or moderate (2b) impact.

    “A modification was proposed in 2014, subdividing EHRA class 2 into mild (2a) or moderate (2b) impact.”
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    • cites [199] Wynn, 2014, The European Heart Rhythm Association symptom classification for atrial fibrillation: validation and improvement through a simple modification, Europace source

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    Premisecitation

    Older age is independently associated with AF; compared with 50-59 years, HRs are 4.98 for 60-69 years, 7.35 for 70-79 years, and 9.33 for 80-89 years.

    “Older age 19 50-59 years 60-69 years 70-79 years 80-89 years HR: 1.00 (reference) 4.98 (95% CI 3.49-7.10) 7.35 (95% CI 5.28-10.2) 9.33 (95% CI 6.68-13.0)”
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    • cites [19] Schnabel, 2015, 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study, Lancet source

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    Premisecitation

    Many AF patients (15-30%) reported severe or disabling symptoms.

    “While some AF patients had no or minimal symptoms (25-40%), many (15-30%) reported severe or disabling symptoms.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [194] Kirchhof, 2014, Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF), Europace source

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    • cites [196] Freeman, 2015, Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), Circ Cardiovasc Qual Outcomes source

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  • May combine two claims.

    Premisecitation

    AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.

    “AF-related symptoms are most commonly fatigue/tiredness and exertional shortness of breath, or less frequently palpitations and chest pain.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [42] Lip, 2014, Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry), Eur Heart J source

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    • cites [194] Kirchhof, 2014, Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF), Europace source

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    • cites [200] Meinertz, 2011, Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry, Clin Res Cardiol source

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  • May combine two claims.

    Premisecitation

    Thyroid dysfunction is independently associated with AF, with hypothyroidism HR 1.23, subclinical hyperthyroidism RR 1.31, and overt hyperthyroidism RR 1.42 compared with euthyroid.

    “Thyroid dysfunction 206, 207 hypothyroidism subclinical hyperthyroidism overt hyperthyroidism (reference: euthyroid) HR 1.23 (95% CI 0.77-1.97)RR 1.31 (95% CI 1.19-1.44)RR 1.42 (95% CI 1.22-1.63)”
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    • cites [206] Selmer, 2012, The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study, BMJ source

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    • cites [207] Kim, 2014, Relation of hypothyroidism and incident atrial fibrillation (from the Framingham Heart Study), Am Heart J source

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  • May combine two claims.

    Premisecitation

    Chronic kidney disease is independently associated with AF, with stage 1 or 2 OR 2.67, stage 3 OR 1.68, and stage 4 or 5 OR 3.52 compared with none.

    “Chronic kidney disease 211 none stage 1 or 2 stage 3 stage 4 or 5 OR: 1.00 (reference) 2.67 (95% CI 2.04-3.48)1.68 (95% CI 1.26-2.24)3.52 (95% CI 1.73-7.15)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [211] Baber, 2011, Association of chronic kidney disease with atrial fibrillation among adults in the United States: REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, Circ Arrhythm Electrophysiol source

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  • May combine two claims.

    Premisecitation

    Alcohol consumption is independently associated with AF, with 15-21 drinks/week RR 1.14 and >21 drinks/week RR 1.39 compared with none.

    “Alcohol consumption 213 None 1-6 drinks/week 7-14 drinks/week 15-21 drinks/week > 21 drinks/week RR: 1.00 (reference) 1.01 (95% CI 0.94-1.09)1.07 (95% CI 0.98-1.17)1.14 (95% CI 1.01-1.28)1.39 (95% CI 1.22-1.58)”
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    • cites [213] Larsson, 2014, Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis, J Am Coll Cardiol source

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    Premisecitation

    Obesity is independently associated with AF, with overweight HR 1.13 and obese HR 1.37 compared with BMI <25 kg/m2.

    “Obesity 19, 208 none (BMI < 25 kg/m²) overweight (BMI 25-30 kg/m²) obese (BMI ≥ 31 kg/m²) HR: 1.00 (reference) 1.13 (95% CI 0.87-1.46)1.37 (95% CI 1.05-1.78)”
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    • cites [19] Schnabel, 2015, 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study, Lancet source

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    • cites [208] Vermond, 2015, Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: A community-based study from the netherlands, J Am Coll Cardiol source

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    Premisecitation

    Smoking is independently associated with AF, with former smoking HR 1.32 and current smoking HR 2.05 compared with never smoking.

    “Smoking 212 never former current HR: 1.00 (reference) 1.32 (95% CI 1.10-1.57)2.05 (95% CI 1.71-2.47)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [212] Chamberlain, 2011, Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study, Heart Rhythm source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Chronic obstructive pulmonary disease is independently associated with AF, with FEV1 60-80% RR 1.28 and FEV1 <60% RR 2.53 compared with FEV1 ≥80%.

    “Chronic obstructive pulmonary disease 209 FEV1 ≥ 80% 60-80% < 60% RR: 1.00 (reference) 1.28 (95% CI 0.79-2.06)2.53 (95% CI 1.45-4.42)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [209] Buch, 2003, Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study, Eur Respir J source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, but further data are needed.

    “Catheter ablation may be a useful method to restore LV function and quality of life in AF patients with HFrEF, 185,[226][227][228] but further data are needed.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [185] Jones, 2013, A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [226] Anselmino, 2014, Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [227] Ganesan, 2015, Catheter ablation of atrial fibrillation in patients with concomitant left ventricular impairment: a systematic review of efficacy and effect on ejection fraction, Heart Lung Circ source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.

    “For patients who develop HFrEF as a result of rapid AF (tachycardiomyopathy), a rhythm control strategy is preferred, based on several relatively small patient cohorts and trials reporting improved LV function after restoration of sinus rhythm.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [185] Jones, 2013, A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [226] Anselmino, 2014, Catheter ablation of atrial fibrillation in patients with left ventricular systolic dysfunction: a systematic review and meta-analysis, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [227] Ganesan, 2015, Catheter ablation of atrial fibrillation in patients with concomitant left ventricular impairment: a systematic review of efficacy and effect on ejection fraction, Heart Lung Circ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Natriuretic peptide levels are part of the diagnostic assessment of HFpEF, although natriuretic peptide levels are elevated in AF patients and the optimum diagnostic cut-off is still unknown.

    “Natriuretic peptide levels are part of the diagnostic assessment of HFpEF, 222 although natriuretic peptide levels are elevated in AF patients and the optimum diagnostic cut-off is still unknown.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [222] Ponikowski, 2016, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure, Eur Heart J source

      Not checked in the free run.

    • cites [235] Kelly, 2015, Patient selection in heart failure with preserved ejection fraction clinical trials, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Diagnosis of HFmrEF is more difficult in patients with AF, as natriuretic peptides are elevated in AF and LA dilatation is common, regardless of concomitant heart failure.

    “However, diagnosis is more difficult in patients with AF, as natriuretic peptides are elevated in AF and LA dilatation is common, regardless of concomitant heart failure.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF and is lost in patients without heart failure.

    “The reduced incidence of AF with ACE inhibitors/ARBs is less evident in patients with HFpEF 239 and is lost in patients without heart failure.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [239] Ducharme, 2006, Prevention of atrial fibrillation in patients with symptomatic chronic heart failure by candesartan in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) program, Am Heart J source

      Not checked in the free run.

    • cites [240] GISSI-AF Investigators, 2009, Valsartan for prevention of recurrent atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [241] Goette, 2012, Angiotensin II-antagonist in paroxysmal atrial fibrillation (ANTIPAF) trial, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 30% of patients with AF have some form of valvular heart disease, often detected only by echocardiography.

    “Approximately 30% of patients with AF have some form of valvular heart disease, often detected only by echocardiography.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [201] Nabauer, 2009, The Registry of the German Competence NETwork on Atrial Fibrillation: Patient characteristics and initial management, Europace source

      Not checked in the free run.

    • cites [253] Vahanian, 2012, Guidelines on the management of valvular heart disease (version 2012), Eur Heart J source

      Not checked in the free run.

    • cites [254] Nishimura, 2014, 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Valvular heart disease can be associated with an increased thromboembolic risk, which probably also adds to the stroke risk in AF patients.

    “Valvular heart disease can be associated with an increased thromboembolic risk, which probably also adds to the stroke risk in AF patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [263] Halperin, 1988, Atrial fibrillation and stroke: new ideas, persisting dilemmas, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Meta-analyses suggested a lower risk of recurrent AF with ACE inhibitors/ARBs, but at least one controlled trial failed to demonstrate benefit.

    “Meta-analyses driven by these studies suggested a lower risk of recurrent AF, [236][237][238]250 but at least one controlled trial failed to demonstrate benefit.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [236] Schneider, 2010, Prevention of atrial fibrillation by Renin-Angiotensin system inhibition a meta-analysis, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [237] Healey, 2005, Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [238] Jibrini, 2008, Prevention of atrial fibrillation by way of abrogation of the renin-angiotensin system: a systematic review and meta-analysis, Am J Ther source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diabetes is a risk factor for stroke and other complications in AF.

    “Diabetes is a risk factor for stroke and other complications in AF.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [284] Fatemi, 2014, Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study), Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In patients with AF, a longer duration of diabetes appears to confer a higher risk of thromboembolism, albeit without greater risk of OAC-related bleeding.

    “In patients with AF, a longer duration of diabetes appears to confer a higher risk of thromboembolism, albeit without greater risk of OAC-related bleeding.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [285] Overvad, 2015, Duration of Diabetes Mellitus and Risk of Thromboembolism and Bleeding in Atrial Fibrillation: Nationwide Cohort Study, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obese patients may have more LV diastolic dysfunction, increased sympathetic activity and inflammation, and increased fatty infiltration of the atria.

    “Obese patients may have more LV diastolic dysfunction, increased sympathetic activity and inflammation, and increased fatty infiltration of the atria.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [293] Karason, 1999, Heart rate variability in obesity and the effect of weight loss, Am J Cardiol source

      Not checked in the free run.

    • cites [294] Russo, 2011, Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [295] Visser, 1999, Elevated C-reactive protein levels in overweight and obese adults, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity may increase the rate of AF recurrence after catheter ablation, with obstructive sleep apnoea as an important potential confounder.

    “Obesity may increase the rate of AF recurrence after catheter ablation, [298][299][300][301] with obstructive sleep apnoea as an important potential confounder.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [298] Cha, 2008, Catheter ablation for atrial fibrillation in patients with obesity, Circulation source

      Not checked in the free run.

    • cites [299] Jongnarangsin, 2008, Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [300] Guijian, 2013, Impact of body mass index on atrial fibrillation recurrence: a meta-analysis of observational studies, Pacing Clin Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity may also be a risk factor for ischaemic stroke, thromboembolism, and death in AF patients.

    “Obesity may also be a risk factor for ischaemic stroke, thromboembolism, and death in AF patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [292] Overvad, 2013, Body mass index and adverse events in patients with incident atrial fibrillation, Am J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Obesity increases the risk for AF (risk ratio 1.5-1.8), with a progressive increase according to body mass index.

    “Obesity increases the risk for AF (risk ratio 1.5-1.8),[288][289][290][291] with a progressive increase according to body mass index.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [288] Huxley, 2014, Physical activity, obesity, weight change, and risk of atrial fibrillation: the Atherosclerosis Risk in Communities study, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [289] Murphy, 2006, Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study), Eur Heart J source

      Not checked in the free run.

    • cites [290] Wanahita, 2008, Atrial fibrillation and obesity—results of a meta-analysis, Am Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Agents used to relieve bronchospasm, notably theophyllines and betaadrenergic agonists, may precipitate AF and make control of the ventricular response rate difficult.

    “Agents used to relieve bronchospasm, notably theophyllines and betaadrenergic agonists, may precipitate AF and make control of the ventricular response rate difficult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Beta-1 selective blockers (e.g. bisoprolol, metoprolol, and nebivolol), diltiazem, and verapamil are often tolerated and effective.

    “Beta-1 selective blockers (e.g.bisoprolol, metoprolol, and nebivolol), diltiazem, and verapamil are often tolerated and effective”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Patients with chronic obstructive pulmonary disease often suffer from atrial tachycardias, which need to be differentiated from AF by ECG.

    “Patients with chronic obstructive pulmonary disease often suffer from atrial tachycardias, which need to be differentiated from AF by ECG.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Risk factor reduction and continuous positive airway pressure ventilation can reduce AF recurrence.

    “Risk factor reduction and continuous positive airway pressure ventilation can reduce AF recurrence.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [308] Patel, 2010, Safety and efficacy of pulmonary vein antral isolation in patients with obstructive sleep apnea: the impact of continuous positive airway pressure, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [309] Fein, 2013, Treatment of obstructive sleep apnea reduces the risk of atrial fibrillation recurrence after catheter ablation, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [310] Naruse, 2013, Concomitant obstructive sleep apnea increases the recurrence of atrial fibrillation following radiofrequency catheter ablation of atrial fibrillation: clinical impact of continuous positive airway pressure therapy, Heart Rhythm source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AF is present in 15-20% of patients with CKD.

    “AF is present in 15-20% of patients with CKD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [316] Hart, 2013, Stroke prevention in atrial fibrillation patients with chronic kidney disease, Can J Cardiol

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Integrated AF management in an RCT increased the use of evidence-base care and reduced by approximately one-third the composite outcome of cardiovascular hospitalization and cardiovascular death over a mean follow-up of 22 months (14.3% vs. 20.8%, HR 0.65; 95% CI 0.45-0.93; P = 0.017) compared with usual care in a large tertiary care centre.

    “Integrated AF management in an RCT increased the use of evidence-base care and reduced by approximately one-third the composite outcome of cardiovascular hospitalization and cardiovascular death over a mean follow-up of 22 months (14.3% vs. 20.8%,HR 0.65; 95% CI 0.45-0.93;P = 0.017) compared with usual care in a large tertiary care centre.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [330] Hendriks, 2012, Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation, Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Technology, such as decision support software, has the potential to enhance the implementation of evidence-based care and improve outcomes, when used to enhance expert advice.

    “Technology, such as decision support software, has the potential to enhance the implementation of evidencebased care and improve outcomes, when used to enhance expert advice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [338] Hendriks, 2010, An integrated chronic care program for patients with atrial fibrillation: study protocol and methodology for an ongoing prospective randomised controlled trial, Int J Nurs Stud source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An Australian RCT showed only a marginal effect on unplanned admissions and death using integrated AF care limited to the initial care period, possibly emphasizing the need for sustained integration of AF care.

    “However, an Australian RCT showed only a marginal effect on unplanned admissions and death using integrated AF care limited to the initial care period, possibly emphasizing the need for sustained integration of AF care.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [332] Stewart, 2015, Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Electronic tools can also ensure coherent communication within the AF team.

    “Electronic tools can also ensure coherent communication within the AF team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    An integrated, structured approach to AF care, as applied successfully to other domains of medicine, will facilitate consistent, guideline-adherent AF management for all patients, with the potential to improve outcomes.

    “An integrated, structured approach to AF care, as applied successfully to other domains of medicine, 322-324 will facilitate consistent, guideline-adherent AF management for all patients 325 (Figure 6), with the potential to improve outcomes.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [322] Page, 2014, A systematic approach to chronic heart failure care: a consensus statement, Med J Aust source

      Not checked in the free run.

    • cites [323] Stock, 2014, Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care, Health Aff (Millwood) source

      Not checked in the free run.

    • cites [324] Lundstrom, 2014, The effectiveness of structured personal care of type 2 diabetes on recurrent outcomes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP), Diabetologia

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Delayed-enhancement MRI of the left atrium using gadolinium contrast, T1 mapping using cardiac MRI, and intracardiac echo may help to guide treatment decisions in AF, but require external validation in multicentre studies.

    “Delayed-enhancement MRI of the left atrium using gadolinium contrast, [345][346][347] T1 mapping using cardiac MRI, 347 and intracardiac echo 348 may help to guide treatment decisions in AF, but require external validation in multicentre studies.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [345] Mahnkopf, 2014, [Relevance of magnetic resonance imaging for catheter ablation of atrial fibrillation], Herzschrittmacherther Elektrophysiol source

      Not checked in the free run.

    • cites [346] Haemers, 2012, The use of cardiac magnetic resonance imaging in the diagnostic workup and treatment of atrial fibrillation, Cardiol Res Pract source

      Not checked in the free run.

    • cites [347] Ling, 2012, Diffuse ventricular fibrosis in atrial fibrillation: noninvasive evaluation and relationships with aging and systolic dysfunction, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Simple, clinically applicable stroke risk-stratification schemes in AF patients were developed in the late 1990s in small cohort studies and later refined and validated in larger populations.

    “Simple, clinically applicable stroke risk-stratification schemes in AF patients were developed in the late 1990s in small cohort studies and have later been refined and validated in larger populations.[364][365][366][367][368]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [364] The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators, 1998, Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: Stroke Prevention in Atrial Fibrillation III Study, JAMA source

      Not checked in the free run.

    • cites [365] Gage, 2001, Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation, JAMA source

      Not checked in the free run.

    • cites [366] van Walraven, 2003, A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although biomarkers such as natriuretic peptides are elevated in AF patients, there is insufficient data to suggest that blood-based parameters are independent markers for AF.

    “Although biomarkers such as natriuretic peptides are elevated in AF patients, there is insufficient data to suggest that blood-based parameters are independent markers for AF.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [341] Filion, 2015, High-sensitivity cardiac troponin T and the risk of incident atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) study, Am Heart J source

      Not checked in the free run.

    • cites [342] Aviles, 2003, Inflammation as a risk factor for atrial fibrillation, Circulation source

      Not checked in the free run.

    • cites [343] Patton, 2009, N-terminal pro-B-type natriuretic peptide is a major predictor of the development of atrial fibrillation: the Cardiovascular Health Study, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.

    “OAC therapy can prevent the majority of ischaemic strokes in AF patients and can prolong life.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [38] Hart, 2007, Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation, Ann Intern Med source

      Not checked in the free run.

    • cites [39] Ruff, 2014, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, Lancet source

      Not checked in the free run.

    • cites [42] Lip, 2014, Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry), Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Explaining the expected benefits to each patient at the start of AF management will prevent unfounded expectations and has the potential to optimize quality of life.

    “Explaining the expected benefits to each patient at the start of AF management will prevent unfounded expectations and has the potential to optimize quality of life.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Rhythm control therapy can be successful if symptoms are controlled, even when AF recurs.

    “Rhythm control therapy can be successful if symptoms are controlled, even when AF recurs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Transoesophageal echocardiography (TOE) is useful to further assess valvular heart disease and to exclude intracardiac thrombi, especially in the LAA, to facilitate early cardioversion or catheter ablation.

    “Transoesophageal echocardiography (TOE) is useful to further assess valvular heart disease and to exclude intracardiac thrombi, especially in the LAA, to facilitate early cardioversion or catheter ablation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [344] Bartel, 2001, Transoesophageal echocardiography for immediate and safe cardioversion in patients with atrial fibrillation, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Ambulatory ECG monitoring in AF patients can assess the adequacy of rate control, relate symptoms with AF recurrences, and detect focal induction of bouts of paroxysmal AF.

    “Ambulatory ECG monitoring in AF patients can assess the adequacy of rate control, relate symptoms with AF recurrences, and detect focal induction of bouts of paroxysmal AF.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Vitamin K antagonist therapy reduces risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy).

    “VKA therapy reduces risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy).38”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Hart, 2007, Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rates of haemorrhagic stroke and intracranial haemorrhage, but not of ischaemic stroke, were lower on apixaban than on warfarin.

    “Rates of haemorrhagic stroke and intracranial haemorrhage, but not of ischaemic stroke, were lower on apixaban.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [402] Hylek, 2014, Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin: The ARISTOTLE Trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation): Predictors, Characteristics, and Clinical Outcomes, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Apixaban significantly reduced stroke or systemic embolism by 55% compared with aspirin, with no significant difference in rates of major bleeding or intracranial haemorrhage.

    “apixaban significantly reduced stroke or systemic embolism by 55% compared with aspirin, with no significant difference in rates of major bleeding or intracranial haemorrhage.354,403”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [354] Connolly, 2011, Apixaban in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [403] Flaker, 2012, Bleeding during treatment with aspirin versus apixaban in patients with atrial fibrillation unsuitable for warfarin: the apixaban versus acetylsalicylic acid to prevent stroke in atrial fibrillation patients who have failed or are unsuitable for vitamin K antagonist treatment (AVERROES) trial, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the ARISTOTLE trial, apixaban reduced stroke or systemic embolism by 21% compared with warfarin, combined with a 31% reduction in major bleeding and an 11% reduction in all-cause mortality, all statistically significant.

    “In the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, 319 apixaban reduced stroke or systemic embolism by 21% compared with warfarin, combined with a 31% reduction in major bleeding and an 11% reduction in all-cause mortality (all statistically significant).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [319] Granger, 2011, Apixaban versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dabigatran 110 mg twice daily was non-inferior to warfarin for prevention of stroke and systemic embolism, with 20% fewer major bleeding events.

    “Dabigatran 110 mg twice daily was non-inferior to warfarin for prevention of stroke and systemic embolism, with 20% fewer major bleeding events.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [318] Connolly, 2009, Dabigatran versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [404] Connolly, 2010, Newly identified events in the RE-LY trial, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both dabigatran doses significantly reduced haemorrhagic stroke and intracranial haemorrhage.

    “Both dabigatran doses significantly reduced haemorrhagic stroke and intracranial haemorrhage.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [318] Connolly, 2009, Dabigatran versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [404] Connolly, 2010, Newly identified events in the RE-LY trial, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There was a non-significant numerical increase in the rate of myocardial infarction with both dabigatran doses, which has not been replicated in large post-authorization analyses.

    “There was a non-significant numerical increase in the rate of myocardial infarction with both dabigatran doses, 318,404 which has not been replicated in large post-authorization analyses.396”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [318] Connolly, 2009, Dabigatran versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [404] Connolly, 2010, Newly identified events in the RE-LY trial, N Engl J Med source

      Not checked in the free run.

    • cites [396] Graham, 2015, Cardiovascular, bleeding, and mortality risks in elderly medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dabigatran 150 mg twice daily significantly reduced ischaemic stroke by 24% and vascular mortality by 12%, while gastrointestinal bleeding was significantly increased by 50%.

    “Dabigatran 150 mg twice daily significantly reduced ischaemic stroke by 24% and vascular mortality by 12%, while gastrointestinal bleeding was significantly increased by 50%.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [318] Connolly, 2009, Dabigatran versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [404] Connolly, 2010, Newly identified events in the RE-LY trial, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the ROCKET-AF trial, rivaroxaban was non-inferior to warfarin for prevention of stroke and systemic embolism in the intent-to-treat analysis, while the per-protocol on-treatment analysis achieved statistical superiority with a 21% reduction in stroke or systemic embolism compared with warfarin.

    “Rivaroxaban was non-inferior to warfarin for the prevention of stroke and systemic embolism in the intent-to-treat analysis, while the per-protocol on-treatment analysis achieved statistical superiority with a 21% reduction in stroke or systemic embolism compared with warfarin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [320] Patel, 2011, Rivaroxaban versus warfarin in nonvalvular atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In an on-treatment analysis, edoxaban 60 mg once daily significantly reduced stroke or systemic embolism by 21% and significantly reduced major bleeding events by 20% compared with warfarin.

    “In an on-treatment analysis, edoxaban 60 mg once daily significantly reduced stroke or systemic embolism by 21% and significantly reduced major bleeding events by 20% compared with warfarin”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [321] Giugliano, 2013, Edoxaban versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [405] Ruff, 2015, Association between edoxaban dose, concentration, anti-Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NOACs in high-dose treatment groups significantly reduced stroke or systemic embolic events by 19% compared with warfarin (RR 0.81; 95% CI 0.73-0.91; P < 0.0001), mainly driven by a reduction in haemorrhagic stroke (RR 0.49; 95% CI 0.38-0.64; P < 0.0001).

    “NOACs in these dosages significantly reduced stroke or systemic embolic events by 19% compared with warfarin (RR 0.81; 95% CI 0.73-0.91;P < 0.0001), mainly driven by a reduction in haemorrhagic stroke (RR 0.49; 95% CI 0.38-0.64;P < 0.0001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Ruff, 2014, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Edoxaban 30 mg once daily was non-inferior to warfarin for prevention of stroke and systemic embolism but significantly reduced major bleeding events by 53%.

    “while edoxaban 30 mg once daily was non-inferior to warfarin for prevention of stroke and systemic embolism but significantly reduced major bleeding events by 53%.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [321] Giugliano, 2013, Edoxaban versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [405] Ruff, 2015, Association between edoxaban dose, concentration, anti-Factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the meta-analysis, mortality was 10% lower in patients randomized to NOAC therapy (RR 0.90; 95% CI 0.85-0.95; P = 0.0003) and intracranial haemorrhage was halved (RR 0.48; 95% CI 0.39-0.59; P < 0.0001), while gastrointestinal bleeding events were more frequent (RR 1.25; 95% CI 1.01-1.55; P = 0.04).

    “Mortality was 10% lower in patients randomized to NOAC therapy (RR 0.90; 95% CI 0.85-0.95;P = 0.0003) and intracranial haemorrhage was halved (RR 0.48; 95% CI 0.39-0.59;P < 0.0001), while gastrointestinal bleeding events were more frequent (RR 1.25; 95% CI 1.01-1.55;P = 0.04).39”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Ruff, 2014, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Rivaroxaban did not reduce the rates of mortality, ischaemic stroke, or major bleeding events compared to vitamin K antagonist.

    “Rivaroxaban did not reduce the rates of mortality, ischaemic stroke, or major bleeding events compared to VKA.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [320] Patel, 2011, Rivaroxaban versus warfarin in nonvalvular atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Both vitamin K antagonists and non-vitamin K antagonist oral anticoagulants are effective for the prevention of stroke in AF.

    “Both VKAs and NOACs are effective for the prevention of stroke in AF.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    There was an increase in gastrointestinal bleeding events, but a significant reduction in haemorrhagic stroke and intracranial haemorrhage with rivaroxaban compared with warfarin.

    “There was an increase in gastrointestinal bleeding events, but a significant reduction in haemorrhagic stroke and intracranial haemorrhage with rivaroxaban compared with warfarin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [320] Patel, 2011, Rivaroxaban versus warfarin in nonvalvular atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are no randomized trials assessing oral anticoagulation in haemodialysis patients, and no controlled trials of NOACs in patients with severe CKD (CrCl < 25-30 mL/min).

    “There are no randomized trials assessing OAC in haemodialysis patients, 418 and no controlled trials of NOACs in patients with severe CKD (CrCl < 25-30 mL/min).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [418] Marinigh, 2011, Severe renal impairment and stroke prevention in atrial fibrillation: implications for thromboprophylaxis and bleeding risk, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [318] Connolly, 2009, Dabigatran versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [319] Granger, 2011, Apixaban versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Antiplatelet therapy increases bleeding risk, especially dual antiplatelet therapy (2.0% vs. 1.3% with antiplatelet monotherapy; P < 0.001), with bleeding rates that are similar to those on oral anticoagulation.

    “Antiplatelet therapy increases bleeding risk, especially dual antiplatelet therapy (2.0% vs. 1.3% with antiplatelet monotherapy; P < 0.001), 433 with bleeding rates that are similar to those on OAC.354,362,431,434”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [433] Connolly, 2009, Effect of clopidogrel added to aspirin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [354] Connolly, 2011, Apixaban in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [362] Mant, 2007, Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67, adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).

    “Warfarin use was associated either with a neutral or increased risk of stroke in database analyses of patients on dialysis, [419][420][421] including a population-based analysis in Canada (adjusted HR for stroke 1.14; 95% CI 0.78-1.67,adjusted HR for bleeding 1.44; 95% CI 1.13-1.85).422”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [419] Wizemann, 2010, Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy, Kidney Int source

      Not checked in the free run.

    • cites [420] Chan, 2009, Warfarin use associates with increased risk for stroke in hemodialysis patients with atrial fibrillation, J Am Soc Nephrol source

      Not checked in the free run.

    • cites [421] Winkelmayer, 2011, Effectiveness and safety of warfarin initiation in older hemodialysis patients with incident atrial fibrillation, Clin J Am Soc Nephrol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    LAA occlusion was non-inferior to VKA treatment for the prevention of stroke in AF patients with moderate stroke risk, with a possibility of lower bleeding rates in patients who continued follow-up.

    “In these data sets, LAA occlusion was non-inferior to VKA treatment for the prevention of stroke in AF patients with moderate stroke risk, with a possibility of lower bleeding rates in the patients who continued follow-up. 452,453”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [452] Reddy, 2014, Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial, JAMA source

      Not checked in the free run.

    • cites [453] Holmes, 2015, Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation: A Patient-Level Meta-Analysis, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Parenteral anticoagulants seem to be associated with a non-significant reduction in recurrent ischaemic stroke when administered 7 to 14 days after acute stroke (OR 0.68; 95% CI 0.44-1.06), with a significant increase in symptomatic intracranial bleeding (OR 2.89; 95% CI 1.19-7.01), and a similar rate of death or disability at final follow-up.

    “Parenteral anticoagulants seem to be associated with a non-significant reduction in recurrent ischaemic stroke when administered 7 to 14 days after the acute stroke (odds ratio [OR] 0.68; 95% CI 0.44-1.06),with a significant increase in symptomatic intracranial bleeding (OR 2.89; 95% CI 1.19-7.01),and a similar rate of death or disability at final follow-up.477”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [477] Paciaroni, 2007, Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.

    “Multiple observational studies indicate the feasibility and safety of surgical LAA occlusion/exclusion, but only limited controlled trial data are available.[461][462][463][464]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [461] Budera, 2012, Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study, Eur Heart J source

      Not checked in the free run.

    • cites [462] Healey, 2005, Left Atrial Appendage Occlusion Study (LAAOS): results of a randomized controlled pilot study of left atrial appendage occlusion during coronary bypass surgery in patients at risk for stroke, Am Heart J source

      Not checked in the free run.

    • cites [463] Tsai, 2015, Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a meta-analysis, Eur J Cardiothorac Surg source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    It seems likely that bleeding risk on parenteral anticoagulation exceeds the stroke prevention benefit in the first days after a large stroke, whereas patients with a TIA or a small stroke may benefit from early initiation or continuation of anticoagulation.

    “It seems likely that the bleeding risk on parenteral anticoagulation exceeds the stroke prevention benefit in the first days after a large stroke, whereas patients with a TIA or a small stroke may benefit from early (immediate) initiation or continuation of anticoagulation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of 47 studies, the overall incidence of major bleeding with VKAs was 2.1 (range 0.9-3.4) per 100 patient-years in controlled trials and 2.0 (range 0.2-7.6) per 100 patient-years for observational data sets.

    “In a meta-analysis of 47 studies, the overall incidence of major bleeding with VKAs was 2.1 (range 0.9-3.4) per 100 patient-years in controlled trials and 2.0 (range 0.2-7.6)per 100 patient-years for observational data sets.488”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [488] Roskell, 2013, Major bleeding in patients with atrial fibrillation receiving vitamin K antagonists: a systematic review of randomized and observational studies, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The available evidence indicates that anticoagulation in patients with AF can be reinitiated after 4-8 weeks, especially when the cause of bleeding or the relevant risk factor has been treated, and that such treatment leads to fewer recurrent ischaemic strokes and lower mortality.

    “The available evidence indicates that anticoagulation in patients with AF can be reinitiated after 4-8 weeks, especially when the cause of bleeding or the relevant risk factor (e.g.uncontrolled hypertension) has been treated, and that such treatment leads to fewer recurrent (ischaemic) strokes and lower mortality.460,484”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [460] Kuramatsu, 2015, Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage, JAMA source

      Not checked in the free run.

    • cites [484] Nielsen, 2015, Restarting Anticoagulant Treatment After Intracranial Hemorrhage in Patients With Atrial Fibrillation and the Impact on Recurrent Stroke, Mortality, and Bleeding: A Nationwide Cohort Study, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The risk of gastrointestinal bleeds was comparable to warfarin on dabigatran 110 mg twice daily and on apixaban 5 mg twice daily.

    “The risk of gastrointestinal bleeds was comparable to warfarin on dabigatran 110 mg twice daily 490 and on apixaban 5 mg twice daily 319”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [490] Eikelboom, 2011, Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial, Circulation source

      Not checked in the free run.

    • cites [319] Granger, 2011, Apixaban versus warfarin in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NOACs seem to convey slightly better outcomes than VKAs in AF patients who survived a stroke, mainly driven by fewer intracranial haemorrhages and haemorrhagic strokes (OR 0.44, 95% CI 0.32-0.62).

    “NOACs seem to convey slightly better outcomes, mainly driven by fewer intracranial haemorrhages and haemorrhagic strokes (OR 0.44, 95% CI 0.32-0.62).482”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [482] Ntaios, 2012, Nonvitamin-K-antagonist oral anticoagulants in patients with atrial fibrillation and previous stroke or transient ischemic attack: a systematic review and meta-analysis of randomized controlled trials, Stroke source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    No prospective studies have investigated the benefit or risk of initiation of oral anticoagulation after intracranial haemorrhage, and patients with a history of intracranial bleeding were excluded from randomized trials comparing NOACs with VKAs.

    “No prospective studies have investigated the benefit or risk of the initiation of OAC after intracranial haemorrhage, 483 and patients with a history of intracranial bleeding were excluded from the randomized trials comparing NOACs with VKAs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [483] Paciaroni, 2014, Should oral anticoagulants be restarted after warfarin-associated cerebral haemorrhage in patients with atrial fibrillation?, Thromb Haemost source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared with warfarin, the risk of gastrointestinal bleeds was increased for dabigatran 150 mg twice daily, rivaroxaban 20 mg once daily, and edoxaban 60 mg once daily.

    “Compared with warfarin, the risk of gastrointestinal bleeds was increased for dabigatran 150 mg twice daily, 396, 490 rivaroxaban 20 mg once daily, 491 and edoxaban 60 mg once daily.321”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [396] Graham, 2015, Cardiovascular, bleeding, and mortality risks in elderly medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation, Circulation source

      Not checked in the free run.

    • cites [490] Eikelboom, 2011, Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial, Circulation source

      Not checked in the free run.

    • cites [491] Goodman, 2014, Factors associated with major bleeding events: insights from the ROCKET AF trial (rivaroxaban once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation), J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Idarucizumab is a clinically available humanized antibody fragment that binds dabigatran and rapidly and dose-dependently reverses its effects without over-correction or thrombin generation.

    “Idarucizumab (approved in 2015 by the US Food and Drug Administration and the European Medicines Agency) is a clinically available humanized antibody fragment that binds dabigatran and rapidly and dose-dependently reverses the effects without over-correction or thrombin generation.475”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [475] Pollack, 2015, Idarucizumab for Dabigatran Reversal, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Genetic testing has little effect on time in therapeutic range or bleeding risk on warfarin, and is not recommended for clinical use at present.

    “Genetic testing has little effect on TTR or bleeding risk on warfarin, and is not recommended for clinical use at present.501”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [501] Tang, 2015, Genotype-Guided Dosing of Coumarin Anticoagulants: A Meta-analysis of Randomized Controlled Trials, J Cardiovasc Pharmacol Ther source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Reinitiation of anticoagulation after a bleeding event is often clinically justified.

    “Reinitiation of anticoagulation after a bleeding event is often clinically justified. 460, 510”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [460] Kuramatsu, 2015, Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage, JAMA source

      Not checked in the free run.

    • cites [510] Staerk, 2015, Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation: nationwide cohort study, BMJ source

      Not checked in the free run.

    • Rests on an assumption: Absolute contraindications to long-term OAC after a bleeding episode are rare.
    • Rests on an assumption: Many causes or triggers of major bleeding events can be treated and/or eliminated.

  • May combine two claims.

    Premisecitation

    In a randomized trial of 1884 patients with AF, interruption of anticoagulation was non-inferior to heparin administration for arterial thromboembolism (incidence 0.4% and 0.3%, respectively) and resulted in a lower risk of major bleeding (1.3% and 3.2%, respectively).

    “In a randomized trial of 1884 patients with AF, interruption of anticoagulation was non-inferior to heparin administration for the outcome of arterial thromboembolism (incidence of 0.4% and 0.3%, respectively) and resulted in a lower risk of major bleeding (1.3% and 3.2%, respectively).502”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [502] Douketis, 2015, Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation, N Engl J Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ciraparantag (PER977) is an antidote targeted to reverse both direct thrombin and factor Xa inhibitors as well as the indirect inhibitor enoxaparin.

    “Another agent under development is ciraparantag (PER977), an antidote targeted to reverse both direct thrombin and factor Xa inhibitors as well as the indirect inhibitor enoxaparin.509”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [509] Crowther, 2015, Antidotes for novel oral anticoagulants: current status and future potential, Arterioscler Thromb Vasc Biol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Andexanet alpha reverses the anticoagulant activity of apixaban and rivaroxaban in healthy probands within minutes after administration and for the duration of infusion, with a transient increase in markers of coagulation activity of uncertain clinical relevance.

    “Andexanet alpha, a modified recombinant human factor Xa that lacks enzymatic activity, reverses the anticoagulant activity of apixaban and rivaroxaban in healthy probands within minutes after administration and for the duration of infusion, with a transient increase in markers of coagulation activity of uncertain clinical relevance.508”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [508] Siegal, 2015, Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the WOEST trial, bleeding was lower in the dual therapy arm (OAC and clopidogrel) versus the triple therapy arm (OAC, clopidogrel, and aspirin), driven by fewer minor bleeding events.

    “Bleeding was lower in the dual versus triple therapy arm, driven by fewer minor bleeding events.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [524] Dewilde, 2013, Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The meta-analysis included 3066 participants with HFrEF and AF, showed consistency across all subgroups and outcomes, with no heterogeneity between the 10 RCTs included (I2 = 0%).

    “The study, which included 3066 participants with HFrEF and AF, showed consistency across all subgroups and outcomes, with no heterogeneity between the 10 RCTs included (I 2 = 0%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Kotecha, 2014, Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The association between digoxin use and excess mortality in AF patients is likely due to selection and prescription biases rather than harm caused by digoxin, particularly as digoxin is commonly prescribed to sicker patients.

    “Observational studies have associated digoxin use with excess mortality in AF patients, [547][548][549] but this association is likely due to selection and prescription biases rather than harm caused by digoxin, [550][551][552][553] particularly as digoxin is commonly prescribed to sicker patients.225”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [550] Gheorghiade, 2013, Lack of evidence of increased mortality among patients with atrial fibrillation taking digoxin: findings from post hoc propensity-matched analysis of the AFFIRM trial, Eur Heart J source

      Not checked in the free run.

    • cites [551] Flory, 2012, Observational cohort study of the safety of digoxin use in women with heart failure, BMJ Open source

      Not checked in the free run.

    • cites [552] Andrey, 2011, Mortality and morbidity of heart failure treated with digoxin, A propensity-matched study. Int J Clin Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In one small trial of low-risk patients with preserved LVEF, beta-blockers reduced exercise capacity and increased B-type natriuretic peptide.

    “Verapamil or diltiazem can improve arrhythmia-related symptoms, 526 in comparison with beta-blockers, which reduced exercise capacity and increased B-type natriuretic peptide in one small trial of low-risk patients with preserved LVEF.542”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [542] Ulimoen, 2014, Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Beta-adrenoreceptor blocker monotherapy is often the first-line rate-controlling agent, largely based on observations of better acute heart rate control than digoxin.

    “Beta-adrenoreceptor blocker monotherapy is often the first-line rate-controlling agent, 539 largely based on observations of better acute heart rate control than digoxin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [539] National Institute for Health and Care Excellence (NICE) guidelines

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a pooled analysis of the AFFIRM and RACE trials (1091 participants), similar results were found, albeit with smaller heart rate differences and without randomization.

    “Similar results were found in a pooled analysis of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) and RACE trials (1091 participants), albeit with smaller heart rate differences and without randomization.562”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [562] Van Gelder, 2006, Does intensity of rate-control influence outcome in atrial fibrillation? An analysis of pooled data from the RACE and AFFIRM studies, Europace source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    In practice, achieving a heart rate < 110 bpm will often require combination therapy.

    “In practice, achieving a heart rate < 110 bpm will often require combination therapy (Figure 15).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the RACE II study, there was no difference in a composite of clinical events (14.9% in the strict rate control group, 12.9% in the lenient group), NYHA class, or hospitalizations.

    “There was no difference in a composite of clinical events (14.9% in the strict rate control group, 12.9% in the lenient group), 560 NYHA class, or hospitalizations.560, 561”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [560] Van Gelder, 2010, Lenient versus strict rate control in patients with atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [561] Groenveld, 2011, The effect of rate control on quality of life in patients with permanent atrial fibrillation: data from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) study, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    AV node ablation and pacing is a relatively simple procedure with a low complication rate and low long-term mortality risk, especially when the pacemaker is implanted a few weeks before the AV nodal ablation and the initial pacing rate after ablation is set at 70-90 bpm.

    “It is a relatively simple procedure with a low complication rate and low long-term mortality risk, 563,564 especially when the pacemaker is implanted a few weeks before the AV nodal ablation and the initial pacing rate after ablation is set at 70-90 bpm.565,566”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [563] Queiroga, 2003, Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation, Heart source

      Not checked in the free run.

    • cites [564] Lim, 2007, Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial, Europace source

      Not checked in the free run.

    • cites [565] Geelen, 1997, Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction, Pacing Clin Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    AV node ablation and pacing does not worsen LV function and may even improve LVEF in selected patients.

    “The procedure does not worsen LV function 567 and may even improve LVEF in selected patients.[568][569][570]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [567] Chatterjee, 2012, Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis and systematic review, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [568] Bradley, 2007, Overview of management of atrial fibrillation in symptomatic elderly patients: pharmacologic therapy versus AV node ablation, Clin Pharmacol Ther source

      Not checked in the free run.

    • cites [569] Wood, 2000, Clinical outcomes after ablation and pacing therapy for atrial fibrillation : a meta-analysis, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The 'rhythm control' effect of cardiac resynchronization therapy is likely to be small and clearly needs confirmation.

    “In some patients in heart failure treated with biventricular pacing (cardiac resynchronization therapy), AF can terminate, 571 although such a 'rhythm control' effect of cardiac resynchronization therapy is likely to be small and clearly needs confirmation.572”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [572] Hoppe, 2006, Effect of cardiac resynchronization on the incidence of atrial fibrillation in patients with severe heart failure, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many 'adequately rate-controlled' patients (resting heart rate 60-100 bpm) are severely symptomatic, calling for additional management.

    “It is worthwhile to note that many 'adequately ratecontrolled' patients (resting heart rate 60-100 bpm) are severely symptomatic, calling for additional management.194”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [194] Kirchhof, 2014, Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events—European Registry in Atrial Fibrillation (PREFER in AF), Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Quinidine and disopyramide are associated with increased all-cause mortality at 1-year follow-up (OR 2.39; 95% CI 1.03-5.59; number needed to harm 109; 95% CI 34-4985), likely due to ventricular arrhythmias (torsades de pointes).

    “Quinidine and disopyramide have been associated with an increase in all-cause mortality (OR 2.39; 95% CI 1.03-5.59;number needed to harm 109; 95% CI 34-4985) at 1-year follow-up, 580, 661 likely due to ventricular arrhythmias (torsades de pointes).580,661”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [580] Lafuente-Lafuente, 2012, Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [661] Freemantle, 2011, Mixed treatment comparison of dronedarone, amiodarone, sotalol, flecainide, and propafenone, for the management of atrial fibrillation, Europace source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Disopyramide reduces left ventricular outflow gradient and improves symptoms in patients with hypertrophic cardiomyopathy.

    “has been shown to reduce LV outflow gradient and improve symptoms in patients with hypertrophic cardiomyopathy.[662][663][664]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [662] Sherrid, 2005, Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [663] Sirak, 2008, Oral disopyramide for the acute treatment of severe outflow obstruction in hypertrophic cardiomyopathy in the ICU setting, Chest source

      Not checked in the free run.

    • cites [664] Sherrid, 2013, Treatment of obstructive hypertrophic cardiomyopathy symptoms and gradient resistant to first-line therapy with beta-blockade or verapamil, Circ Heart Fail source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ranolazine inhibits potassium and sodium currents and increases glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen.

    “The antianginal compound ranolazine inhibits potassium and sodium currents and increases glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen.676, 677”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [676] Schram, 2004, Ranolazine: ion-channel-blocking actions and in vivo electrophysiological effects, Br J Pharmacol source

      Not checked in the free run.

    • cites [677] McCormack, 1996, Ranolazine stimulates glucose oxidation in normoxic, ischemic, and reperfused ischemic rat hearts, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The reduction in symptomatic atrial fibrillation recurrences by beta-blockers may be driven by the beneficial effect of rate control, which renders atrial fibrillation more often asymptomatic.

    “but this finding may be driven by the beneficial effect of rate control, which will render AF more often asymptomatic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Extracardiac toxic effects of amiodarone are common and increase with time.

    “Amiodarone is more effective in preventing AF recurrences than other antiarrhythmic drugs but extracardiac toxic effects are common and increase with time.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [596] Chevalier, 2003, Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [597] Letelier, 2003, Effectiveness of amiodarone for conversion of atrial fibrillation to sinus rhythm: a meta-analysis, Arch Intern Med source

      Not checked in the free run.

    • cites [598] Khan, 2003, Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Catheter ablation of atrial fibrillation is primarily achieved through isolation of the pulmonary veins, probably requiring complete isolation for full effectiveness.

    “This is primarily achieved through isolation of the pulmonary veins, probably requiring complete isolation for full effectiveness, 716”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [716] Kuck, 2016, Impact of Complete Versus Incomplete Circumferential Lines Around the Pulmonary Veins During Catheter Ablation of Paroxysmal Atrial Fibrillation: Results From the Gap-Atrial Fibrillation-German Atrial Fibrillation Competence Network 1 Trial, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Pulmonary vein isolation is achievable by point-by-point radiofrequency ablation, linear lesions encircling the pulmonary veins, or cryoballoon ablation, with similar outcomes.

    “achievable by point-by-point radiofrequency ablation, linear lesions encircling the pulmonary veins, or cryoballoon ablation, with similar outcomes.[732][733][734]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [732] Luik, 2015, Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation: The Prospective, Randomized, Controlled, Noninferiority FreezeAF Study, Circulation source

      Not checked in the free run.

    • cites [733] Schmidt, 2014, Cryoballoon versus RF ablation in paroxysmal atrial fibrillation: results from the German Ablation Registry, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [734] Kuck, 2016, Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is no current indication for catheter ablation to prevent cardiovascular outcomes, to allow desired withdrawal of anticoagulation, or to reduce hospitalization.

    “There is no current indication for catheter ablation to prevent cardiovascular outcomes (or desired withdrawal of anticoagulation), or to reduce hospitalization.40,594”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [40] Kirchhof, 2013, Improving outcomes in patients with atrial fibrillation: rationale and design of the Early treatment of Atrial fibrillation for Stroke prevention Trial, Am Heart J source

      Not checked in the free run.

    • cites [594] ClinicalTrials.gov, Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial (CABANA)

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Extended ablation procedures beyond pulmonary vein isolation consistently require longer procedures and more ionizing radiation, potentially creating risk for patients.

    “Extended ablation procedures (beyond PVI) consistently require longer procedures and more ionizing radiation, potentially creating risk for patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisereasoning

    Left atrial macro-reentrant tachycardia may occur in up to 25% of patients after left atrial substrate modification ablation, often due to incomplete ablation lines.

    “but may occur in up to 25% of patients after left atrial substrate modification ablation, often due to incomplete ablation lines.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Five to seven per cent of patients will suffer severe complications after catheter ablation of atrial fibrillation, and 2-3% will experience life-threatening but usually manageable complications.

    “Five to seven per cent of patients will suffer severe complications after catheter ablation of AF, and 2-3% will experience life-threatening but usually manageable complications.727,[748][749][750]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [727] Cappato, 2010, Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [748] Dagres, 2009, Complications of atrial fibrillation ablation in a high-volume center in 1,000 procedures: still cause for concern?, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [749] Deneke, 2015, Silent cerebral events/lesions related to atrial fibrillation ablation: a clinical review, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sinus rhythm without severely symptomatic recurrences of atrial fibrillation is found in up to 70% of patients with paroxysmal atrial fibrillation and around 50% in persistent atrial fibrillation.

    “Sinus rhythm without severely symptomatic recurrences of AF is found in up to 70% of patients with paroxysmal AF, and around 50% in persistent AF. 713,728,735,1042”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [713] Calkins, 2009, Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [728] Ganesan, 2013, Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis, J Am Heart Assoc source

      Not checked in the free run.

    • cites [735] Verma, 2015, Approaches to catheter ablation for persistent atrial fibrillation, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Multiple variables have been identified as risk factors for recurrence after catheter ablation of atrial fibrillation, but their predictive power is weak.

    “Multiple variables have been identified as risk factors for recurrence after catheter ablation of AF, but their predictive power is weak.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Better rhythm outcome and lower procedure-related complications can be expected in younger patients with a short history of atrial fibrillation and frequent, short atrial fibrillation episodes in the absence of significant structural heart disease.

    “In general, better rhythm outcome and lower procedure-related complications can be expected in younger patients with a short history of AF and frequent, short AF episodes in the absence of significant structural heart disease.745”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [745] Lee, 2011, Low risk of major complications associated with pulmonary vein antral isolation for atrial fibrillation: results of 500 consecutive ablation procedures in patients with low prevalence of structural heart disease from a single center, J Cardiovasc Electrophysiol

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The most important severe complications of catheter ablation of atrial fibrillation are stroke/TIA (<1%), cardiac tamponade (1-2%), pulmonary vein stenosis, and severe oesophageal injury leading to atrio-oesophageal fistula weeks after ablation.

    “The most important severe complications are stroke/TIA (< 1%), cardiac tamponade (1-2%), pulmonary vein stenosis, and severe oesophageal injury leading to atrio-oesophageal fistula weeks after ablation (Table 18).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Table 18

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Post-procedure complications of catheter ablation include stroke with the highest risk within the first week, late pericardial tamponade several days after catheter ablation, and oesophageal fistulas usually apparent 7-30 days after ablation.

    “Post-procedure complications include stroke, with the highest risk within the first week, 753 late pericardial tamponade several days after catheter ablation, 751 and oesophageal fistulas, which usually become apparent 7-30 days after ablation.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [753] Kosiuk, 2014, Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: incidence, characteristics, and risk factors, Heart Rhythm source

      Not checked in the free run.

    • cites [751] Cappato, 2011, Delayed cardiac tamponade after radiofrequency catheter ablation of atrial fibrillation: a worldwide report, J Am Coll Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    The Cox maze procedure creates an electrical labyrinth of passages through which the sinoatrial node impulse finds a route to the atrioventricular node while preventing fibrillatory conduction.

    “Thereby, the Cox maze procedure creates an electrical labyrinth (maze) of passages through which the sinoatrial node impulse finds a route to the atrioventricular node while preventing fibrillatory conduction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Several smaller trials suggest reduced hospitalizations after catheter ablation in heart failure with reduced ejection fraction patients, especially in patients without a previous myocardial infarction.

    “and reduced hospitalizations, 720, 777 especially in patients without a previous myocardial infarction.780”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [720] Al Halabi, 2015, Catheter Ablation for Atrial Fibrillation in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials, JACC Clin Electrophysiol source

      Not checked in the free run.

    • cites [777] Di Biase, Ablation vs. Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial, Circulation

      Not checked in the free run.

    • cites [780] Dagres, 2011, Catheter ablation for atrial fibrillation in patients with left ventricular systolic dysfunction. A systematic review and meta-analysis, J Card Fail source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Predictors of atrial fibrillation recurrence after surgery include left atrial dilatation, older age, >10-year history of atrial fibrillation, and non-paroxysmal atrial fibrillation.

    “Predictors of AF recurrence after surgery include left atrial dilatation, older age, > 10-year history of AF, and non-paroxysmal AF. [800][801][802][803][804]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [800] Chen, 2004, Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery, Chest source

      Not checked in the free run.

    • cites [801] Sunderland, 2011, What size of left atrium significantly impairs the success of maze surgery for atrial fibrillation?, Interact Cardiovasc Thorac Surg source

      Not checked in the free run.

    • cites [802] Chaiyaroj, 2008, Predictors of sinus rhythm after radiofrequency maze and mitral valve surgery, Asian Cardiovasc Thorac Ann source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Preliminary experience with hybrid simultaneous ablation shows promise, but procedural time and rates of bleeding complications are higher.

    “Although preliminary experience with hybrid simultaneous ablation shows promise, procedural time and rates of bleeding complications are higher.812, 823”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [812] Krul, 2011, Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [823] La Meir, 2013, Minimally invasive surgical treatment of lone atrial fibrillation: early results of hybrid versus standard minimally invasive approach employing radiofrequency sources, Int J Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.

    “The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.468,812,813”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [468] Boersma, 2012, Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial, Circulation source

      Not checked in the free run.

    • cites [812] Krul, 2011, Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation, Circ Arrhythm Electrophysiol source

      Not checked in the free run.

    • cites [813] La Meir, 2012, The hybrid approach for the surgical treatment of lone atrial fibrillation: one-year results employing a monopolar radiofrequency source, J Cardiothorac Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Current technology (e.g., bipolar radiofrequency or cryothermy) renders stand-alone atrial fibrillation surgery easier, more reproducible, and feasible via a mini-thoracotomy.

    “Current technology (e.g.bipolar radiofrequency or cryothermy) renders the procedure easier and more reproducible and feasible via a mini-thoracotomy.786,807,808”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [786] Basu, 2012, How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery?, Interact Cardiovasc Thorac Surg source

      Not checked in the free run.

    • cites [807] Saint, 2012, Cox-Maze IV results for patients with lone atrial fibrillation versus concomitant mitral disease, Ann Thorac Surg source

      Not checked in the free run.

    • cites [808] Lawrance, 2014, A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay, J Thorac Cardiovasc Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    AF has many different drivers, which are only partially targeted by antiarrhythmic drug or catheter ablation.

    “AF has many different drivers, which are only partially targeted by antiarrhythmic drug or catheter ablation.96”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] Schotten, 2011, Pathophysiological mechanisms of atrial fibrillation: a translational appraisal, Physiol Rev source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisenone given

    Many published series of patients undergoing atrial fibrillation ablation included those who failed antiarrhythmic drug therapy.

    “Many of the published series of patients undergoing AF ablation included those who failed antiarrhythmic drug therapy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In selected patients with sick sinus syndrome and fast ventricular response during AF paroxysms requiring rate control therapy, the addition of a pacemaker optimizes rate control and may help to control rhythm.

    “In selected patients with sick sinus syndrome and fast ventricular response during AF paroxysms requiring rate control therapy, the addition of a pacemaker not only optimizes rate control but may also help to control rhythm.711,712”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [711] Andersen, 1997, Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome, Lancet source

      Not checked in the free run.

    • cites [712] Connolly, 2000, Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Elderly AF patients are at higher risk of stroke and thus are more likely to benefit from OAC than younger patients.

    “Elderly AF patients are at higher risk of stroke and thus are more likely to benefit from OAC than younger patients, 841”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [841] Marinigh, 2010, Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis, J Am Coll Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AF prevalence in long QT syndrome is 5-10%.

    “Long QT syndrome KCNQ1 KCNH2 SCN5A ANK2 others IKs  IKr  INa  INa,K  Various effects 5-10% 846-850”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [846] Johnson, 2008, Prevalence of early-onset atrial fibrillation in congenital long QT syndrome, Heart Rhythm source

      Not checked in the free run.

    • cites [847] Kirchhof, 2003, Prolonged atrial action potential durations and polymorphic atrial tachyarrhythmias in patients with long QT syndrome, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [848] Zellerhoff, 2009, Atrial Arrhythmias in long-QT syndrome under daily life conditions: a nested case control study, J Cardiovasc Electrophysiol source

      Not checked in the free run.

    • cites [849] Moss, 1995, ECG T-wave patterns in genetically distinct forms of the hereditary long QT syndrome, Circulation source

      Not checked in the free run.

    • cites [850] Schwartz, 2001, Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    AF prevalence ranges from 5% to 20% in patients with long QT syndrome or Brugada syndrome, and is up to 70% in short QT syndrome.

    “AF prevalence ranges from 5% to 20% in patients with long QT syndrome or Brugada syndrome, and is up to 70% in short QT syndrome (Table 20).853,[856][857][858]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [853] Antzelevitch, 2007, Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death, Circulation source

      Not checked in the free run.

    • cites [856] Brugada, 2004, Sudden death associated with short-QT syndrome linked to mutations in HERG, Circulation source

      Not checked in the free run.

    • cites [857] Gaita, 2003, Short QT Syndrome: a familial cause of sudden death, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    While there is more experience with VKAs, there are no data to suggest that NOACs cannot be used in patients with hypertrophic cardiomyopathy.

    “While there is more experience with VKAs, there are no data to suggest that NOACs cannot be used in these patients.845”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [845] Elliott, 2014, 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC), Eur Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AF prevalence in hypertrophic cardiomyopathy is 5-15%.

    “Hypertrophic cardiomyopathy Sarcomeric genes 5-15% 862-864”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [862] Lee, 2007, Clinical characteristics and outcomes of hypertrophic cardiomyopathy in Taiwan—a tertiary center experience, Clin Cardiol source

      Not checked in the free run.

    • cites [863] Losi, 2004, Determinants of atrial fibrillation development in patients with hypertrophic cardiomyopathy, Am J Cardiol source

      Not checked in the free run.

    • cites [864] Maron, 2002, Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Detraining can reduce AF in models and reduces ventricular arrhythmias in athletes.

    “Detraining can reduce AF in models 904 and reduces ventricular arrhythmias in athletes, 907”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [904] Guasch, 2013, Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [907] Biffi, 2011, Patterns of ventricular tachyarrhythmias associated with training, deconditioning and retraining in elite athletes without cardiovascular abnormalities, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity improves cardiovascular health, which translates into a lower risk of AF.

    “Physical activity improves cardiovascular health, which translates into a lower risk of AF. 898”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [898] Mozaffarian, 2008, Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Electrical cardioversion can be effective for restoration of sinus rhythm when tachyarrhythmia is causing haemodynamic instability, with low rates of adverse outcomes for both mother and foetus.

    “Electrical cardioversion can be effective for restoration of sinus rhythm when tachyarrhythmia is causing haemodynamic instability, with low rates of adverse outcomes for both mother and foetus.921”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [921] Tromp, 2011, Electrical cardioversion during pregnancy: safe or not?, Neth Heart J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    AF is common after cardiac surgery (occurring in 15-45% of patients).

    “AF is common after cardiac surgery (occurring in 15-45% of patients), [924][925][926]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [924] Ahlsson, 2007, Postoperative atrial fibrillation is not correlated to C-reactive protein, Ann Thorac Surg source

      Not checked in the free run.

    • cites [925] Arsenault, 2013, Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [926] Mathew, 2004, A multicenter risk index for atrial fibrillation after cardiac surgery, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Postoperative AF is associated with increased length of hospital stay and higher rates of complications and mortality.

    “and is associated with increased length of hospital stay and higher rates of complications and mortality.927”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [927] Steinberg, 2014, Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry, Clin Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    None of the rate control agents are teratogenic, but they readily cross the placenta.

    “None of the agents are teratogenic, but they readily cross the placenta.914”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [914] Page, 1995, Treatment of arrhythmias during pregnancy, Am Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diltiazem will be present at high levels in breast milk and should be considered second-line treatment.

    “Diltiazem will be present at high levels and should be considered second-line treatment.918”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [918] Joint Formulary Committee, British National Formulary (online)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low-molecular-weight heparins are a safe substitute for VKAs in pregnancy, as they do not cross the placenta.

    “Low-molecular-weight heparins are a safe substitute, as they do not cross the placenta.923”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [923] Bates, 2012, VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, Chest source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    They are associated with heart failure, syncope, thromboembolic events, and sudden death.

    “They are associated with heart failure, syncope, thromboembolic events, and sudden death.[963][964][965][966][967]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [963] Triedman, 2002, Arrhythmias in adults with congenital heart disease, Heart source

      Not checked in the free run.

    • cites [964] Ammash, 2012, Outcome of direct current cardioversion for atrial arrhythmias in adults with congenital heart disease, Int J Cardiol source

      Not checked in the free run.

    • cites [965] Greason, 2003, Surgical management of atrial tachyarrhythmias associated with congenital cardiac anomalies: Mayo Clinic experience, Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Intracardiac thrombi are common in GUCH patients undergoing cardioversion for AF, but also in patients with atrial tachycardias or atrial flutter.

    “Intracardiac thrombi are common in GUCH patients undergoing cardioversion for AF, but also in patients with atrial tachycardias or atrial flutter.970”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [970] Feltes, 1994, Transesophageal echocardiographic detection of atrial thrombi in patients with nonfibrillation atrial tachyarrhythmias and congenital heart disease, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.

    “Postoperative AF is associated with an increased early stroke risk, increased morbidity, and 30-day mortality.927,951,952”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [927] Steinberg, 2014, Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry, Clin Cardiol source

      Not checked in the free run.

    • cites [951] LaPar, 2014, Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs, Ann Thorac Surg source

      Not checked in the free run.

    • cites [952] Saxena, 2012, Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients), Am J Cardiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    The aim of rhythm control therapy should be to improve AF-related symptoms in postoperative AF.

    “underpinning that the aim of rhythm control therapy should be to improve AF-related symptoms in postoperative AF.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Atrial flutter and fibrillation occur in 14-22% of adults with unoperated atrial septal defects, especially in older patients, and can lead to heart failure.

    “Atrial flutter and fibrillation occur in 14-22% of adults with unoperated atrial septal defects, especially in older patients, 971 and can lead to heart failure. 972”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [971] Nagao, 1995, [Studies on atrial arrhythmias in atrial septal defect. The influences of aging on atrial fibrillation], Nihon Ronen Igakkai Zasshi source

      Not checked in the free run.

    • cites [972] Giamberti, 2008, Surgical treatment of arrhythmias in adults with congenital heart defects, Int J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    OAC at discharge has been associated with a reduced long-term mortality in patients with postoperative AF, without evidence from controlled trials.

    “OAC at discharge has been associated with a reduced long-term mortality in patients with postoperative AF, 959 without evidence from controlled trials.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [959] El-Chami, 2010, New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.

    “In the long term, patients with an episode of postoperative AF have a twofold increase in cardiovascular mortality and a substantially increased risk of future AF and ischaemic stroke compared with patients that remain in sinus rhythm after surgery.952-958”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [952] Saxena, 2012, Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients), Am J Cardiol source

      Not checked in the free run.

    • cites [953] Gialdini, 2014, Perioperative atrial fibrillation and the long-term risk of ischemic stroke, JAMA source

      Not checked in the free run.

    • cites [954] Ahlsson, 2009, Patients with postoperative atrial fibrillation have a doubled cardiovascular mortality, Scand Cardiovasc J source

      Not checked in the free run.

    • cites [955] Ahlsson, 2010, Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality, Eur J Cardiothorac Surg source

      Not checked in the free run.

    • cites [956] Mariscalco, 2008, Atrial fibrillation after isolated coronary surgery affects late survival, Circulation source

      Not checked in the free run.

    • cites [957] Villareal, 2004, Postoperative atrial fibrillation and mortality after coronary artery bypass surgery, J Am Coll Cardiol source

      Not checked in the free run.

    • cites [958] Phan, 2015, New-onset atrial fibrillation following coronary bypass surgery predicts long-term mortality: a systematic review and meta-analysis, Eur J Cardiothorac Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Biatrial volume overload, pulmonary hypertension, and possibly the arrhythmogenic effect of atrial patches can contribute to atrial arrhythmias in atrial septal defects.

    “Biatrial volume overload, 974 pulmonary hypertension, 975 and possibly the arrhythmogenic effect of atrial patches can contribute to these arrhythmias.976”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [974] Yamada, 2007, Pulmonary vein isolation in patients with paroxysmal atrial fibrillation after direct suture closure of congenital atrial septal defect, Circ J source

      Not checked in the free run.

    • cites [975] Van De Bruaene, 2011, The importance of pulmonary artery pressures on late atrial arrhythmia in transcatheter and surgically closed ASD type secundum, Int J Cardiol source

      Not checked in the free run.

    • cites [976] de Salle, 1975, [Rhythm disorders occurring after surgical closure of the interatrial communication], Acta Cardiol

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Atrial arrhythmias occur in up to 40% of patients with a Fontan circulation, and can manifest as atrial flutter, primary atrial tachycardia, AF, and accelerated junctional rhythm or junctional tachycardia with or without sinoatrial node dysfunction.

    “Atrial arrhythmias occur in up to 40% of patients with a Fontan circulation, and can manifest as atrial flutter, primary atrial tachycardia, AF, and accelerated junctional rhythm or junctional tachycardia 978 with or without sinoatrial node dysfunction.979”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [978] Kanter, 1997, Atrial arrhythmias during chronic follow-up of surgery for complex congenital heart disease, Pacing Clin Electrophysiol source

      Not checked in the free run.

    • cites [979] Porter, 1993, Incidence and management of dysrhythmias after Fontan procedure, Herz

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients with atriopulmonary anastomoses and those with early postoperative atrial arrhythmias are more likely to develop long-term atrial arrhythmias.

    “Patients with atriopulmonary anastomoses (possibly due to higher atrial volume and pressure load) and those with early postoperative atrial arrhythmias are more likely to develop long-term atrial arrhythmias.980”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [980] Gelatt, 1994, Risk factors for atrial tachyarrhythmias after the Fontan operation, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Right atrial thrombus formation is common in Fontan patients with atrial arrhythmias and requires oral anticoagulation.

    “Right atrial thrombus formation is common in Fontan patients with atrial arrhythmias and requires oral anticoagulation.981”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [981] Peters, 1992, Arrhythmias after the Fontan procedure, Br Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Operative conversion to total cavopulmonary artery connection with concomitant arrhythmia surgery can in some patients improve heart failure symptoms and reduce recurrent arrhythmias, with low recurrence rates of clinically apparent atrial arrhythmias in the first few years after repeat surgery.

    “Operative conversion to total cavopulmonary artery connection with concomitant arrhythmia surgery can in some patients improve heart failure symptoms and reduce recurrent arrhythmias, 969,982 with low recurrence rates of clinically apparent atrial arrhythmias in the first few years after repeat surgery.[983][984][985]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [969] Fujita, 2009, Management of late atrial tachyarrhythmia long after Fontan operation, J Cardiol source

      Not checked in the free run.

    • cites [982] Kwak, 2009, Surgical therapy of arrhythmias in single-ventricle patients undergoing Fontan or Fontan conversion, J Card Surg source

      Not checked in the free run.

    • cites [983] Backer, 2008, Maze procedure in single ventricle patients, Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Catheter ablation of left atrial macroreentrant tachycardia is more complex, with lower success rates and higher recurrence rates.

    “Catheter ablation of left atrial macroreentrant tachycardia is more complex, with lower success rates and higher recurrence rates.1006,1007”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1006] Esato, 2009, Color-coded three-dimensional entrainment mapping for analysis and treatment of atrial macroreentrant tachycardia, Heart Rhythm source

      Not checked in the free run.

    • cites [1007] Huo, 2014, Atrial Arrhythmias Following Surgical AF Ablation: Electrophysiological Findings, Ablation Strategies, and Clinical Outcome, J Cardiovasc Electrophysiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Isthmus ablation may also reduce AF recurrences in selected patients and help to prevent hospitalizations.

    “It may also reduce AF recurrences in selected patients, 1003,1004 and help to prevent hospitalizations.1004,1005”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1003] Schmieder, 2003, Acute and long-term results of radiofrequency ablation of common atrial flutter and the influence of the right atrial isthmus ablation on the occurrence of atrial fibrillation, Eur Heart J source

      Not checked in the free run.

    • cites [1004] Bandini, 2011, Atrial fibrillation after typical atrial flutter ablation: a long-term follow-up, J Cardiovasc Med (Hagerstown) source

      Not checked in the free run.

    • cites [1005] Dewland, 2014, Healthcare utilization and clinical outcomes after catheter ablation of atrial flutter, PLoS One source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Isthmus ablation is comparably safe and more effective than antiarrhythmic drug therapy.

    “Isthmus ablation is comparably safe and more effective than antiarrhythmic drug therapy, and is recommended for recurrent atrial flutter.[585][586][587]713”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [585] Cosedis Nielsen, 2012, Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation, N Engl J Med source

      Not checked in the free run.

    • cites [586] Wilber, 2010, Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial, JAMA source

      Not checked in the free run.

    • cites [587] Arbelo, 2014, The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ibutilide is more effective for conversion of atrial flutter than AF, whereas vernakalant is less effective in converting typical atrial flutter.

    “Ibutilide is more effective for conversion of atrial flutter than AF, whereas vernakalant is less effective in converting typical atrial flutter.996,997”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [996] Bronis, 2012, Vernakalant: review of a novel atrial selective antiarrhythmic agent and its place in current treatment of atrial fibrillation, Hosp Chronicles

      Not checked in the free run.

    • cites [997] Nair, 2011, Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation, J Am Board Fam Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Patients in an active role tend to have better health outcomes and care experiences, and engagement itself can be considered as an intermediate outcome.

    “Patients in an active role tend to have better health outcomes and care experiences, and engagement itself can be considered as an intermediate outcome, particularly where related to improved clinical outcomes.1010”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1010] Hibbard, 2013, What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs, Health Aff (Millwood) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Autonomous, informed patients are better placed to adhere to long-term therapy, and long-term management of chronic conditions such as AF will benefit from informed patients involved in the disease management.

    “Autonomous, informed patients are better placed to adhere to long-term therapy, and it is very likely that longterm management of chronic conditions such as AF will benefit from informed patients involved in the disease management who are aware of their own responsibilities.328”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [328] Nuno, 2012, Integrated care for chronic conditions: the contribution of the ICCC Framework, Health Policy source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Shared decision-making and patient-centred organization of care can help to ensure adherence to management and empower patients, and respect individual patient preferences, needs, and values.

    “Shared decision-making 747 and patient-centred organization of care can help to ensure adherence to management and empower patients, and respect individual patient preferences, needs, and values (see Chapter 7.2).326,1008,1009”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [747] Seaburg, 2014, Shared decision making in atrial fibrillation: where we are and where we should be going, Circulation source

      Not checked in the free run.

    • cites [326] Wagner, 1996, Organizing care for patients with chronic illness, Milbank Q source

      Not checked in the free run.

    • cites [1008] Institute of Medicine Committee on Quality of Health Care in America, 2001, Crossing the Quality Chasm: A New Health System for the 21st Century

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Within a multidisciplinary team, allied health professionals can guide this interactive process in which communication, trust, and reciprocal respect foster patient engagement.

    “Within a multidisciplinary team, allied health professionals can guide this interactive process in which communication, trust, and reciprocal respect foster patient engagement.1021”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1021] Stiggelbout, 2012, Shared decision making: really putting patients at the centre of healthcare, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-management is primarily focused on tasks to manage the condition, such as adhering to a therapeutic regimen or modifying behaviour.

    “Self-management is primarily focused on tasks to manage the condition, such as adhering to a therapeutic regimen or modifying behaviour (e.g.resulting in smoking cessation or weight loss).1020”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1020] Lorig, 2003, Self-management education: history, definition, outcomes, and mechanisms, Ann Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-management requires understanding of the treatment modalities and goals.

    “It requires understanding of the treatment modalities and goals.350”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [350] Alonso-Coello, 2008, Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives: protocol for a two-phase study, BMC Health Serv Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Models of care that integrate education, engagement, and shared decision making are now available and may be of particular value in the management of AF.

    “Models of care that integrate education, engagement, and shared decision making are now available, 1023 and may be of particular value in the management of AF.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1023] Elwyn, 2012, Shared decision making: a model for clinical practice, J Gen Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Minimally invasive epicardial ablation surgery for the treatment of stand-alone AF was reported a decade ago.

    “Minimally invasive epicardial ablation surgery for the treatment of stand-alone AF was reported a decade ago.1035”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1035] Wolf, 2005, Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation, J Thorac Cardiovasc Surg source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The procedure for stand-alone AF has since evolved towards a totally thoracoscopic procedure, and lesion sets were extended to a complete left atrial maze.

    “The procedure has since evolved towards a totally thoracoscopic procedure, 1036 and lesion sets were extended to a complete left atrial maze.822”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1036] Yilmaz, 2008, Completely thoracoscopic bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation, J Thorac Cardiovasc Surg source

      Not checked in the free run.

    • cites [822] Weimar, 2012, Approaching a paradigm shift: endoscopic ablation of lone atrial fibrillation on the beating heart, Ann Thorac Surg source

      Not checked in the free run.

173 of 173

  • The paper relies on this without support.

    External stressors such as structural heart disease, hypertension, possibly diabetes, and AF itself induce a slow but progressive process of structural remodelling in the atria.

    “External stressors such as structural heart disease, hypertension, possibly diabetes, but also AF itself induce a slow but progressive process of structural remodelling in the atria (Figure 2).”

  • The paper relies on this without support.

    In many patients, AF progresses from short, infrequent episodes to longer and more frequent attacks.

    “In many patients, AF progresses from short, infrequent episodes to longer and more frequent attacks.”

  • The paper relies on this without support.

    Over time, many patients will develop sustained forms of AF.

    “Over time, many patients will develop sustained forms of AF.”

  • The paper relies on this without support.

    AF may also regress from persistent to paroxysmal AF.

    “AF may also regress from persistent to paroxysmal AF.”

  • The paper relies on this without support.

    AF is often asymptomatic.

    “As AF is often asymptomatic, these healthcare professionals are important stakeholders to enable adequate detection of AF and to ensure consistent management.”

  • The paper relies on this without support.

    Most patients access the healthcare system initially through pharmacists, community health workers, or primary care physicians.

    “Most patients access the healthcare system initially through pharmacists, community health workers, or primary care physicians.”

  • The paper relies on this without support.

    Age 65 years and older conveys a relatively high and continuously increasing stroke risk that also potentiates other risk factors such as heart failure and sex.

    “Importantly, age (65 years and older) conveys a relatively high and continuously increasing stroke risk that also potentiates other risk factors (such as heart failure and sex).”

  • The paper relies on this without support.

    All non-vitamin K antagonist oral anticoagulants have a predictable effect (onset and offset) without need for regular anticoagulation monitoring.

    “All NOACs have a predictable effect (onset and offset) without need for regular anticoagulation monitoring.”

  • The paper relies on this without support.

    Only the higher dose edoxaban regimen has been approved for stroke prevention in AF.

    “Only the higher dose regimen has been approved for stroke prevention in AF.”

  • The paper relies on this without support.

    Absolute contraindications to long-term OAC after a bleeding episode are rare.

    “absolute contraindications to long-1481 term OAC after a bleeding episode are rare.”

  • The paper relies on this without support.

    Many causes or triggers of major bleeding events can be treated and/or eliminated.

    “Many causes or triggers of major bleeding events can be treated 1483 and/or eliminated, including uncontrolled hypertension, gastrointestinal ulcers, and intracranial aneurysms.”

  • The paper relies on this without support.

    Between 5% and 15% of AF patients will require stenting at some point in their lives.

    “Between 5% and 15% of AF patients will require stenting at some point in their lives.”

  • The paper relies on this without support.

    Rate control is often sufficient to improve AF-related symptoms.

    “Rate control is an integral part of the management of AF patients, and is often sufficient to improve AF-related symptoms.”

  • The paper relies on this without support.

    All available rate control therapies have the potential for adverse effects.

    “All available therapies have the potential for adverse effects and patients should initially be treated with a low dose and uptitrated to achieve symptom improvement.”

  • The paper relies on this without support.

    Amiodarone has a wide array of extracardiac adverse effects.

    “The wide array of extracardiac adverse effects associated with amiodarone renders it a reserve agent in patients whose heart rate cannot be controlled with combination therapy (e.g.beta-blocker or verapamil/diltiazem combined with digoxin).”

  • The paper relies on this without support.

    AV nodal ablation renders patients pacemaker-dependent for the rest of their lives.

    “AV nodal ablation renders patients pacemaker-dependent for the rest of their lives, limiting AV nodal ablation and pacing to patients whose symptoms cannot be managed by rate controlling medication or by reasonable rhythm control interventions.”

  • The paper relies on this without support.

    The stroke risk estimated from non-ablation atrial fibrillation cohorts is applicable to patients after catheter ablation.

    “the expected stroke risk has been adopted from nonablation AF cohorts.”

  • The paper relies on this without support.

    General anticoagulation recommendations are appropriate for patients after catheter ablation regardless of the presumed rhythm outcome.

    “In the absence of controlled trial data, OAC after catheter ablation should follow general anticoagulation recommendations, regardless of the presumed rhythm outcome.”

  • The paper relies on this without support.

    Many channelopathies and inherited cardiomyopathies are associated with AF.

    “Many channelopathies and inherited cardiomyopathies are associated with AF.”

  • The paper relies on this without support.

    Both shortening as well as prolongation of the atrial action potential have been demonstrated as likely mechanisms underlying AF in these diseases.

    “Both shortening as well as prolongation of the atrial action potential have been demonstrated as likely mechanisms underlying AF in these diseases.”

  • The paper relies on this without support.

    There is no clear link between detected mutations and specific outcomes or therapeutic needs in AF.

    “Furthermore, there is no clear link between detected mutations and specific outcomes or therapeutic needs.”

  • The paper relies on this without support.

    The role of detraining for AF in human athletes is unknown.

    “but the role of detraining for AF in human athletes is unknown.”

  • The paper relies on this without support.

    AF in pregnant women is rare and is usually associated with pre-existing heart disease.

    “AF in pregnant women is rare and is usually associated with pre-existing heart disease.”

  • The paper relies on this without support.

    Beta-blockers, verapamil, diltiazem, and digoxin all carry a US Food and Drug Administration pregnancy safety category of C, except for atenolol (category D).

    “Owing to a lack of specific data, beta-blockers, verapamil, diltiazem, and digoxin all carry a US Food and Drug Administration pregnancy safety category of C (benefits may outweigh risk), except for atenolol (category D: positive evidence of risk).”

  • The paper relies on this without support.

    There are insufficient data to comment on verapamil or diltiazem for rate control in pregnancy.

    “There are insufficient data to comment on verapamil or diltiazem, hence rate control using beta-blockers and/or digoxin is recommended.917”

  • The paper relies on this without support.

    All rate control agents are present in breast milk, although levels of beta-blockers, digoxin, and verapamil are too low to be considered harmful.

    “With regards to breastfeeding, all rate control agents are present in breast milk, although levels of beta-blockers, digoxin, and verapamil are too low to be considered harmful.”

  • The paper relies on this without support.

    All of the information on the benefit of OAC has been in patients with AF diagnosed by ECG.

    “All of the information on the benefit of OAC has been in patients with AF diagnosed by ECG.”

  • The paper relies on this without support.

    Technological advances allow ready detection of AHRE in patients with implanted devices and an atrial lead.

    “Technological advances allow ready detection of AHRE in patients with implanted devices and an atrial lead.”

  • The paper relies on this without support.

    Patients with AHRE detected by implanted devices are at increased stroke risk.

    “Such patients are at increased stroke risk, but it is unclear whether they benefit from OAC.”

  • The paper relies on this without support.

    The use of NOACs has not been tested in patients with creatinine clearance < 30 mL/min, and there is very little evidence on the effects of OAC in patients on haemodialysis or on other forms of renal-replacement therapy.

    “The use of NOACs has not been tested in patients with creatinine clearance < 30 mL/min, and there is very little evidence on the effects of OAC in patients on haemodialysis or on other forms of renal-replacement therapy.”

  • The paper relies on this without support.

    At least 2% of anticoagulated patients with AF will experience a serious bleeding event per year.

    “At least 2% of anticoagulated patients with AF will experience a serious bleeding event per year.”

  • The paper relies on this without support.

    Previous recommendations on the safe time-window in which a cardioversion can be performed in new-onset AF used ≤ 48 hours as the 'gold standard' for non-protected cardioversion.

    “Based on retrospective data, previous recommendations on the safe time-window in which a cardioversion can be performed in new-onset AF used ≤ 48 hours as the 'gold standard' for non-protected cardioversion.”

  • The paper relies on this without support.

    Few of the studies of carotid endarterectomy vs stenting included patients with AF.

    “However, few of these studies included patients with AF.”

  • The paper relies on this without support.

    The optimal antithrombotic therapy in the first months after biological valve replacement (including after catheter-based valve replacement) is not known.

    “The optimal antithrombotic therapy in the first months after biological valve replacement (including after catheter-based valve replacement) is not known.”

  • The paper relies on this without support.

    VKAs remain the mainstay during the initial postoperative period after biological valve replacement.

    “VKAs remain the mainstay during the initial postoperative period; NOACs probably deliver the same protection.”

  • The paper relies on this without support.

    NOACs probably deliver the same protection as VKAs during the initial postoperative period after biological valve replacement.

    “VKAs remain the mainstay during the initial postoperative period; NOACs probably deliver the same protection.”

  • The paper relies on this without support.

    The safety and efficacy of NOACs in patients with rheumatic mitral valve disease has not been evaluated.

    “The safety and efficacy of NOACs in patients with rheumatic mitral valve disease has not been evaluated and should be studied.”

  • The paper relies on this without support.

    Long-term recurrence rates of AF are high after successful catheter ablation.

    “In view of the long-term recurrence rates of AF, this Task Force recommends to continue OAC in AF patients after 'successful' catheter ablation.”

  • The paper relies on this without support.

    Robust data comparing rate control therapies are scant, with the majority of studies being small uncontrolled trials over short periods of follow-up.

    “Although the use of rate control therapy is very common in AF patients, robust data comparing rate control therapies are scant, with the majority of studies being small uncontrolled trials over short periods of follow-up.”

  • The paper relies on this without support.

    A few recent randomized studies support the use of catheter or surgical ablation in patients with persistent AF and long-standing persistent AF.

    “While a few recent randomized studies support the use of catheter or surgical ablation in patients with persistent AF and long-standing persistent AF, there is a clear need for more data evaluating this intervention in adequately powered randomized trials.”

  • The paper relies on this without support.

    PVI emerges as the most important target for catheter ablation of AF.

    “PVI emerges as the most important target for catheter ablation of AF.”

  • The paper relies on this without support.

    Many patients are in need of multiple catheter-ablation procedures, and such interventions often follow local or operator-specific protocols without clear evidence to support the choice of ablation target or intervention.

    “Many patients are in need of multiple catheter-ablation procedures, and such interventions often follow local or operator-specific protocols without clear evidence to support the choice of ablation target or intervention.”

  • The paper relies on this without support.

    In the follow-up after initially successful catheter ablation, even when done in experienced centres, many patients will experience symptomatic recurrences of AF.

    “In the follow-up after initially successful catheter ablation, even when done in experienced centres, many patients will experience symptomatic recurrences of AF.”

  • The paper relies on this without support.

    There is a surprising paucity of data evaluating different rhythm control interventions in patients with recurrent AF after catheter ablation.

    “There is a surprising paucity of data evaluating different rhythm control interventions in patients with recurrent AF after catheter ablation.”

  • The paper relies on this without support.

    The progress in rhythm control therapy and observational long-term analyses suggest that rhythm control therapy may have a prognostic benefit.

    “The progress in rhythm control therapy (catheter ablation, new antiarrhythmic drugs) and observational longterm analyses suggest that rhythm control therapy may have a prognostic benefit.”

  • The paper relies on this without support.

    Scientific evidence on long-term results of thoracoscopic AF ablation is still limited.

    “With such rapid development and the coexistence of different techniques and lesion sets, scientific evidence on long-term results is still limited.”

  • The paper relies on this without support.

    Prospective randomized studies comparing the rate of ischaemic stroke with or without left appendage exclusion are presently lacking.

    “Exclusion of the LAA has been performed by cardiothoracic surgeons for decades, but prospective randomized studies comparing the rate of ischaemic stroke with or without left appendage exclusion are presently lacking.”

  • The paper relies on this without support.

    NOACs have a short plasma half-life of approximately 12 hours and improved haemostasis is expected within 12-24 hours after a delayed or omitted dose.

    “NOACs have a short plasma half-life of approximately 12 hours and improved haemostasis is expected within 12-24 hours after a delayed or omitted dose.”

  • The paper relies on this without support.

    Dialysis clears dabigatran but is not effective for the other NOACs.

    “Dialysis clears dabigatran but is not effective for the other NOACs.”

  • The paper relies on this without support.

    Coagulation tests do not provide much information in patients on NOACs, except for activated partial thromboplastin time in the case of dabigatran.

    “Coagulation tests do not provide much information in patients on NOACs, except for activated partial thromboplastin time in the case of dabigatran.”

  • The paper relies on this without support.

    More specific coagulation tests do exist, including diluted thrombin time (HEMOCLOT).

    “More specific coagulation tests do exist, including diluted thrombin time (HEMOCLOT) for”
51 of 51

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Carotid stenting is called higher-risk despite a lower reported event rate

    Major

    The reported composite event rate is 6.0% for stenting and 8.6% for endarterectomy, so the stated direction of the comparison is reversed.

1 of 1

Cites

2 retracted

Flagged first, then by citations

Research works printed but not linked: 12

  1. Nieuwlaat, 2007, Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation, The Euro Heart Survey on Atrial Fibrillation. Am Heart J, 153, 1006
  2. Kirchhof, 2007, Outcome parameters for trials in atrial fibrillation: executive summary: Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA), Eur Heart J, 28, 2803, 10.1093/eurheartj/ehm358 · DOI
  3. Stroke Prevention in Atrial Fibrillation Investigators, 1991, Stroke Prevention in Atrial Fibrillation Study, Final results. Circulation, 84, 527
  4. Whitlock, 2014, Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III, Ann Cardiothorac Surg, 3, 45
  5. Segal, The evidence regarding the drugs used for ventricular rate control, In. J Fam Practice 2000;, 49, 47
  6. Waldo, 1996, Effect of d-sotalol on mortality in patients with left ventricular dysfunction after recent and remote myocardial infarction. The SWORD Investigators, Survival With Oral d-Sotalol. Lancet, 348, 7
  7. Savelieva, 2011, Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines, Part II: secondary prevention. Europace, 13, 610
  8. Swedberg, 2012, Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study, J Am Coll Cardiol, 59, 1598, 10.1016/j.jacc.2011.11.063 · DOI · Paper page
  9. Cappato, 2014, Rivaroxaban vs. vitamin K antagonists for cardioversion in atrial fibrillation, Eur Heart J, 35, 3346, 10.1093/eurheartj/ehu367 · DOI
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Authors
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., Hindricks, G., Manolis, A. S., Oldgren, J., Popescu, B. A., Schotten, U., Van Putte, B., Vardas, P., ESC Scientific Document Group, Agewall, S., Camm, J., Esquivias, G. B., Budts, W., Carerj, S., Casselman, F., Coca, A., De Caterina, R., Deftereos, S., Dobrev, D., Ferro, J. M., Filippatos, G., Fitzsimons, D., Gorenek, B., Guenoun, M., Hohnloser, S. H., Kolh, P., Lip, G. Y. H., Manolis, A., McMurray, J., Ponikowski, P., Rosenhek, R., Ruschitzka, F., Savelieva, I., Sharma, S., Suwalski, P., Tamargo, J. L., Taylor, C. J., Van Gelder, I. C., Voors, A. A., Windecker, S., Zamorano, J. L., Zeppenfeld, K., Zamorano, J. L., Aboyans, V., Achenbach, S., Agewall, S., Badimon, L., Barón-Esquivias, G., Baumgartner, H., Bax, J. J., Bueno, H., Carerj, S., Dean, V., Erol, Ç., Fitzsimons, D., Gaemperli, O., Kirchhof, P., Kolh, P., Lancellotti, P., Lip, G. Y. H., Nihoyannopoulos, P., Piepoli, M. F., Ponikowski, P., Roffi, M., Torbicki, A., Vaz Carneiro, A., Windecker, S., Hayrapetyan, H. G., Roithinger, F. X., Aliyev, F., Chasnoits, A., Mairesse, G. H., Matičević, D. L., Shalganov, T., Skorić, B., Antoniades, L., Taborsky, M., Pehrson, S., Khaled, S., Kampus, P., Hedman, A., Poposka, L., Le Heuzey, J.-Y., Estadashvili, K., Bänsch, D., Csanádi, Z., Keane, D., Beinart, R., Romeo, F., Koshumbayeva, K., Bajraktari, G., Mirrakhimov, A., Kalejs, O., Nasr, S., Marinskis, G., Dimmer, C., Sammut, M., Grosu, A., Abdelali, S., Hemels, M. E. W., Anfinsen, O.-G., Średniawa, B., Adragao, P., Dan, G.-A., Mikhaylov, E. N., Zavatta, M., Potpara, T., Slovenia, P. H., Zupan, I., Arenal, A., Braunschweig, F., Shah, D., Ouali, A. S., Demir, M., Sychov, O., & Duncan, E.
Affiliations
University Hospitals Birmingham NHS Foundation Trust (GB)
Corresponding author
Benussi, Stefano
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2016-08-27
Volume
37
Issue
38
Pages
2893-2962
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehw210
OpenAlex
W3004050106
Semantic Scholar
1f0d7a31a8bbb5720b0fa33e3a83fce3ac52dd89
Cited by
6,418
References
1,040
Citations by year
2026: 126 · 2025: 177 · 2024: 277 · 2023: 322 · 2022: 430 · 2021: 786 · 2020: 1265 · 2019: 1105 · 2018: 1073 · 2017: 781 · 2016: 65 · 2015: 1 · 2014: 1 · 2012: 1
FWCI
831.50
Type
journal article
Language
en
Open access
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion, other-oa)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Open Repository and Bibliography (University of Liège) (submittedVersion, other-oa)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
  • National Institute for Health and Care Research (CL-2015-13-006, CDF-2015-08-074)
  • British Heart Foundation (FS/13/43/30324, RG/11/15/29375)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
atrial fibrillation, atrial fibrillation management, anticoagulation, stroke prevention, cardioversion, catheter ablation, rhythm control, rate control, risk-benefit assessment
MeSH terms
Atrial Fibrillation, Cardiology, Europe, Humans, Societies, Medical

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