Treating Atrial Fibrillation with Vitamin K Antagonist Therapy

Blood to the heart muscles is supplied by the coronary arteries and the entire pumping process is controlled by the heart’s electrical conduction system. Any disruption to the electrical signal transmission affects the blood flow and functioning of the heart. Whenever there is an obstruction in the blood supply, the heart muscles become starved of oxygen and nutrients, which leads to more chest pain or discomfort.  Atrial fibrillation (AF) is one of the common heart conditions characterised with excessively higher or abnormal heart rates. Moreover, it also increases the risk of blood clots causing stroke or life-threatening congestive heart failures. That is why it is highly recommended to seek treatment for AF at the right time.

Atrial fibrillation is categorised into paroxysmal, persistent and permanent depending on the degree and frequency of AF episodes. Diagnostic tests and accurate evaluation of symptoms is essential to devise the right treatment method. Atrial fibrillation has strong associations with other serious cardiovascular diseases such as congestive heart failure, hypertension and coronary artery diseases. Treatment options for AF include medical therapy, catheter ablation and insertion of pacemaker. Drug treatment is often preferred to prevent the risk of stroke or to control the heart rhythm. Patients with permanent AF are at an increased risk of stroke and thromboembolism. Oral anticoagulation common vitamin K antagonist therapy (VKA) is the standard medication prescribed for AF patients with moderate or high risk of stroke.  Also known as blood thinners, this medication demands regular blood tests to monitor its interactions. Some of the common vitamin K antagonist therapy medications include warfarin, apixaban, dabigatran and rivaroxaban.

Catheter ablation is another procedure to treat AF, where the source of erratic signals is destroyed using high-frequency radio waves. Having an artificial atrial fibrillation pacemaker fitted below the skin near the collar bone is another option to maintain the normal heart rhythm. A pacemaker is a small device that consists of a pulse generator and lead wires. Implantation of an artificial atrial fibrillation pacemakeris a minor surgical procedure that is typically done in an electrophysiology lab. Right after the implantation, the device takes over the job of sinoatrial node (SA node) and helps the heart beat regularly. Treatment for atrial fibrillation is decided on the basis of the patient’s symptoms, underlying cause, overall health condition and other factors.

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Percutaneous Coronary Intervention in Managing Acute Coronary Syndromes

Damage of the heart muscles due to inadequate blood flow or oxygenation is known as myocardial ischemia. The condition becomes worse in some cases, resulting in myocardial infarctions (heart attacks) or unstable angina. Atherosclerotic plaque build up in the coronary arteries is the main cause of restriction in the blood supply. Termed as Coronary Artery Disease (CAD) or coronary heart disease, this condition has been a leading cause of mortality and morbidity. CAD can lead to acute coronary syndrome (ACS), a condition characterised by the signs and symptoms compatible with myocardial infarctions (MI) and unstable angina (UA). The spectrum of ACS clinical presentation covers a range from UA to non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). In a nutshell, ACS is associated with the sudden and unexpected rupture of a vulnerable plaque followed by the partial or complete blockage of a stenotic artery. Reperfusion therapy is recommended for ACS patients on an immediate basis. Aggressive medical therapy or non-invasive percutaneous coronary intervention is performed to restore the blood flow to the heart.

Either a combination of anti-ischemic and antithrombotic agents or a non-invasive percutaneous coronary intervention is preferred for treating UA and NSTEMI patients. Accurate diagnosis and prompt revascularization procedures are crucial in devising the management strategy of ACS. Guide-wire based Fractional Flow Reserve (FFR) has become an indispensable tool for the interventional procedures. In-vivo evaluation of the vulnerable plaque and the well-validated cut off value offered by  FFR measurements, guides the ACS treatment. To help choose between drug therapy and revascularization procedure, Guide-wire based fractional flow reserve helps the interventional cardiologist to make a decision.

Although PCI has bbeen considered the safest way to reduce complications related with MI and ACS, some findings reported the occurrence of cardiac arrhythmias among patients undergoing the percutaneous procedure. Irregularity in the heart beat or rhythm leads to twitching of atria and desynchronised contractions of heart chambers, thereby increasing the risk of stroke and heart failure. Insertion of a medical Atrial Fibrillation Pacemaker provides a solution to help prevent adverse clinical conditions and outcomes. Hooked up to the heart with tiny wires, an artificial medical atrial fibrillation pacemaker reduces the risk of complications. Appropriate management of arrhythmia is crucial to improve clinical outcomes.

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Barostim Therapy & Cardiovascular Health

Whenever there is an obstruction or blockage in the coronary arteries, it hinders the oxygen-rich blood flow to the heart muscles, resulting either in angina (chest pain) or myocardial infarctions (heart attacks). In some cases, the blockage occurs more slowly so that collateral circulation starts to take up the role of coronary arteries. In medical terms Coronary chronic total occlusion is defined as – “a complete blockage of the coronary artery with TIMI (Thrombolysis in Myocardial Infarction) zero flow present for an estimated duration greater than or equal to three months”. Chronic Total Occlusion (CTO) is often found in patients with significant coronary artery disease (CAD), presenting a management dilemma for interventional cardiologists.

Coronary artery chronic total occlusion which occurs due to the deposit of fibrocalcific plaque is one of the most commonly identified lesion subsets in CAD patients. Revascularization of CTO can offer varied benefits as it provides improved heart function and reduced risks of arrhythmic events. Intricate pathophysiology of organized fibrocalcific atherosclerotic plaque which makes it difficult to cross with guide –wire increases the complications of percutaneous approach for CTOs. A promising solution to this guide-wire problem was the delivery of radiofrequency energy through the catheter guide wire that can burn off the blockage. Similar to the novel latest Thermocool Smarttouch Catheter, this method allows the interventional cardiologist to ablate the atherosclerotic plaque without causing any injury to the wall of the coronary artery. As the latest Thermocool Smarttouch Catheter is mainly used during the cardiac ablation procedure, the safe-cross-guided radiofrequency total occlusion crossing system allows the physician to clear out the CTO blockage to perform percutaneous coronary intervention (PCI). 

Another risk factor that can increase the chances of major acute cardiovascular events among the CAD patients is the presence of resistant hypertension. As the name implies, it is a medical condition when the blood pressure remains stubbornly high despite medical treatment. Promising results from the novel barostim therapy presents new hope to the medical community. Reducing the excessive blood pressure and improving cardiovascular function by a great extent, barostim neo implantation and therapy is projected to be an ideal choice for treating resistant hypertension. Novel barostim therapy can reduce the likelihood of adverse cardiovascular events thereby improving the quality of life. 

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Stenting For Multivessel Coronary Artery Disease

Hardening of arteries (atherosclerosis) not only causes lesions in the blood vessels but also results in the obstruction of blood supply to the heart muscles. During strenuousactivities, narrowed coronary arteries won’t be able to supply enough blood to the myocardium leading to angina (chest pain). Coronary artery disease (CAD) can be fatal as it is a major cause of heart attacks (myocardial infarction). CAD  can also lead to disability and decreased quality of life. Managing coronary heart disease has always been a challenge to cardiologists due to the increasing complexity of lesions and location of stenosis. Symptomatic Multivessel coronary artery disease that affects two or more epicardial vessels is a case in point. Optical therapeutic approach for treating multivessel disease (MVD) is still a point of fervent discussion within the medical community.

There are mainly three treatment modalities available for patients with MVD which includes medical therapy, non-invasive percutaneous coronary intervention (PCI)and coronary artery bypass graft (CABG) surgery. Though bypass surgery was a preferred approach over stenting in MVD treatment, the recent advancements in catheterization procedures and technologies have reignited an interest in percutaneous intervention. Drug eluting stenting (DES) has proven successful in overcoming the adverse clinical outcomes of bare metal stenting (BMS) by a greater extent.  Moreover, widespread application of fractional flow reserve measurement technique has made it easier for physicians to choose between the non-invasive percutaneous coronary intervention and pharmaceutical treatment for a CAD patient. As per the famous FAME study, it has been proved that FFR guided percutaneous approach can ensure better outcomes in managing the symptomatic multivessel coronary disease. Followed by that, the FAME 2 study results demonstrated PCI along with medical therapy can ensure better outcomes when compared to medical therapy alone.

Innovative advancements in the cath lab set up and interventional environments have been helping physicians to perform both interventional and surgical procedures with great accuracy and precision. For example, Philip’sXper Flex Cardio equipped with multiple functionalities aids physicians in treatment decisions. This hemodynamic cardiac monitoring system supports FFR measurements and provides 16-lead ECG analysis, culprit Artery detection and patented ST maps. Philip’s Xper Flex Cardio system and similar physiomonitoring systems can surely enhance the efficiency on multiple levels.

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FFR-Guided Percutaneous Coronary Intervention Gain Advantage Over Medical Therapy

Coronary heart disease also known as ischemic heart disease can be described as a condition where the coronary arteries are severely narrowed because of atherosclerosis. When the heart muscle is starved of oxygen and nutrients, it induces chest pain (angina). However, in some cases there is a complete blockage in blood supply leading to heart muscle damage and myocardial infarctions (heart attacks). Some of the common symptoms of coronary artery disease (CAD) to watch out for include chest pain, nausea, dizziness and shortness of breath. It is advisable to seek medical treatment immediately before the symptoms turn severe and frequent. Remarkable advances in the diagnostic procedures, standard blood flow measurement techniques and medical imaging devices have been helping cardiologists to evaluate CAD in a better way.

Angiography is the first-line diagnostic investigation recommended by cardiologists. Having a detailed physiological analysis of stenosis in the arteries is essential to choose between the varied treatment options – pharmaceutical therapy, FFR-guided percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.  However, several studies and clinical trials have pointed out the limitations of coronary angiography in estimating the degree of luminal narrowing. Standard blood flow measurement techniques and imaging tools can provide a detailed visualization of the blood flow and performance of the heart.  Fractional Flow Reserve (FFR), as a case in point, assists the physicians in identifying the ischemic and non-ischemic lesions. Results published by the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study demonstrated the superiority of FFR over angiography in deciding whether or not to stent the lesions. Moreover, it has been proved that FFR-guided percutaneous coronary intervention assure better outcomes and significantly lower complication rates.

Medical therapy was considered to be the best approach for patients with stable CAD and significant stenosis. Results from the latest FAME 2 trials conclude that FFR-guided drug-eluting stenting (PCI) is superior to medical therapy for managing stable coronary disease. Two year data from FAME 2 trials shows a great reduction in the major adverse cardiac events and decrease in the risk of urgent revascularization. As per the latest FAME 2 study results, FFR-guided PCI plus optimal medical therapy shows sustained clinical and economic benefits when compared with medical therapy alone.

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