One-Year Outcomes in Anticoagulated Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention: Insights From the Greek Antiplatelet Atrial Fibrillation Registry.

ABSTRACT: GReek-AntiPlatElet Atrial Fibrillation registry is a multicenter, observational, noninterventional study of atrial fibrillation patients undergoing percutaneous coronary intervention. Primary endpoint included clinically significant bleeding rate at 12 months between different antithrombotic regimens prescribed at discharge; secondary endpoints included major adverse cardiovascular events and net adverse clinical events. A total of 647 patients were analyzed. Most (92.9%) were discharged on novel oral anticoagulants with only 7.1% receiving the vitamin K antagonist. A little over half of patients (50.4%) received triple antithrombotic therapy (TAT)-mostly (62.9%) for ≤1 month-whereas the rest (49.6%) received dual antithrombotic therapy (DAT). Clinically significant bleeding risk was similar between TAT and DAT [Hazard ratio (HR) = 1.08; 95% confidence interval (CI), 0.66-1.78], although among TAT-receiving patients, the risk was lower in those receiving TAT for ≤1 month (HR = 0.50; 95% CI, 0.25-0.99). Anticoagulant choice (novel oral anticoagulant vs. vitamin K antagonist) did not significantly affect bleeding rates ( P = 0.258). Age, heart failure, leukemia/myelodysplasia, and acute coronary syndrome were associated with increased bleeding rates. Risk of major adverse cardiovascular events and net adverse clinical events was similar between ΤAT and DAT (HR = 1.73; 95% CI, 0.95-3.18, P = 0.075 and HR = 1.39; 95% CI, 0.93-2.08, P = 0.106, respectively). In conclusion, clinically significant bleeding and ischemic rates were similar between DAT and TAT, although TAT >1 month was associated with higher bleeding risk.

Atrioventricular nodal dysfunction secondary to hyperparathyroidism.

The relationship of hyperparathyroid-associated hypercalcemia with clinical significant bradyarrythmias still remains controversial. We present a 66-year-old patient with dizziness, headache and paroxysmal 2:1 atrioventricular block. A 24-hour Holter report revealed symptomatic intermittent 2(nd) degree (2:1) atrioventricular block with a mean heart rate of 46 bpm. A 2D echocardiogramm showed normal ejection fraction and there was no valve dysfunction or calcification. The biochemistry results showed elevated serum calcium level, low phosphate level, elevated serum parathyroid hormone level and normal serum levels of potassium, magnesium and sodium. The urine calcium excretion was 390 mg/24 h. A coronary angiography was performed and revealed no critical lesions. The patient continued to have symptoms despite of the treatment of hypercalcemia and a DDDR pacemaker was implanted. He had a Sestamibi-scan of the neck, that was suggestive of parathyroid adenoma, and parathyroidectomy was performed. The presuming mechanism is the degeneration of AV node due to calcium deposit.