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Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Dysrhythmias VI: Management of Dysrhythmias01:25

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Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Health economic evaluation of left atrial appendage closure in patients with atrial fibrillation and at high risk for stroke and bleeding: a study protocol.

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Related Experiment Video

Updated: Mar 20, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

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Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation.

Ulf Landmesser1,2,3, Carsten Skurk1,2, Paulus Kirchhof4,5,6

  • 1Department of Cardiology, Angiology, and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Charité University Medicine Berlin, Berlin.

The New England Journal of Medicine
|March 18, 2026
PubMed
Summary

Left atrial appendage closure did not prove noninferior to best medical care for preventing stroke and bleeding events in high-risk atrial fibrillation patients. This finding suggests current medical management remains the standard for these complex cases.

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Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Catheter-based left atrial appendage (LAA) closure is an alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF).
  • Effectiveness of LAA closure versus physician-directed best medical care in high-risk AF patients for stroke and bleeding is not well-established.

Purpose of the Study:

  • To compare the noninferiority of LAA closure versus best medical care in patients with AF at high risk for stroke and bleeding.

Main Methods:

  • A multicenter randomized trial in Germany assigned high-risk AF patients to LAA closure or physician-directed best medical care.
  • The primary endpoint was a composite of stroke, systemic embolism, major bleeding, or death, assessed via time-to-event analysis with a noninferiority margin of hazard ratio 1.3.

Main Results:

  • The study included 912 patients (mean age 77.9 years; mean CHA2DS2-VASc score 5.2; mean HAS-BLED score 3.0).
  • After 3 years median follow-up, the primary endpoint occurred in 16.8% of the LAA closure group and 13.3% of the medical therapy group (P=0.44 for noninferiority).
  • Serious adverse events were reported in 82.5% of the device group and 77.4% of the medical therapy group.

Conclusions:

  • Left atrial appendage closure was not noninferior to physician-directed best medical care in high-risk AF patients.
  • The composite endpoint of stroke, systemic embolism, major bleeding, or death was not significantly reduced by LAA closure compared to best medical care.