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Articles by Mark S. Link
Left Atrial Occlusion Devices vs. Anticoagulation: A Meta-Analysis
Left atrial occlusion devices are attractive because they can negate the need for anticoagulation in patients with atrial fibrillation (AF). Six randomized trials have compared left atrial appendage closure (LAAC) with anticoagulation (warfarin in 2 and direct oral anticoagulants [DOACs] in 4); now, a meta-analysis evaluated these trials (7028 patients in total).
Anticoagulation for Patients with Atrial Fibrillation and One Risk Factor
Whether patients with atrial fibrillation (AF) and intermediate risk for stroke (CHA DS -VASc score of 1 for men or 2 for women) would benefit from anticoagulation is unclear. Observational data have been mixed, and randomized trial data are sparse. To address this question, South Korean researchers randomized 1800 patients (mean age, 60) with AF and intermediate risk for stroke to a direct-acting oral anticoagulant (DOAC; apixaban or rivaroxaban) or to no anticoagulation.
A New Sham-Controlled Trial of Atrial Fibrillation Ablation
Clinical Takeaway : Ablation reduced AF but was not associated with better quality of life compared to a sham procedure. Context As with other surgical therapies, there have been suggestions that the benefit of atrial fibrillation (AF) ablation is largely placebo. Only a few sham-controlled randomized trials have been published: One in 2024, with 126 patients, and another in 2026, with 60 patients, showed a benefit of AF ablation in quality of life and AF outcomes.
Should We Continue Anticoagulation after Atrial Fibrillation Ablation?
Clinical Takeaway : Patients in a registry who had discontinued anticoagulation by 6 months were no more likely to have ischemic events and were less likely to bleed. Context Patients with atrial fibrillation (AF) who discontinued anticoagulants 1 year after ablation had better outcomes than those who continued the drugs in both the ALONE-AF trial and the OCEAN trial.
Should We Continue Anticoagulation Indefinitely after Catheter Ablation of Atrial Fibrillation?
Mark S. Link, M.D., reviewing Another trial indicates that it isn't necessary in most patients. Current guidelines recommend indefinite anticoagulation after ablation of atrial fibrillation (AF) in patients with a CHA 2DS 2-VASc score ≥2-3, but few data support this practice. In a recent randomized trial ( ALONE-AF), stopping anticoagulation 1 year after ablation did not raise stroke risk; now, another trial (OCEAN) has examined the same issue.
Is Routine Defibrillation Testing Necessary for Patients Undergoing Subcutaneous ICD Implantation?
Mark S. Link, MD, reviewing Based on a large, prospective French registry study, the answer is no. Defibrillation testing (DFT) is recommended for all patients undergoing implantation of a subcutaneous implantable cardioverter defibrillator (S-ICD). DFT was also once recommended for patients receiving transvenous ICDs - until randomized trials showed that they were not only unnecessary but potentially harmful, after which the practice was largely abandoned.
A Shift Toward Shared Decision Making
Mark S. Link, MD, reviewing Updated recommendations move away from universal disqualification, emphasizing individualized risk assessment and shared decision making for athletes with heart conditions. Sponsoring Organizations: American Heart Association (AHA) and American College of Cardiology (ACC) The Bethesda conference proceedings on athletes and cardiovascular conditions were published in 1985, 1994, and 2005, and changed to a scientific statement that was published in 2015.
Risk of Running-A Contemporary Look at Cardiac Arrest in Long-Distance Races
Cardiac Arrest During Long-Distance Running Races Jonathan H. Kim, MD, MSc; Austin J. Rim, MD; James T. Miller, MS; Mekensie Jackson, MS; Neeya Patel, BA; Sanchitha Rajesh; Yi-An Ko, PhD; Heather DiGregorio, MLA; George Chiampas, DO; David McGillivray, BS; Jay Holder, BA; Aaron L.
Extensive Ablation vs. Pulmonary Vein Isolation in Persistent Atrial Fibrillation
Mark S. Link, MD, reviewing A large, randomized trial in China shows improved efficacy with extensive ablation. For patients with paroxysmal atrial fibrillation (AF), pulmonary vein isolation (PVI) alone is clearly the most reasonable ablation strategy. However, for patients with persistent AF, it is unclear whether more-extensive ablation is needed to achieve success.
To Lower Stroke Risk in Patients Undergoing Atrial Fibrillation Ablation, Is a Device or a Medication Better?
Mark S. Link, MD, reviewing Closure of the atrial appendage was superior to oral anticoagulation in safety and noninferior in effectiveness. Multiple trials have shown that left atrial appendage occlusion has efficacy similar to oral coagulation (typically warfarin) in patients at elevated stroke risk. Whether this approach is effective in patients undergoing ablation of atrial fibrillation (AF) was tested in an industry-sponsored trial ( NCT03795298).
Mitigation of pacing‐induced cardiomyopathy with superficial right ventricular mid‐septal pacing: A long‐term retrospective comparison with apical pacing
CONFLICT OF INTEREST STATEMENT Dr. Takata has research support and a consulting contract with Medtronic. C. Hickman reports ownership of Medtronic stock. The other authors declare no conflicts of interest. REFERENCES 1, , , , . Pacing-induced cardiomyopathy: a systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm. 2023; 20: 282-290. 2, , , et al.
Does Screening for Atrial Fibrillation Reduce Stroke Risk?
Mark S. Link, MD, reviewing A 14-day monitor detected more atrial fibrillation but did not affect hospitalization rates for stroke or hemorrhage. Screening followed by appropriate anticoagulation for atrial fibrillation (AF) has yet to show a benefit in reducing stroke risk. The industry-funded, prospective, randomized, controlled GUARD-AF trial ( NCT04126486) evaluated whether a 14-day patch monitor would lead to a reduction in stroke risk without increasing risk for hemorrhage.
Omega-3 Fatty Acids and Arrhythmias
Get full access to this article View all available purchase options and get full access to this article. REFERENCES 1. Bang, H, Dyerberg, J, Nielsen, A. Plasma lipid and lipoprotein pattern in Greenlandic west-coast Eskimos. Lancet. 1971;1:1143–1146. doi: 10.1016/s0140-6736(71)91658-8 2. Dyerberg, J, Bang, H, Stoffersen, E, Moncada, S, Vane, J. Eicosapentaenoic acid and prevention of thrombosis and atherosclerosis? Lancet. 1978;312:117–119. doi: 10.1016/s0140-6736(78)91505-2 3.
1-Year inspire Outcomes
Mark S. Link, MD, reviewing PFA appears safe and effective, but whether it's better than radiofrequency or cryoablation remains unclear. Pulsed-field ablation (PFA) is currently the darling of electrophysiology, and various PFA systems are under development and testing. Preliminary results from the prospective, multicenter, single-arm inspIRE trial ( NCT04524364) of the non-FDA-approved Varipulse system showed effectiveness and safety for paroxysmal atrial fibrillation (AF).
How Do Pulsed-Field and Thermal Ablation Compare for AF Burden? An ADVENT Substudy
Mark S. Link, MD, reviewing A secondary analysis of a randomized, controlled trial suggests an edge for PFA, but findings should be interpreted with caution. The recent, long-awaited ADVENT trial randomized patients undergoing ablation for paroxysmal atrial fibrillation (AF) to receive pulsed field ablation (PFA) or thermal ablation, which could be radiofrequency or cryoablation ( NCT04612244; NEJM JW Cardiol Aug 28 2023 and N Engl J Med 2023; 389:1660).
Returning Athletes to Play
Mark S. Link, MD, reviewing In new consensus guidance on arrythmias in athletes, the focus is on returning to play and avoiding unnecessary restrictions.
Does Early Rhythm Control for Atrial Fibrillation Reduce Dementia Risk in Patients with Prior Stroke?
Mark S. Link, MD, reviewing Observational data from South Korea show an association between early rhythm control and lower risk for dementia in stroke survivors. Early rhythm control has been associated with a reduced risk for dementia in patients with atrial fibrillation (AF); however, whether this association is found in patients with previous stroke is unknown.
Updated Guideline for Hypertrophic Cardiomyopathy
Mark S. Link, MD, reviewing New recommendations include exercise prescription and treatment with cardiac myosin inhibitors.
Updated Guideline for Atrial Fibrillation Management
Mark S. Link, MD, reviewing Major changes include greater support for early rhythm control and consideration of ablation as first-line therapy.
Does Device-Detected Atrial Fibrillation Lasting <24 Hours Merit Anticoagulation?
Mark S. Link, MD, reviewing A meta-analysis of two large randomized trials suggests that the extra major-bleeding risk outweighs the small reduction in absolute risk for ischemic stroke.
Post-Approval Study of Subcutaneous ICD Supports a Benefit
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have been around for about 10 years. There have been three randomized trials of S-ICDs.
Thorny Clinical Dilemmas: Arrhythmias and Heart Failure
close Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider. Michelle M. Kittleson, MD, PhD: Welcome to Medscape InDiscussion: Heart Failure. I'm your host, Dr Michelle Kittleson.
Extreme heat and pollution can double the risk of a heart attack
Comment on this story Comment Exposure to extreme temperatures combined with suffocating air pollution can double the risk of dying from a heart attack, according to Chinese researchers who analyzed more than 200,000 cardiac deaths in China between 2015 and 2020.
Absence of Atrial Fibrillation Reduction in REDUCE LAP-HF II
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Intranasal Calcium-Channel Blocker Shows Promise for Acute Treatment of Supraventricular Tachycardia
Supraventricular tachycardias (SVTs) are quite common. They include arrhythmias such as atrioventricular nodal reentrant tachycardia (AVNRT),
Dual-Chamber Leadless Pacemakers Are Possible!
Leadless pacemakers have been approved for many years. They have predominantly been ventricular single-chamber pacemakers; the Medtronic leadless
The utility of anti-tachycardia pacing in hypertrophic cardiomyopathy
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Risk of Arrhythmia Among New Users of Hydroxychloroquine: Comment on the article by Hoque, et al
Letters This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/art.42618. No abstract is available for this article.
Risk of arrhythmia among new users of hydroxychloroquine: comment on the article by Hoque et al
Letters Risk of arrhythmia among new users of hydroxychloroquine: comment on the article by Hoque et al Julianna Desmarais, Corresponding Author Julianna Desmarais Oregon Health & Science University, Portland, Oregon Search for more papers by this authorJames T Rosenbaum, James T Rosenbaum Legacy Devers Eye Institute, Portland, Oregon Search for more papers by this authorMark Link, Mark Link University of Texas, Southwestern Medical Center, Dallas, Texas Search for more papers by this...
Is Ablation Effective in Brugada Syndrome?
Brugada syndrome is a rare condition that causes sudden cardiac death and can be devastating due to frequent, painful implantable
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