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Hauguel-Moreau M, Guedeney P, Dauphin C, Auffret V, Marijon E, Aldebert P, Clerc JM, Beygui F, Elbaz M, Khalil WA, Da Costa A, Macia JC, Elhadad S, Cayla G, Brugier D, Silvain J, Hammoudi N, Duthoit G, Vicaut E, Montalescot G. Flecainide to prevent atrial arrhythmia after patent foramen ovale closure, Rationale and design of the randomized AFLOAT study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:184-189. [PMID: 38216511 DOI: 10.1093/ehjcvp/pvad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/25/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN The Assessment of Flecainide to Lower the PFO closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release (SR) dose) for 6 months (Group 1), Flecainide (150 mg per day in a single SR dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30 s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analysed as a secondary objective of the study. CONCLUSION AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. CLINICAL TRIAL REGISTRATION NCT05213104 (clinicaltrials.gov).
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Affiliation(s)
- Marie Hauguel-Moreau
- Université de Versailles-Saint Quentin, INSERM U1018, CESP, ACTION Study Group, Department of Cardiology, Ambroise Paré Hospital (AP-HP), 92100 Boulogne, France
| | - Paul Guedeney
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Claire Dauphin
- Department of Cardiology and Cardiovascular Diseases, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Vincent Auffret
- University Hospital Pontchaillou, Cardiology and Vascular Disease Department, CIC-IT 804, Rennes 1 University, Signal and Image Processing Laboratory (LTSI), INSERM U1099, 35000 Rennes, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France
| | | | - Jean-Michel Clerc
- Cardiology Department, Centre Hospitalier Universitaire de Tours, 37000 Tours, France
| | - Farzin Beygui
- CHU de la Côte de Nacre, Département de Cardiologie, 14000 Caen, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, 31000 Toulouse, France
| | - Wissam Abi Khalil
- Institut Mitovasc, University of Angers, UMR CNRS 6015-INSERMU1083, 49000 Angers, France
| | - Antoine Da Costa
- Service de cardiologie, Hôpital Nord, Université Jean-Monnet, CHU de Saint-Étienne, 42000 Saint-Étienne, France
| | - Jean-Christophe Macia
- Montpellier University Hospital, UFR de Médecine, Université Montpellier 1, Department of Cardiology, 371, avenue du Doyen-Gaston-Giraud, 34000 Montpellier 5, France
| | - Simon Elhadad
- Service de Cardiologie, Centre hospitalier de Marne-la-Vallée, 77600 Jossigny, France
| | - Guillaume Cayla
- Cardiology department, Nimes University Hospital, Montpellier University, ACTION group, 34000 Nimes, France
| | - Delphine Brugier
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Guillaume Duthoit
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
| | - Eric Vicaut
- ACTION Study Group, Unité de Recherche Clinique, Hopital Lariboisière, (APHP), Université Paris-Diderot Paris 7, 75010 Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), 75013 Paris, France
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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