[Perioperative heparin bridging is rarely indicated].

Numerous studies have shown that perioperative heparin bridging in patients treated with a vitamin K antagonist leads to an increased incidence of bleeding and so far, there is no evidence that it leads to a significant reduction in postoperative thromboembolism as summarised in this review. Prophylactic dosage of heparin is recommended after major surgery. Heparin bridging is not relevant in patients receiving a direct oral anticoagulant due to the rapid onset and offset of action of DOACs.

Effect of physical exercise training on muscle strength and body composition, and their association with functional capacity and quality of life in patients with atrial fibrillation: a randomized controlled trial.

OBJECTIVE: Atrial fibrillation diminishes cardiac function, exercise tolerance and quality of life. The objective of this study was to determine whether exercise training in atrial fibrillation affects muscle strength, body composition, maximal exercise capacity and walking capacity positively, thus improving quality of life. DESIGN: Randomized clinical trial. Twelve weeks of physical exercise training or control. PATIENTS: Forty-nine patients in permanent atrial fibrillation were randomized to training or control. METHODS: Intervention consisted of aerobic training for 1 h 3 times per week at 70% of maximal exercise capacity vs control. Muscle strength, exercise capacity, 6-minute walk test, lean body mass, fat percentage, and quality of life were assessed. RESULTS: Muscle strength increased in the training group (p = 0.01), but no change was observed in controls. Lean body mass was unchanged in both groups. Fat percentage decreased in both groups, but there was no significant difference between the groups. Exercise capacity improved in the training group (p < 0.001), with no change in the control group. There was a significant difference after the training period between the training and control groups in terms of exercise capacity. (p = 0.001). Six-min walk test improved in the training group compared with controls (p < 0.01). Overall quality of life score, as measured by the Minnesota Living with Heart Failure Questionnaire, improved in the training group (p = 0.03). Quality of life, measured by Short Form-36, improved in the training group in 3 out of 8 subscales: physical functioning (p = 0.02), general health perceptions (p = 0.001) and vitality (p = 0.02). CONCLUSION: Muscle strength, exercise capacity and quality of life increased with exercise training in subjects with atrial fibrillation. Lean body mass was unchanged.

A randomized study of the effects of exercise training on patients with atrial fibrillation.

BACKGROUND: Exercise training is beneficial in ischemic and congestive heart disease. However, the effect on atrial fibrillation (AF) is unknown. METHODS: Forty-nine patients with permanent AF (age [mean ± SD], 70.2 ± 7.8 years; male-to-female ratio, 0.75; body mass index [mean ± SD], 29.7 ± 4.3 kg/m(2)) were randomized to 12-week aerobic exercise training or a control group. Exercise capacity, 6-minute walk test (6MWT), cardiac output, quality of life, and natriuretic peptides were measured. Cardiac output was measured at rest and during ergometer testing, and atrial natriuretic peptide and N-terminal pro-B-type natriuretic peptide were measured before and after the training period. Quality of life was evaluated using the Short-Form 36 and Minnesota Living With Heart Failure (MLHF-Q) questionnaires. RESULTS: Improved exercise capacity and 6MWT were observed in the active patients (P < .001), and at study end, there was a significant difference between the active patients and the controls (P = .002). Resting pulse decreased in the active patients (94.8 ± 22.4 to 86.3 ± 22.5 beats/min, P = .049) but remained unchanged in the controls. Cardiac output was unchanged from baseline to end-of-study period. The MLHF-Q score improved in the active group (21.1 ± 18.0 vs 15.4 ± 17.5, P = .03). Active patients showed progress in 3 of the 8 Short-Form 36 subscales: physical functioning (P = .02), general health perceptions (P = .001), and vitality (P = .02). Natriuretic peptides were unchanged. CONCLUSION: Twelve weeks of exercise training increased exercise capacity and 6MWT and decreased resting pulse rate significantly in patients with AF. Overall quality of life increased significantly as measured by the cardiology-related MLHF-Q. Cardiac output and natriuretic peptides were unchanged in both groups.

71-year-old woman with dizziness and lipomatous hypertrophy of the left atrium.

Lipomatous hypertrophy, an unencapsulated atrial mass of adipose tissue, occurs in 1% of the population; the clinical significance of this is uncertain. Diagnosis is by echocardiography, computed tomography or magnetic resonance imaging scan. Surgical intervention is thought to be indicated in patients with obstruction, thromboembolism, uncontrollable arrhythmia or when liposarcoma cannot be excluded. We describe a case in which a 71-year-old woman was diagnosed with lipomatous hypertrophy of the left atrium. The finding of a large atrial mass was unexpected in this case. The clinical implications of the finding are unclear, since the aetiology and prognostic consequences are unknown. As the finding is not that uncommon others may find similar cases. It is therefore important that echocardiographers are aware of this entity and the aspects one needs to consider when deciding upon the best evaluation and treatment strategy.