A randomised answer for AF at intermediate stroke risk

The edition in brief

SINGLE-AF randomised 1803 Korean patients with atrial fibrillation at intermediate stroke risk to a DOAC or no anticoagulation. At 24 months the composite of stroke, systemic embolism, major bleeding or cardiovascular death occurred in 0.5% versus 1.5% (HR 0.31, 95% CI 0.10 to 0.94); stroke in 0.3% versus 1.1%. Major bleeding appeared similar. It is the first randomised support for the class IIa recommendation, though absolute event numbers were small. CMR GUIDE randomised 353 patients with LVEF 36–50% and CMR scar to an ICD or a loop recorder; the ICD did not reduce sudden death or haemodynamically significant ventricular arrhythmia over 6.3 years (HR 0.76, 0.37 to 1.58). ACASA-TAVI found factor Xa inhibitor monotherapy after TAVI roughly halved leaflet thickening on CT at 12 months against aspirin (16.2% vs 28.6%) and was non-inferior for bleeding, thromboembolism and death. The Enlighten registry of 787 EV-ICD implants reported 89.1% freedom from major complications at one year, 100% shock success and 7.1% inappropriate shocks. SHIELD-MI, a non-randomised phase IIa study of 50 patients, associated intravenous dexrazoxane at primary PCI with less intramyocardial haemorrhage and smaller infarcts.