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    Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation

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    To the Editor: Pluymaekers et al. (April 18 issue)(1) evaluated the occurrence of spontaneous cardioversion in patients with recent-onset (<36 hours) atrial fibrillation. The proposed wait-and-see approach included cardioversion within 48 hours in the absence of spontaneous resumption of sinus rhythm, and delayed cardioversion was actually necessary in 28% of the patients randomly assigned to this strategy. We think that the idea of waiting for spontaneous cardioversion of atrial fibrillation is interesting, but for practical reasons, better patient targeting would be required. In two previous prospective, randomized trials, we found that in patients with recent-onset atrial fibrillation, spontaneous cardioversion can . .

    Obesity Paradox in Atrial Fibrillation: Implications for Outcomes and Relationship with Oral Anticoagulant Drugs

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    In the last 40 years, concern about the obesity epidemic has increased. Data from the current literature highlight a strong relationship between obesity and atrial fibrillation (AF), particularly in relation to an increased risk for incident and recurrent AF. A phenomenon called the “obesity paradox” has emerged: the apparently counterintuitive evidence from epidemiological data indicating that overweight and obese patients may have a better prognosis than healthy-weight patients. A differential impact of oral anticoagulants (OACs) in terms of effectiveness and safety in the various body mass index categories has been postulated, particularly in the comparison between non-vitamin-K antagonist oral anticoagulants and vitamin K antagonists. This review aims to summarize the evidence on the impact of obesity in patients with AF, focusing on descriptions of the obesity paradox and its relationships with OAC treatment
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