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Background: For patients with atrial fibrillation (AF) receiving cardiac implantable electronic device (CIED) implantations, current consensus recommends uninterrupted non--vitamin K antagonist oral anticoagulant (NOAC) considering low incidence of bleeding or thrombo-embolic events. It remains unknown whether uninterrupted strategy outweighs discontinuation method for patients receiving NOAC. Methods: From January 1, 2013 to June 1, 2017, we enrolled 100 patients (mean age 78.3 ± 10.2 years, 58% male) with AF taking NOAC for stroke prevention eligible for CIED implantation in a tertiary medical center, Taipei, Taiwan. NOAC was continued without skipping any doses during the surgery. The baseline characteristics, underlying diseases, CHA2DS2-VASc score, and clinical course of every patient were reviewed and analyzed. Results: Among these patients, 28 were on dabigatran, 61 on rivaroxaban, 10 on apixaban, and one on edoxaban, respectively. There were no adverse events except one case of pericardial effusion and another one with large pocket hematoma. One patient receiving implantable cardioverter defibrillator implantation had late onset of pericardial effusion with impending tamponade necessitating pericardiocentesis. Another patient had large pocket hematoma, which spontaneously resolved within 1 month without further intervention. No periprocedural mortality and stroke occurred. Conclusion: Uninterrupted NOAC during CIED implantations may be an acceptable option especially in patients with high risk for thromboembolism. However, special caution should be paid during defibrillator implantation considering relatively higher risk of bleeding, perhaps due to the larger size of the defibrillator lead. [ABSTRACT FROM AUTHOR]

Some cardiovascular diseases are associated with seasonal or meteorological factors. We tried to identify the relationship between meteorological parameters and the requirement for a permanent pacemaker (PPM) implantation for advanced sinus node dysfunction (SND) and atrioventricular block (AVB). This study enrolled 656 patients (67% male, age = 76 ± 11 years) who underwent a PPM implantation due to SND or AVB from January 2004 to December 2008. Using daily temperature, barometric pressure, humidity, and daylight hour records from Taipei, we evaluated the effect of these meteorological parameters within different time periods on the occurrence of SND and AVB. There were 355 patients in the SND group and 301 in the AVB group. In the AVB group, more patients presented in the spring than in other seasons ( P = 0.003). In the SND group, there was no relationship with the seasons ( P = 0.137). The proportion of patients with AVB did not depend on the average temperature, barometric pressure, humidity, or daylight hours within 3, 7, and 14 days prior to admission ( P = NS). A temperature change of greater than 11°C within 30 days prior to admission was associated with a significantly higher proportion of patients with advanced AVB compared to those with advanced SND ( P = 0.009). Extreme change in temperature was the most independent predictor of the development of advanced AVB. The peak occurrence of advanced AVB was in the spring. The occurrence of advanced AVB was associated with extreme temperature changes within 30 days, especially in the spring. [ABSTRACT FROM AUTHOR]