経カテーテル的大動脈弁置換術後心房細動に対する抗凝固薬の比較

心房細動患者数は、日本では80万人と推計されており、
実際には100万人を超すとも言われています。
高齢の方に多く、今後、高齢化に伴って患者数は増えると
考えられており、予防的な事も含めて適切な対策が重要になります。
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大動脈弁が損傷を受けた場合、
それを人工弁に置き換える必要がある場合があります。
それに対して経カテーテル的大動脈弁置換術が選択される事があります。
高齢の方や、呼吸器疾患を持っている方など
開胸による外科的手術に対するリスクがある場合には
上述のカテーテルを使って大腿部の血管からアプローチします。
そのような施術後に心房細動が生じることがあります。
おおよそ33%の人に生じるとされています(2-8)。
それに対して血流を保つため抗凝固薬が使われる事があります。
その際、ビタミンKの働きを抑えて
血液の凝固を防ぐ薬が使われていましたが、
ビタミンK含有食品(納豆、野菜)の摂食制限、
用量調整のための頻繁な血液検査が問題とされていました。
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そこでN.M. Van Mieghem, M. Unverdorben, C. Hengstenberg(敬称略)ら
ヨーロッパを中心とする国際的な医療研究グループは
経カテーテル的大動脈弁置換術後に心房細動が生じた患者さんに対する
心臓血管系のメンテナンスにおいて、
凝固に関わる第Xa因子阻害薬であるエドキサバンと
ビタミンK阻害薬の臨床効果の比較を行っています(1)。
本日は血管の凝固に関わる疾患や出血などの副作用についての
結果の概要を読者の方と情報共有いたします。

//結果//---
年齢;18歳以上
確率:それぞれ713人に対して
エドキサバン(左)/ビタミンK阻害薬(右)---ハザード比(左)/(右)
出血: 9.7%/7.0%---1.40
死亡: 7.8%/9.1%---0.86
虚血性脳卒中: 2.1%/2.8%---0.75
心筋梗塞: 1.1%/0.7%
全身性血栓塞栓: 0.2%/0.3%
弁血栓: 0%/0%
脳卒中: 2.7%/3.5%---0.78
心臓、心臓血管有害事象: 8.2%/8.1%---1.02
致命的な出血: 1.0%/1.0%
生命に関わる出血: 1.6%/1.9%
頭蓋内出血: 1.5%/2.1%---0.72%
Clinically relevant nonmajor bleeding:18.2%/16.4%---1.13
---
エドキサバン群の出血は多いが
多くのケースでは胃腸の出血です。
脳内出血や重篤な出血は少ないか、同程度であると評価されています。
その他、死亡、脳卒中、心筋梗塞、血管塞栓、心臓有害事象など
循環器系の異常に関連する有害事象においては
エドキサバンはビタミンK阻害薬に劣らないとされています。
しかしながら、
この結果は主に高齢の方であり
無症候性大動脈弁狭窄症の若い人には適用できない
とされています。

//Special message//
This article is updated based on my “気持ち”. 

//Trial//---
Trial was conducted in accordance with the International Council for Harmonisation and the Declaration of Helsinki.
From April 2017 through January 2020
Successful TAVR at 173 centers in 14 countries
Asia 
Japan South Korea 
Europe 
Austria Belgium France Germany Italy Netherlands Poland Spain Switzerland United Kingdom 
North America 
Canada United States 

//Support//---
Supported by Daiichi Sankyo.

//ENVISAGE-TAVI AF STUDY ORGANIZATION//---
Executive Committee members: George Dangas, Nicolas van Mieghem (Global Lead
Investigators), Cathy Chen, Christian Hengstenberg, Roxana Mehran, Shigeru Saito, Martin
Unverdorben, Marco Valgimigli, Roland Veltkamp, Pascal Vranckx
Sponsor Leadership (Daiichi): Anil Duggal, James Jin, Petra Laeis, Martin Unverdorben
Data Monitoring Committee: Bernard Gersh (Chairperson), Deepak Bhatt, Jonathan
Halperin, Freek Verheugt, Timothy Collier
Clinical Events Committee: Steven Marx (Chairperson), Nicola Corvaja, Douglas DiStefano,
Newsha Ghodsi, Jose Meller, Jesse Weinberger, David Kaufman, Mark Milstein
National Leads: Austria: I. Lang; Belgium: P. Vranckx; Canada: J. Rodés-Cabau; France:
P. Ohlmann; Germany: H. Mӧllmann; Italy: C. Tamburino; Japan: K. Hayashida,
Y. Watanabe; Korea: H.-S. Kim; Netherlands: N. Van Mieghem; Poland: M. Grygier; Spain:
R. Moreno, L. Nombela-Franco; Switzerland: T. Pilgrim; United Kingdom: R. Anderson;
United States: G. Dangas
Site Principal and Co-Investigators (**number of patients randomized):
Austria (**62): I. Lang, J. Bergler-Klein, C. Gatterer, J. Kastner, M. Lenz, C. Nitsche, P.
Pichler, S. Stojkovic (MUW – Medizinische Universität Wien, AKH – Allgemeines Krankenhaus –
Universitätsklinik für Innere Medizin II, Vienna); F. Guy, N. Bonaros, L. Gutierrez-Roman, J. Kilo,
B. Metzler, F. Plank (Medizinische Universität Innsbruck – Universitätsklinik für Innere Medizin
III, Innsbruck); K. Huber, T. Andric, A. Geppert, E. Wessely, F. Egger (Wiener
Gesundheitsverbund – Klinik Ottakring, Vienna); R. Zweiker, S. Gharibeh, T. Glantschnig, D.
Zweiker (Medizinische Universität Graz – Klinische Abteilung für Kardiologie, Graz); R. Binder, K.
Danninger, E. Laβnig (Klinikum Wels-Grieskirchen GmbH, Wels); C. Adlbrecht, A. Schober, P.
Stratil, A. Strouhal (Krankenhaus Nord – Wien, Vienna); J. Egresits, C. Kaulfersch, H. Alber, K
Ferlic, K. Laubreiter, K. Leitner, M. Rybczynkski, P. Wimmer (Klinikum Klagenfurt am
Wörthersee, Wörthersee)
Belgium (**34): P. Vranckx, E. Benit (Jessa Ziekenhuis, Hasselt); J. Bosmans, T.
Vandendriessche, H. Heidbuchel (Antwerp University Hospital, Edegem); B. Ferdinande, D.
Cottens, S. Deferm (Ziekenhuis Oost-Limburg, Genk); F. Stammen, S. Van de Walle (AZ Delta –
Campus Rumbeke, Roeselare); I. Buysschaert, P. Vanduynhoven, M. Rosseel (Algemeen
Stedelijk Ziekenhuis, Aalst)
Canada (**14): J. Rodés-Cabau, L. Asmarats Serra, C. Chamandi, R. De Larochelliere, D.
Doyle, E. Dumont, L. Faroux, A. Ferrira Neto, A. Garcia, L. Guimaraes, F. Maes, S. Mohammadi,
J.-M. Paradis, T. Rodriguez Gabella (Institut Universitaire de Cardiologie et de Pneumologie de
Québec, Quebec City); R. Whitlock, A. Smith (Population Health Research Institute [PHRI],
Hamilton); M. Chu, R. Bagur, P. Diamantouros, B. Kiaii, P. Teefy (London Health Sciences
Centre – University Hospital, London)
France (**46): N. Dumonteil, D. Tchetche (Clinique Pasteur, Toulouse); D. Himbert, J. Abtan,
M. Urena-Alcazar (Hôpital Bichat – Claude-Bernard, Paris); L. Leroux, C. Alexandrino, M. Dijos,
N. Nasser, J. Peltan, B. Seguy (CHU Hopitaux de Bordeaux – Hôpital Haut-Lévêque, Pessac); S.
Delepine, F. Pinaud (Centre Hospitalier Universitaire d'Angers, Angers); C. Caussin, N. Amabile,
F. Rauox, C. Roig, A. Veugeois (Institut Mutualiste Montsouris, Paris); E. Teiger, R. Gallet,
Gauthier, Mouillet, V. Rubimbura (CHU Hôpital Henri Mondor, Créteil); P. Ohlmann, S. Hess, O.
Morel (Hôpitaux Universitaires de Strasbourg – Hôpital Civil, Strasbourg); E. Van Belle, N.
Debry, C. Delhaye, T. Denimal, F. Juthier, A. Mugnier, T. Pamart, N. Rousse, H. Spillemaeker, B.
Verdier, F. Vincent (Centre Hospitalier Régional Universitaire de Lille [CHRU] – Hôpital
Cardiologique, Lille)
Germany (**336): W. Koenig, C. Hengstenberg, S. Ates, M. Joner, A. Knyphausen, C.
Pellegrini, T. Rheude, T. Trenkwalder (Herzzentrum München, Munich); H. Möllmann, J.
Blumenstein, B. Dickmann, J. Froemke, L. Gaede, J.-E. Guelker, O. Guerocak, O. Husser, M.
Marks, N. Schulze-Waltrup, D. Soetemann (St.-Johannes-Hospital, Dortmund); R. Hambrecht, A.
Ammar, A. Fach, M. Kuehl, R. Osteresch, P. Pader, H. Wienbergen, E. Wolters, J. Hassfurther,
A. Martel-Coll (Klinikum Links der Weser gGmbH, Bremen); N. Gessler, F. Meincke, C. Freker, N.
Gosau, S. Hakmi, K.-H. Kuck, T. Ubben, S. Willems (Asklepios Klinik St. Georg, Hamburg); H.
Thiele, C. Binner, S. Desch, P. Hartung, D. Holzhey, P. Kiefer, S. Leontyev, P. Münch, M. Sandri
(Heart Center Leipzig at University of Leipzig – Department of Internal Medicine/Cardiology,
Leipzig); T. Zeus, S. Afzal, L. Dannenberg, L. Kleinebrecht, A. Mohring, K. Piayda, A. Polzin, D.
Stötemann, V. Veulemans (Universitätsklinikum Düsseldorf, Düsseldorf); K. Debl, M. Fischer, M.
Hilker, L. Maier, C. Strack, M. Tafelmeier (Universitätsklinikum Regensburg, Regensburg); W.
Rottbauer, J. Woehrle, B. Gonska, D. Scharnbeck, J. Seeger, O. Smirnova, J. Mörike, M. Kessler
(Universitätsklinikum Ulm, Ulm); P. Nordbeck, S. Herrmann, O. Maniuc, T. Salinger, L. K.
Seidlmayer (Universitätsklinikum Würzburg, Würzburg); T. Geisler, O. Borst, M. Droppa
(Universitätsklinikum Tübingen, Tübingen); E. Freiherr von Hodenberg, D. Federov (MediClin
Herzzentrum Lahr/Baden Klinik für Innere Medizin – Kardiologie, Lahr); W. Reents, G. Kucinoski,
M. Zacher (RHÖN-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale); R. Toelg, M.
Abdel-Wahab, M. Landt, A. Allali, D. Sulimov (Segeberger Kliniken GmbH [SKG], Bad Segeburg);
R. von Bardeleben, E. Schulz, M. Geyer, T. Jansen, F. Kreidel, T. Ruf, B. Schnorbus, A. Tamm
(Universitätsmedizin der Johannes Gutenberg – Universität Mainz, Mainz); M. Lutz, D. Frank, J.
Frank, J. Gänsbacher, C. Kuhn (Universitätsklinikum Schleswig-Holstein, Kiel); M. Licka, J.
Destani, M. Preusch (Medizinische Universitätsklinik Innere Medizin III, Heidelberg); A. Wolf, E.
Blank, R. Schueler, E. Vogel, T. Schmitz, C. Jensen (Elisabeth-Krankenhaus Essen GmbH, Klinik 
Tarantini, A. Barioli, F. Cardaioli, C. Fraccaro (Azienda Ospedaliera di Padova, Padua); D.
Trabattoni, P. Olivares (Centro Cardiologico Monzino, Milano); A. S. Petronio, M. Angelillis, M.
De Carlo, C. Giannini, P. Spontoni (Azienda Ospedaliero Universitaria Pisana - Stabilimento di
Cisanello, Pisa); G. Bruschi, C. Marchetti, B. Merlanti (ASST Grande Ospedale Metropolitano
Niguarda, Milan); C. Di Mario, P. Demola, F. Meucci, F. Ristalli, M. Stolcova (Azienda
Ospedaliero – Universitaria Careggi, Florence); F. Ribichini, M. Bellamoli, G. Berton, L. Maritan,
A. Pepe, F. Zucchelli, G. Pesarini (Azienda Ospedaliera Universitaria Integrata Verona –
Ospedale Borgo Trento, Verona); S. Imme, M. Patanè, D. Tempio (Casa di Cura G.B. Morgagni,
Catania); A. Poli, E. Ferrara, P. Martina (Azienda Ospedaliera Ospedale Civile di Legnano,
Legnano); Tiziana Attisano, E. De Angelis, G. Galasso, A. G. Maione, C. Sellitto, F. Vigorito
(Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d'Aragona, Salerno); G. P.
Perna, L. Angelini (Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Torrette); O.
Piro, M. Crisci, V. Monda, I. Monteforti (AORN – Ospedali dei Colli Ospedale V. Monaldi, Napoli);
C. Briguori, G. Ciccarelli, C. DAmore, A. Focaccio, M. Golino (Clinica Mediterranea SpA – Napoli,
Naples); A. Berni, F. Giovannelli, S. Rigattieri (Azienda Ospedaliera Sant'Andrea, Rome); G.
Tiberti, A. Farina (Ospedale “Alessandro Manzoni”, Lecco); R. Rossini, G. Musumeci , G. Baralis
(Azienda Sanitaria Ospedaliera S. Croce e Carle Cuneo, Cuneo); R. F. E. Pedretti, S. De Servi, A.
Antonelli, L. Alberti (Casa di Cura Multimedica, Sesto San Giovanni); D. Maffeo, O. Leonzi, L.
Bettari, C. Maiandi (Fondazione Poliambulanza Istituto Ospedaliero, Brescia); C. Trani, C.
Aurigemma, F. Burzotta, S. Cangemi (Fondazione Policlinico Universitario Agostino Gemelli,
Roma); P. Calabro, D. Di Maio, V. Diana, A. Cesaro, E. Moscarella (Azienda Ospedaliera di
Caserta "Sant'Anna e San Sebastiano", Caserta)
Japan (**159): K. Ando, M. Hayashi, A. Isotani, S. Ito, T. Kawaguchi, S. Mori, T. Morinaga, S.
Shirai, H. Takiguchi, T. Taniguchi, M. Yano (Kokura Memorial Hospital, Kitakyushu); K. 
Hayashida, H. Hase, Y. Kobari, S. Myojin, T. Ryuzaki, T. Saito, N. Yoshijima (Keio University
Hospital, Tokyo); M. Izumo, Y. Akashi, K. Chatani, T. Kaihara, R. Kamijima, K. Okuyama, Y.
Sato, Y. Tanabe, M. Watanabe (St. Marianna University School of Medicine Hospital, Kawasaki);
K. Mizutani, A. Ito, S. Iwata, M. Ogawa, T. Okai, T. Yamaguchi, M. Yoshiyama (Osaka City
University Hospital, Osaka); N. Morioka, A. Higashimori, K. Fukuda, Y. Yokoi (Kishiwada
Tokushukai Hospital, Kishiwada); T. Naganuma, T. Amano, H. Kawamoto, S. Matsuoka, A.
Nakajima, K. Tani (New Tokyo Hospital, Matsudo); Y. Nakajima, T. Fusazaki, Y. Ishikawa, A.
Kumagai, Y. Morino, R. Ninomiya (Iwate Medical University Hospital, Yahaba); H. Nishina, A.
Sugano (Tsukuba Medical Center Hospital, Tsukuba); Y. Ohno, Y. Ikari, J. Miyamoto, T.
Murakami, G. Nakazawa, K. Sakai (Tokai University Hospital, Isehara); N. Tada, Y. Enta, A.
Inoue, K. Ishiii, Y. Mizutani (Sendai Kousei Hospital, Sendai); H. Ueno, H. Kuwahara, H. Onoda,
M. Sobajima, Y. Ueno (Toyama University Hospital, Toyama); N. Watanabe, K. Takagi (Ogaki
Municipal Hospital, Ogaki); Y. Watanabe, M. Arai, M. Hatsuno, H. Hioki, Y. Ikeda, Y. Iseki, R.
Ishibashi, M. Ito, A. Kataoka, T. Katayama, H. Kawashima, K. Konno, K. Kozuma, H. Kyono, M.
Mitsui, M. Miyanaga, F. Nagura, M. Nakashima, T. Nomura, R. Okabe, T. Ota, S. Otsuki, K.
Sasaki, S. Takahashi, S. Takamura, Y. Terada, Y. Watari, H. Yamamoto, N. Yokoyama, N.
Yukimitsu (Teikyo University Hospital, Tokyo); M. Yamamoto, Y. Adachi, S. Hosoba, S. Kano, T.
Shimura, R. Yamaguchi (Toyohashi Heart Center [Cardiovascular Center], Toyohashi); M.
Yamamoto, A. Kagase, Y. Koyama, S. Tsujimoto (Nagoya Heart Center, Nagoya); F. Yamanaka,
K. Shishido, S. Yokota (Shonan Kamakura General Hospital, Kamakura); K. Yamasaki, H. Bouta,
Y. Gohira, Y. Hosoi, K. Kayanuma, K. Kuroda, Y. Otomaru, G. Takenouchi, T. Tani, S. Yamazaki
(Sapporo Higashi Tokushukai Hospital, Sapporo); M. Yamawaki, M. Araki, S. Hayashi, Y. Honda,
Y. Ito, N. Kobayashi, K. Makino, M. Mori, S. Mori, Y. Sakamoto, S. Shirai, M. Tsutsumi (Saiseikai
Yokohamashi Tobu Hospital, Yokohama) 
Netherlands (**55): N. van Mieghem, J. Daemen, N. El Faquir, H. Kroon, J. Ooms, Z.
Rahhab, M. van Wiemen, P. de Jaegere (Erasmus MC, Amsterdam); J. Piek, R. Delewi, W.
Vlastra (Universiteit Van Amsterdam – Academisch Medisch Centrum, Amsterdam); T.
Vossenberg, A. Van Boven (Medisch Centrum Leeuwarden, Leeuwarden); C. Schotborgh, A.
Haasdijk, V. van Driel (HagaZiekenhuis van den Haag, Den Haag); E. Lipsic, P. van der Harst,
R.A.J. Schurer, P. Vandorp, H.W. van der Werf (University Medical Center Groningen,
Groningen)
Poland (**20): M. Grygier, A. Komosa, A. Olasinska-Wisniewska, M. Wrotynski (Szpital
Kliniczny Przemienienia Pańskiego Uniwersytetu Medycznego im. Karola Marcinkowskiego,
Poznań); M. Fijalkowski, W. Bachorski, D. Jagielak, A. Mickiewicz, I. Pisowodzka (Uniwersyteckie
Centrum Kliniczne, Gdańsk); T. Hirnle, M. Frank, M. Mirtosz, R. Trzcinski (Uniwersytecki Szpital
Kliniczny w Białymstoku, Białystok); Z. Huczek, J. Kochman, B. Rymuza, K. Zbronski
(Samodzielny Publiczny Centralny Szpital Kliniczny – II Klinika Anestezjologii i Intensywnej
Terapii, Warsaw)
South Korea (**19): H.-S. Kim, M. Chang, J.-K. Han, J. Kang (Seoul National University
Hospital, Seoul); K. Chang, Y. Choi (The Catholic University of Korea, Seoul St. Mary’s Hospital,
Seoul); D.-W. Park, J.-M. Ahn, D.-Y. Kang, S.-J. Park (Asan Medical Center, Seoul); M.-K, Hong,
I.J. Cho, G.-R. Hong, Y.-G. Ko, C. Y. Yu (Yonsei University College of Medicine, Seoul); H. Kook,
C. W. Yu, H. Joo, H. Kook (Korea University Anam Hospital, Seoul)
Spain (**344): P. Jimenez-Quevedo, G. Armijo, A. Castro, M. Del Trigo Espinosa, J. Escaned,
C. Espejo, N. Gonzalo, R. Guerra, C. Macaya, L. Marroquin, A. McInerney, L. Nombela-Franco, I.
Nuñez, P. Salinas, G. Tirado-Conte, O. Vedia, A. Fernández-Ortiz, A. Arturo (Hospital Clínico San
Carlos, Madrid); J. R. Moreno-Gomez, G. Galeote, H. Hernandez, S. Jimenez, J. R. Rey, A.
Sanchez (Hospital Universitario La Paz, Madrid); J. J. Gomez Doblas, J. María Hernandez, A. 
Domínguez, A. Muñoz (Hospital Universitario Virgen de la Victoria, Málaga); J. L. Zamorano
Gómez, L. M. Rincón Díaz, L. Salido, M. Sanmartin, D. del Val, V. Jiménez Franco (Hospital
Universitario Ramón y Cajal, Madrid); C. Morís, P. Avanzas, R. Díaz Méndez, R. Del Valle
(Hospital Universitario Central de Asturias, Oviedo); L. Tercedor, D. Castro, E. Molina, R. Rivera
(Hospital Virgen de las Nieves, Granada); V. A. Jimenez Diaz, J. A. Baz Alonso, R. Estevez
Loureiro, S. Fernandez Barbeira, G. Fernández Bastos, A. Iñiguez Romo, A. Ortiz Saez, T.
Torrado Chedas, A. A. de Miguel Castro (Hospital Xeral, Vigo); V. Mainar, P. Bordes, P. Llamas,
J. Meseguer, M. Sandin (Hospital General Universitario de Alicante, Alicante); E. Pinar
Bermudez, J. Garcia, F. Marin, A. Tello Montoliu (Hospital Universitario Virgen Arrixaca, El
Palmar); D. Lopez-Otero, B. Cid Álvarez, J. López País, X. C. San Martin Pena, R. Trillo Nouche
(Complexo Hospitalario Universitario de Santiago [CHUS] - Hospital Clínico Universitario,
Santiago); J. de la Torre Hernandez, T. Garcia Camerero, D.-H. Lee, F. Sainz Laso, G. Veiga
Fernández, J. Zueco (Hospital Universitario Marqués de Valdecilla, Santander); A. San Roman, I.
Amat, A. Aparisi-Sanz, H. Gutiérrez, B. Ramos, T. Rodríguez Cabella, S. Santos-Martinez, A.
Serrador, S. Vera (Hospital Clínico Universitario de Valladolid, Valladolid); E. Fernandez
Nofrerias, O. Abdul-Jawad, X. Carillo Suarez, J. Mauri, O. Rodriguez, V. Villalta del Olmo
(Hospital Universitari Germans Trias i Pujol, Barcelona); J. Nunez, R. De la Espriela, S. Garcia,
G. Minana, E. Valero, E. Santas Olmeda (Hospital Clinico Universitario de Valencia, Valencia); R.
Hidalgo Urbano, J. Ramón Benitez, R. Calvo, L. Madrona, B. Prado (Hospital Universitario Virgen
Macarena, Seville); G. Lasa Larraya, I. Elizondo, L. Ma (Koldo) Gaviria, F. J. Irazusta, S. Solana,
M. Tellería, A. Tramullas (Hospital Universitario Donostia, San Sebastián); F. Alfonso, T.
Alvarado, F. Rivero, F. J. de la Cuerda Llorente (Hospital Universitario de la Princesa, Madrid);
B. Garcia del Blanco, G. Marti Aquasca, V. Serra García (Hospital Universitario Vall d'Hebron,
Barcelona); R. Reyes, J. Benezet Mazuecos, D. Gemma, A. Lopez Ricardo, A. Lozano Rosada, J.
Curtis, K. Nollette (Providence Medical Research Center, Spokane); A. Nanjundappa, C. Adams,
S. Lewis (Charleston Area Medical Center Health Education and Research Institute, Charleston);
J. Schultz (Essentia Health – St. Mary’s Medical Center, Duluth); L. Wiley Nifong, H. DeAntonio,
B. Carabello, M. Patel, A. Siddiqui (East Carolina Hearth Institute, Inc, Greenville); M. Sanjay, N.
Adoni, U. Kanakadandi (Carle Foundation Hospital, Urbana); K. Harjai, B. Young (Geisinger
Medical Center, Danville); T. Noel (Tallahassee Research Institute, Inc., Tallahassee); N.
Kakouros, L. Rosenthal (University of Massachusetts Memorial Medical Center, Worcester); V.
Nkomo, M. Eleid, K. Greason, G. Sandhu (Mayo Clinic – Rochester Methodist Hospital,
Rochester); R. Makkar, T. Chakravarty, M. Nakamura (Cedars-Sinai Medical Center, Los
Angeles); D. Arab, D. Bamberger, D. Henderson, B. Sickinger, N. Valin (Cardiology Research
Associates, Daytona Beach); F. Shawl, D. Brill, L. Dobrovolay (Adventist HealthCare White Oak
Medical Center, Calverton); O. Aksoy, W. Suh (UCLA); H. Gada, G. Gustafson, A. Hancock, M.
Mumtaz (Pinnacle Health – CardioVascular Institute [PHCVI] – Wormleysburg, Wormleysburg);
R. Waksman, I. Bendor, L. Waksman (MedStar Washington Hospital Center, Washington); J.
Tuma, R. DeRaad, B. Purushottam (Monument Health Clinical Research, Rapid City); J. Depta,
F. Abtahian, A. Ahmed, T. Albro (Rochester General Hospital, Rochester); W. Crowder, J.
Bennett (Jackson Cardiology Associates, PA, Jackson); J. McClurken, J. Auteri, D. Boland, S. A.
Guidera, J. Harrar (Doylestown Hospital, Doylestown); D. Baldwin, W. Hwang, G. Velamoor
(Virginia Mason Hospital & Seattle Medical Center, Seattle); L. Tejada, P. Puleo, C. Sarnoski
(Saint Luke’s University Health Network, Bethlehem); A. Pineda Maldonado (University of Florida
[UF] Jacksonville, Jacksonville); M. Ahmed (HealthEast Medical Research Institute, St. Paul); A.
Goodman, S. Horr, J. Riddick (TriStar Centennial Medical Center, Nashville); P. Meraj, L. Boutis
(North Shore University Hospital, Manhasset); C. Rowan, A. Akinapelli (University of Nevada
School of Medicine Internal Medicine and Multispecialty Clinic, Reno) 

(Reference)
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Nicolas M. Van Mieghem, M.D., Ph.D., Martin Unverdorben, M.D., Ph.D., Christian Hengstenberg, M.D., Helge Möllmann, M.D., Roxana Mehran, M.D., Diego López-Otero, M.D., Ph.D., Luis Nombela-Franco, M.D., Ph.D., Raul Moreno, M.D., Ph.D., Peter Nordbeck, M.D., Holger Thiele, M.D., Irene Lang, M.D., José L. Zamorano, M.D., Fayaz Shawl, M.D., Masanori Yamamoto, M.D., Ph.D., Yusuke Watanabe, M.D., Ph.D., Kentaro Hayashida, M.D., Ph.D., Rainer Hambrecht, M.D., Felix Meincke, M.D., Pascal Vranckx, M.D., Ph.D., James Jin, Ph.D., Eric Boersma, Ph.D., Josep Rodés-Cabau, M.D., Patrick Ohlmann, M.D., Ph.D., Piera Capranzano, M.D., Ph.D., Hyo-Soo Kim, M.D., Ph.D., Thomas Pilgrim, M.D., Richard Anderson, M.D., Usman Baber, M.D., Anil Duggal, M.D., Petra Laeis, Ph.D., Hans Lanz, M.D., Cathy Chen, M.D., Marco Valgimigli, M.D., Ph.D., Roland Veltkamp, M.D., Shigeru Saito, M.D., and George D. Dangas, M.D., Ph.D. for the ENVISAGE-TAVI AF Investigators*
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The New England Journal of Medicine August 28, 2021
---
Author Affiliations
From the Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands (N.M.V.M., E.B.); Daiichi Sankyo, Basking Ridge, NJ (M.U., J.J., A.D., C.C.); the Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University, Vienna (C.H., I.L.); the Department of Internal Medicine, St. Johannes Hospital, Dortmund (H.M.), the Department of Internal Medicine I, University Hospital Würzburg, Würzburg (P.N.), the Department of Internal Medicine–Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig (H.T.), Bremer Institute for Heart and Circulation Research at Klinikum Links der Weser, Bremen (R.H.), the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg (F.M.), Daiichi Sankyo Europe, Munich (P.L., H.L.), the Department of Neurology, Alfried Krupp Krankenhaus, Essen (R.V.), and the Department of Neurology, University Hospital Heidelberg, Heidelberg (R.V.) — all in Germany; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York (R. Mehran, G.D.D.); the Department of Cardiology, Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela (D.L.-O.), the Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (L.N.-F.), the Department of Cardiology, University Hospital La Paz (R. Moreno), and the Department of Cardiology, University Hospital Ramon y Cajal (J.L.Z.), Madrid — all in Spain; the Department of Cardiology, Washington Adventist Hospital, Takoma Park, MD (F.S.); the Department of Cardiology, Toyohashi Heart Center, Toyohashi (M.Y.), the Department of Cardiology, Teikyo University School of Medicine (Y.W.), and the Department of Cardiology, Keio University School of Medicine (K.H.), Tokyo, and the Division of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura (S.S.) — all in Japan; the Department of Cardiology, Jessa Hospital, Hasselt, Belgium (P.V.); Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada (J.R.-C.); the Division of Cardiovascular Medicine, University Hospital of Strasbourg, Strasbourg, France (P.O.); the Division of Cardiology, Policlinico Hospital, University of Catania, Catania, Italy (P.C.); the Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea (H.-S.K.); the Department of Cardiology, University of Bern, Bern (T.P.), and Cardiocentro Ticino Institute and Department of Biomedical Sciences, University of Italian Switzerland, Lugano (M.V.) — both in Switzerland; the Department of Cardiology, University Hospital of Wales, Cardiff (R.A.), and the Division of Brain Sciences, Imperial College London, London (R.V.) — both in the United Kingdom; the Cardiology Section, University of Oklahoma Health Sciences Center, Oklahoma City (U.B.); and National and Kapodistrian University of Athens, School of Medicine, Athens (G.D.D.).
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