CHA2DS2-VASc and CHA2DS2-VA scores are often used to demonstrate thromboembolic risk in nonvalvular atrial fibrillation. Elevated whole blood viscosity is an independent risk factor for ischemic stroke.

This study aimed to ascertain the correlation between whole blood viscosity and CHA2DS2-VASc/CHA2DS2-VA scores.

This study was performed retrospectively in a tertiary cardiac facility, encompassing 150 patients.

The study's results demonstrate that whole blood viscosity, concerning both high shear rate and low shear rate variables, are statistically significant in forecasting the likelihood of elevated CHA2DS2-VA and CHA2DS2-VASc scores. (AUC: 0.690, 0.693; p: <0.001; 0.647, 0.665; p: <0.05).

Whole blood viscosity had a substantial correlation with the CHA2DS2-VASc/CHA2DS2-VA scores in patients with atrial fibrillation and may be used to evaluate thromboembolism risk, akin to these scores.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia characterized by consistently irregular atrial and ventricular contractions. Heart rate variability (HRV) refers to the changes in the intervals between consecutive ventricular heartbeats. In sinus rhythm, HRV may be subtle and is quantitatively reflecting the dynamic interplay of the cardiac autonomic nervous system, which plays a crucial role in the onset, development, and maintenance of AF. HRV metrics, consisting of time-domain, frequency-domain, and nonlinear parameters, have been verified to vary significantly before and after AF episodes, and AF treatment-related procedures such as electrical cardioversion, ablation, and surgery of AF. Therefore, HRV may serve as a digital biomarker in predicting AF risk in long-term and acute risk period, identification of patients with AF risk in sinus rhythm and recurrence risk stratification after procedures. HRV in AF rhythm, predominantly influenced by dynamic atrioventricular node conduction under the onslaught of irregular atrial impulses, shows a huge disparity compared to that in sinus rhythm. Despite this, HRV in AF rhythm still provides valuable prognostic information, as reduced HRV may indicate a poor heart function and outcomes in patients with AF. Despite being influenced by lots of variables, HRV can still serve as an independent digital biomarker in the clinical management of AF throughout its entire lifecycle.

Patients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve the optimal rate control. In this study, we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF.

The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018. The number of AAD purchases and the proportions of all prevalent AF patients in a certain year of interest were calculated. In total, 391030 AF patients were identified between 2007 and 2018, and 39,816 (10.2%) of them had purchased either class I or III AADs. The proportion of patients using classes I and III AADs decreased from 8.6% to 6.3%. Flecainide and amiodarone were the most often used AADs. The use of flecainide and amiodarone decreased from 4.9% to 3.9% and 1.9% to 1.5%, respectively. The proportion of patients on beta-blockers remained stable at 75%. Dronedarone became available in 2011 when it also was the most used (0.8% of patients), but the use decreased thereafter. The use of sotalol and digoxin decreased from 1.5% to 0.6% and 24.6% to 11.0% over the study period.

The number of AAD purchases increased alongside with the increasing prevalence of AF, whereas the proportion of AF patients on classes I and III AADs and digoxin decreased between 2007 and 2018. Flecainide remained the most used AAD followed by amiodarone.

Predicting thromboembolic events caused by left atrial appendage thrombosis (LAAT) is crucial since it is the most concerning complication of nonvalvular atrial fibrillation (NVAF).

The objective of this study was to establish the predictive effectiveness of a novel scoring system known as the CLOTS-AF score in identifying the existence of thrombus using transesophageal echocardiography (TEE) in patients with NVAF and to compare it with the CHA2DS2-VASc score.

This study was conducted retrospectively with 668 NVAF patients who underwent TEE in a single centre. The patients were categorized into two categories based on the presence or absence of LAAT on TEE. The CLOTS-AF score was computed for all patients, which was then compared to the CHA2DS2-VASc score.

Thrombus was detected in the left atrial appendage (LAA) of 114 (17%) individuals. The study revealed that the thrombus (+) group had substantially higher CHA2DS2-VASc scores and CLOTS-AF scores (3 (2-4); 4 (3-6), p < .001), respectively. Furthermore, the CLOTS-AF score was shown to be a better predictor of LAAT than the CHA2DS2-VASc score (AUC: 0.70 vs. AUC: 0.61, p < .001).

This study could validate the CLOTS-AF score in an external cohort by demonstrating its significant predictive power and underscoring its vital role in clinical practice.

Background. Flecainide is a first-line rhythm control treatment for patients with atrial fibrillation (AF), however long-term treatment outcomes are understudied. Objective. To investigate associations of electro- (ECG) and echocardiographic indices with safety and efficacy outcomes of long-term flecainide treatment for recurrent AF. Methods. Consecutive patients with AF admitted for in-hospital flecainide initiation over a 5-year period were retrospectively included (n = 130, age 60 ± 12 years, 65% males, 29% with persistent AF). Baseline ECGs were processed using the 12SL algorithm. P-wave duration (PWD), Deep terminal negativity of the P-wave in lead V1 (DTNP-V1), left atrial volume index (LAVI), valvular dysfunction and right ventricular fractional area change (RV-FAC) were assessed. The primary endpoint was flecainide discontinuation for any reason. Secondary endpoints were discontinuation due to rhythm control failure and rhythm-related adverse events. Results. After hospital discharge, 120 patients were followed for a median of 1.5 years (interquartile range 0.34-3.1). During follow-up 31% discontinued flecainide, 14% due to rhythm control failure and 10% due to rhythm-related adverse events. Flecainide discontinuation was associated with PWD ≥130 ms (HR 3.65, [1.36-9.75]), DTNP-V1 > 0.1 mV (HR 3.78, [1.15-12.4]), LAVI >48 ml/m2 (HR 4.43, [2.02-9.70]), moderate mitral regurgitation (HR 4.40, [1.57-12.4]), and RV-FAC <35% (HR 2.30, [1.03-5.16]). Rhythm control failure was associated with PWD, DTNP-V1, LAVI and moderate mitral regurgitation. Rhythm-related adverse events were associated with RV-FAC, LAVI and moderate mitral regurgitation. Conclusion. ECG and echocardiographic indices were associated with discontinuation of flecainide, including safety and efficacy outcomes in long-term treated patients with AF.

There is limited knowledge of physicians' antiarrhythmic drug (AAD) treatment practices for patients with atrial fibrillation and adherence to guidelines in European countries.

An online survey (n = 321) of cardiologists, cardiac electrophysiologists and interventional electrophysiologists was conducted in Germany (DE; n = 83), Italy (IT; n = 95), Sweden (SE; n = 60) and the United Kingdom (UK; n = 83) including 96 questions on treatment practices.

ESC guidelines were the most important non-patient factor influencing treatment practice (55-72 %). However, while amiodarone was frequently (88-93 %) used in heart failure with reduced left ventricular ejection fraction, it was also a typical treatment choice for minimal/no-structural heart disease (SHD) (28 %), particularly in UK. Other deviations from guidelines were the use of class 1C drugs in coronary artery disease (CAD) and other SHD, and use of sotalol in left ventricular hypertrophy and renal impairment. In-hospital initiation of sotalol was low, with the exception of SE. Sotalol (16-41 %) and dronedarone use (10-54 %) in CAD varied among countries. For frequent, symptomatic paroxysmal AF, ablation was generally favoured, but AADs were preferred by 53 % in SE. In asymptomatic or subclinical AF, AADs were used by 41 % (range: 22-60 %), ablation by 11 % (range 2-18 %). In contrast to guidelines that prioritize safety, anticipated efficacy was more important (51 %) than safety (31 %) when selecting AADs.

Despite recognizing the importance of guidelines, deviations in AAD use were common with the potential to compromise patient safety. These findings indicate the need for more educational support for optimal AAD selection in AF management.

Randomized controlled trials (RCTs) comparing the efficacy and safety of direct oral anticoagulants (DOACs) versus Vitamin K antagonists (VKAs) in patients with thrombotic antiphospholipid syndrome (APS) have yielded inconsistent results, partly due to the inherent challenges of conducting RCTs in populations with rare medical conditions. We conducted a systematic review and meta-analysis to evaluate the comparative effects of DOACs versus VKAs in thrombotic APS.

RCTs and observational studies comparing DOACs versus VKAs in patients with thrombotic APS were included. The primary endpoint was a composite of arterial (ATE) and venous thrombotic events (VTE). Incidence rate ratios (IRRs) and associated 95 % confidence intervals (CI) were used to account for different follow-up durations. GRADE was used for rating the certainty of evidence.

Twelve studies, four randomized and eight observational, encompassing a total of 1307 APS patients were included. The use of DOACs was associated with an increase in the primary endpoint (IRR 2.33; 95 % CI 1.18-4.58; GRADE=moderate) driven by increased ATE (IRR 2.70; 95 % CI 1.42-5.13; GRADE=low), compared with the use of VKA. VTE (IRR 0.98; 95 % CI 0.59-1.64; GRADE=low), major (IRR 0.83; 95 % CI 0.48-1.43; GRADE=low) and non-major (IRR 1.32; 95 % CI 0.81-2.14; GRADE=very low) bleeding did not differ significantly between groups. Compared with VKAs, DOACs were associated with an increase in myocardial infarction (IRR 4.71; 95 % CI 1.00-22.21; GRADE=very low) and stroke (IRR 7.48; 95 % CI 1.27-44.13; GRADE=very low). The increased risk of arterial thrombotic events with DOACs was consistently observed in a dedicated analysis of RCTs and was mitigated by the concomitant use of single antiplatelet therapy.

In patients with thrombotic APS, the use of DOACs is associated with increased thrombotic events compared with VKAs, mainly driven by arterial thrombotic events. A single antiplatelet therapy combined with DOACs maight offer a promising alternative to VKAs, warranting further dedicated investigations.

The study was not funded.

This study is registered in PROSPERO (CRD42024582033).

Rheumatic heart disease (RHD) disproportionately impacts minority groups. Indigenous Australians living in remote areas such as Central Australia account for 3.8% of the population and 92% of RHD cases. A complication of RHD is valvular atrial fibrillation (vAF). Previous studies favour Vitamin K antagonist (VKA) use in vAF over direct oral anti-coagulants (DOACs). However, challenges to VKA use remain. This real-world retrospective observational study aimed to compare clinical outcomes between patients prescribed VKAs or DOACs for vAF in Central Australia over a five-year period.

Patients with RHD and vAF on the Northern Territory RHD Register in January 2019 were identified and five-year outcome data collected. Patients were grouped and analysed according to prescribed oral anticoagulant therapy in January 2019 (intention to treat (ITT)) or in January 2024/time of event (as-treated analysis (AT)). The primary outcome was major adverse cardiac and cerebrovascular events (MACCE). The safety endpoint was major bleeding.

Of patients with vAF, 49 were included in the ITT analysis and 51 in the AT analysis. The mean age was 61.9 ± 13.9 years and 68.9 % were female. There was no difference in MACCE (25.0 % vs 22.2 %, p = 0.86) or major bleeding (20.0 % vs 11.1 %, p = 0.53) between VKAs and DOACs in the ITT analysis. Findings were similarly non-significant in AT analysis.

This study demonstrates no significant advantage to VKA over DOAC therapy in vAF in a small cohort of RHD patients living in remote Australia. Further investigation is required to optimise treatment strategies in this important group.

Atrial fibrillation detected after stroke (AFDAS) affects secondary stroke prevention, yet identification can be challenging. Easily accessible cardiac blood biomarkers such as NT-proBNP (N-terminal pro-B-type natriuretic peptide) could guide diagnostic workup, but optimal cutoff values and the time-dependent relationship between NT-proBNP and AFDAS are unclear. We aimed (1) to externally validate earlier presented NT-proBNP cutoffs for atrial fibrillation prediction and (2) to assess the time-dependent relationship of NT-proBNP and early in-hospital AFDAS versus AFDAS after discharge.

We conducted a pooled data analysis of patients with ischemic stroke from the prospective international multicenter BIOSIGNAL (Biomarker Signature of Stroke Aetiology) cohort study (European Stroke Centers from October 2014 to October 2017) and the prospective single-center Graz stroke pathway study (Austria from May 2018 to August 2020). AFDAS was defined as ≥30-s atrial fibrillation/flutter diagnosed within 1 year post-admission and categorized in in-hospital versus after discharge. NT-proBNP was assessed ≤24 hours of symptom onset. The association between NT-proBNP and AFDAS was evaluated by a multivariable logistic regression analysis.

AFDAS was diagnosed in 374 (16%) of 2292 patients with ischemic stroke (median age, 74 years; 42% female), 268 (72%) during hospitalization, and 106 (28%) after discharge (median duration of hospitalization, 15 days). NT-proBNP levels at admission had a good predictive capacity for in-hospital AFDAS (area under the receiver operating characteristic curve, 0.83 [95% CI, 0.81-0.86]). For patients diagnosed with AFDAS after discharge, the predictive capacity of NT-proBNP was poor (area under the receiver operating characteristic curve, 0.65 [95% CI, 0.60-0.70]), and 20% had normal NT-proBNP values <125 pg/mL at admission. The NT-proBNP cutoff of 505 pg/mL exhibited high sensitivity (82%) and specificity (71%) for in-hospital AFDAS, with a negative predictive value of 96%.

In patients with ischemic stroke, the admission NT-proBNP cutoff of 505 pg/mL seems to be a reliable predictor for in-hospital AFDAS, while the predictive capacity of NT-proBNP for AFDAS after discharge is limited. Our results might influence the designs of future secondary stroke prevention trials.

Atrial fibrillation (AF) significantly increases stroke risk, particularly among older adults, leading to severe outcomes and elevated mortality. This study investigates trends and disparities in AF-related stroke mortality among U.S. adults aged 65 and older from 1999 to 2020.

Mortality data from the CDC WONDER database were analyzed, identifying stroke as the underlying cause of death (ICD-10 codes I60-I69) with AF as a contributing cause (ICD-10 code I48). Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Annual percentage change (APC) and average annual percentage change (AAPC) were used to assess trends over time using Joinpoint regression.

A total of 197,453 deaths were recorded between 1999 and 2020. The AAMR increased from 20.85 in 1999 to 24.09 in 2020, reflecting an AAPC of 0.55 % (95 % CI: 0.19-0.95). Women had a slightly higher overall AAMR (21.69) compared to men (20.38). AAMR for Non-Hispanic (NH) Whites (22.15) was 1.5 times higher than that for Hispanics (14.17). Nonmetropolitan areas reported a higher AAMR (22.68) compared to metropolitan areas (21.03). The West had the highest regional overall AAMR (26.57). States in the top 90th percentile reported nearly double the rates of the lowest 10th percentile states.

AF-related stroke mortality in older adults has risen over the past two decades, with disparities across gender, race, and geography. Targeted interventions are essential to address these disparities and reduce the burden of AF-related stroke mortality.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with significant health consequences. Identifying modifiable risk factors, such as obesity, is crucial. While body mass index (BMI) is linked to increased AF risk, the association between new-onset AF (NOAF) and other anthropometric measures like waist circumference (WC) and body surface area (BSA) warrants further investigation.

This systematic review and meta-analysis aimed to compare mean WC and BSA between individuals who developed NOAF and those who did not.

We conducted a comprehensive search up to February 2024 for studies comparing mean WC and BSA in groups with and without incident NOAF. Participants had no prior AF history. We used a random-effects model to calculate standardized mean differences (SMDs) and 95 % confidence intervals (CIs). Subgroup analyses explored NOAF occurrence following coronary artery bypass graft (CABG) surgery, in the absence of any preceding procedure, and after other cardiac procedures.

Our analysis of 34 studies revealed that adults with NOAF had significantly higher WC (SMD = 0.20, 95 % CI 0.01; 0.39) and BSA (SMD = 0.06, 95 % CI 0.01; 0.11) compared to those without NOAF. Subgroup analysis showed a more pronounced association in individuals developing NOAF after CABG (SMD = 0.33, 95 % CI 0.17; 0.48) and in those without any prior procedure before NOAF diagnosis (SMD = 0.23, 95 % CI 0.08; 0.38) versus those without NOAF.

Higher WC and BSA appear to be significantly associated with an increased risk of NOAF, with the relations being more pronounced in specific subgroups.

Atrial fibrillation (AF) is the most common tachyarrhythmia, exhibiting faster and irregular beating. Although there is growing evidence of the impact of AF on the cerebral hemodynamics, ocular hemodynamic alterations induced by AF are still poorly investigated to date. The objective of this study is to computationally inquire into the role of AF on the ocular hemodynamics as one of the possible vascular triggers of glaucoma, which is the leading cause of blindness due to the damage of the optic nerve.

A validated 0D-1D multiscale cardiovascular model is exploited to compute the hemodynamic response of AF against sinus rhythm (SR), by simulating 2000 beats for each condition. To mimic AF rhythm, its main features are accounted for: (i) accelerated, variable and uncorrelated beating; (ii) absence of atrial kick; (iii) ventricular systolic dysfunction.

We focused on intraocular pressure (IOP), ocular perfusion pressure (OPP), and translaminar pressure (TLP). Apart from a modest OPP decrease, beat-averaged values of IOP and TLP barely vary in AF with respect to SR. Instead, during AF a significant reduction and dispersion of pulsatile values (i.e., maximum minus minimum values reached in a beat), as well as wave amplitude damping, is observed for IOP, OPP and TLP. The marked variability of pulsatile values, which are hardly measured due to clinical difficulties, can induce transient hypoperfusions and hypo-pulsatility events (for OPP) as well as hypertensive episodes (for TLP).

Awaiting necessary clinical data which are to date lacking, the present study can enrich - through hemodynamic-driven hints in the AF framework - the vascular theory, which associates reduced ocular perfusion (by means of decreased OPP and increased TLP) to an augmented risk of glaucoma. In this context, present modeling findings suggest a possible mechanistic link between AF-induced hemodynamic alterations and the increased risk of glaucoma development.

A strong association exists between left atrial (LA) structural remodeling and the development of atrial fibrillation (AF). The role of LA function in AF prediction remains unclear. We studied the relationship between LA function and incident AF using cardiac CT.

We retrospectively analyzed patients who underwent multiphasic cardiac CT. LA volumes and parameters of LA global, reservoir and booster function were calculated. The association between measures of LA function and incident AF was analyzed using multivariable Cox regression adjusting for clinical variables, LA volume and left ventricular function.

1025 patients (age 64 years ± 14) were evaluated. Over a median of 3.9 years, 90 patients developed AF. There was a significant association between LA total emptying fraction (adjusted hazard ratio (HR) 1.05; 95% CI: 1.02-1.05 per 1% decrease, p < 0.001), LA reservoir function (HR 1.04; 95% CI: 1.02-1.06 per 1 mL/m2 decrease in LA expansion index, p < 0.001) and passive LA emptying (HR 1.08; 95% CI: 1.03-1.13 per 1% decrease in LA passive emptying fraction, p < 0.001) with incident AF, but no association with LA booster function. Incorporating LA function into predictive models improved risk stratification beyond clinical variables and LA volume. Mediation analysis demonstrated that 46% of the effect of LA volume on AF was mediated via LA dysfunction.

LA functional impairment is common even in patients with normal LA volume and provides additional prognostic information for AF risk. The findings underscore the significance of LA mechanical dysfunction in the pathogenesis of AF.

Question A strong association exists between left atrial structural remodeling and incident atrial fibrillation. The role of left atrial function in atrial fibrillation prediction remains unclear. Findings Left atrial reservoir and passive emptying function (but not booster function) predict incident atrial fibrillation independent of left atrial volume and clinical risk factors. Clinical relevance Left atrial functional impairment precedes the development of atrial fibrillation. Measures of left atrial reservoir and passive emptying function are independent predictors of incident atrial fibrillation.

Interactions with anticoagulants causing an increase in their effect may potentially enhance the bleeding risk. We aimed to analyze the risk of major hemorrhage in anticoagulated patients simultaneously exposed to potentially interacting drugs which may enhance the bleeding risk.

Case-control study nested in a cohort of anticoagulated patients in 2011-2020. Cases were all people hospitalized for a major hemorrhage (cerebral or gastrointestinal), matched to individuals without bleeding. The index date was the day of hospital admission for cases and the same date for the matched controls.

SIDIAP database, containing information from primary health care electronic records, and the database of diagnoses at hospital discharge in Catalonia, Spain. We analyzed exposure to interacting drugs during 3 months prior to the index date. The association between hemorrhage and exposure to interacting drugs was calculated through multivariate logistic regression models.

We included 2,811 cases (77.9% cerebral and 22.1% gastrointestinal hemorrhages), matched to 28,054 controls. We found association between hemorrhage in patients receiving vitamin K antagonists (OR 1.30, 95% CI 1.16-1.47). All types of interactions resulted in higher bleeding risk for all anticoagulants. Proton pump inhibitors were found protective for gastrointestinal (OR 0.55, 95% CI 0.46-0.65) but not for cerebral bleeding (OR 1.18, 95% CI 1.08-1.30).

We estimated the risk of major hemorrhage in anticoagulated patients simultaneously exposed to potentially interacting drugs which may enhance bleeding risk. Our study underscores the potential impact of interactions on cerebral and gastrointestinal bleeding risk in anticoagulated patients.

Post-stroke cognitive impairment (PSCI) is a significant neurological complication, affecting up to one-third of stroke survivors. Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, significantly increasing the risk of ischemic stroke. Increasing evidence suggests that AF plays a pivotal role in exacerbating cognitive decline in stroke patients. This review integrates current clinical, imaging, and mechanistic findings to elucidate how AF-related strokes exacerbate cognitive decline through multiple overlapping pathways, including thromboembolism, neuroinflammation, atherosclerosis, cerebral hypoperfusion, cerebral small vessel disease, and silent infarctions. These processes collectively impair cerebrovascular integrity, induce neuronal damage, and accelerate brain aging. The review further evaluates the role of clinical and neuroimaging biomarkers as predictive tools and their utility in guiding therapeutic strategies. By integrating insights of the latest researches, we aim to provide a comprehensive framework for alleviating cognitive decline in patients with AF-related stroke and highlight future research directions.

Stroke and reduced survival are devastating complications of atrial fibrillation (AF). Biomarker-based ABC-AF risk scores improve risk prediction in AF, and risk-guided treatment recommendations may improve patient outcomes.

The ABC AF-study is a national, multicenter, prospective, registry-based, randomized controlled, parallel-group, open-label study. Its primary objective is to evaluate whether ABC-AF risk score-guided treatment recommendations improve outcomes in patients with AF. Consenting patients with AF registered in the Swedish national quality register for AF, AURICULA AF, will be randomized in a 1:1 ratio to either ABC-AF risk score-guided treatment recommendations or standard care. For participants in the active arm, investigators will receive a visual presentation of stroke and bleeding risks along with recommendations regarding the choice of oral anticoagulant (OAC) and additional treatments for stroke and bleeding prevention. In the control arm, patients are managed at the discretion of the investigator.

The primary outcome is a composite of stroke or death. Secondary outcomes include the composite of stroke, death, and major bleeding, and the individual components of the primary outcome, myocardial infarction, and hospitalization for heart failure; and a safety endpoint of major bleeding. Study enrollment commenced on October 25, 2018, and terminated on May 12, 2023, after 3,933 patients had been recruited. Study results are expected in 2025.

The ABC AF-study evaluates whether a personalized treatment recommendation strategy - guided by the biomarker-based ABC-AF risk score decision support - improves outcomes in AF.

Early postoperative atrial fibrillation (early-POAF) is the most common complication after cardiac surgery. Although prior studies have demonstrated an association between early-POAF and late outcomes, it is questionable whether these long-term adverse events result from early-POAF or from comorbidities that underlie the development of early-POAF. Therefore, the aim of this study was to investigate the association of early-POAF with late mortality and stroke after adjustment for age and cardiovascular comorbidities.

A systematic search was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without early-POAF. Articles presenting Kaplan-Meier were included for a pooled analysis of late mortality (primary outcome) and stroke (secondary outcome). Individual time-to-event data were reconstructed from the Kaplan-Meier curves and incorporated into a multivariable mixed-effects Cox model.

In total, 33 studies were included in the analysis for late mortality (131 031 patients) and 10 studies in the analysis for late stroke (42 042 patients). Overall, 36 991 patients had early-POAF with a pooled incidence of 31.5% (95% CI: 27.7 to 35.6%). Unadjusted analysis showed that early-POAF was significantly associated with late mortality (Hazard Ratio [HR] = 1.62, 95%CI: 1.58-1.67, P < 0.001) and late stroke (HR = 1.72, 95%CI: 1.61-1.85, P < 0.001). Early-POAF was significantly associated with late mortality (adjusted HR = 1.19, 95% CI: 1.07-1.33, P = 0.002), but not with late stroke (adjusted HR = 1.14, 95% CI: 0.96-1.35, P = 0.122) after adjustment for age, comorbidities, surgery type, and the random effects term.

Early-POAF after cardiac surgery is significantly associated with late mortality, but not with late stroke, after adjustments for age, sex, cardiovascular comorbidities, and type of surgery.

Cardiac magnetic resonance (CMR) is crucial for diagnosing myocardial infarction with non-obstructive coronary arteries (MINOCA) and is recommended by current guidelines for its diagnostic and prognostic capabilities. However, the prognostic value of CMR parameters, particularly extracellular volume (ECV), in predicting major adverse cardiovascular events (MACE) among MINOCA remains unclear. This study analyzes ECV distribution across different MINOCA etiologies and its predictive value for MACE in "true" MINOCA.

Consecutive patients with a working diagnosis of MINOCA who underwent CMR were included. We investigated the relationships between CMR parameters and MACE in "true" MINOCA. Cox regression and ROC curve analyses were used to assess ECV in predicting MACE. "True" MINOCA was defined by evidence of ischemia or infarction on CMR.

Among 275 patients with a working diagnosis of MINOCA (median 4 days to CMR), 96 were diagnosed with "true" MINOCA, 66 with myocarditis, 31 with Takotsubo syndrome (TS), 34 with cardiomyopathies, and 48 had normal findings. "True" MINOCA had higher ECV compared to other etiologies (29.10 % vs. 26.00 %, P < 0.001). During a median follow-up of 26.6 months, 29.2 % of "true" MINOCA patients experienced MACE. In the adjusted Cox model, ECV (HR 1.063, 95 % CI 1.019-1.108, P = 0.004) was an independent predictor of MACE in patients with "true" MINOCA. According to optimal cut-off values from ROC, patients with ECV >28.94 % had a significantly higher MACE risk (log-rank P < 0.001).

CMR-derived ECV varies by MINOCA etiology, with higher levels in "true" MINOCA. Elevated ECV independently predicts increased MACE risk in "true" MINOCA patients.

ClinicalTrials.gov (ID: NCT06502899).

We compared the effectiveness of direct oral anticoagulants (DOACs) and warfarin for resolving left atrial appendage (LAA) thrombus in patients with acute stroke with non-valvular atrial fibrillation (NVAF).

Among consecutive patients with acute stroke admitted to five major comprehensive stroke centers in Japan between January 2017 and December 2022, those with NVAF and LAA thrombus detected by transesophageal echocardiography (TEE) and underwent follow-up TEE were included. All patients received DOAC or warfarin treatment. We compared the clinical characteristics, changes in LAA thrombus size, resolution, recurrent stroke, and bleeding complications within 3 months of stroke onset.

This study included 63 patients (DOAC group, 22; warfarin group, 41). Sex, age, and National Institutes of Health Stroke Scale scores on admission did not significantly differ between the groups. The initial LAA thrombus size was 0.83 cm2 and 0.88 cm2 in the DOAC and warfarin groups, respectively. On follow-up evaluation 10 days after initial TEE, LAA thrombus was completely resolved in 59 % and 34 % of patients in the DOAC and warfarin groups, respectively (P = 0.02). Multivariable analysis revealed DOAC treatment as an independent factor for LAA thrombus resolution (odds ratio, 3.21; 95 % confidence interval: 1.07-10.23, P = 0.04). Recurrent stroke occurred in one and three patients in the DOAC and warfarin groups, respectively. No intracerebral hemorrhage cases were observed in either group within 3 months of stroke onset.

In patients with acute stroke with NVAF and LAA thrombus detected by TEE, DOACs may be more effective than warfarin in resolving LAA thrombus.

Guideline-adherent care is associated with better patient outcomes, but whether this can be achieved by professional education is unclear. Here we conducted a cluster-randomized controlled trial across 70 centers in six countries to understand if a program for the education of healthcare professionals could improve patient-level adherence to clinical practice guidelines on atrial fibrillation (AF). Each center recruited patients with AF seen in routine practice (total N = 1,732), after which the centers were randomized, accounting for baseline guideline adherence to class I and III recommendations from the European Society of Cardiology on stroke prevention and rhythm control. Healthcare professionals in the intervention centers received a 16-week structured educational program with an average of 9 h of online engagement, whereas those at control centers received no additional education beyond standard practice. For the co-primary stroke prevention outcome, guideline adherence was 63.4% and 58.6% at baseline and 67.5% and 60.9% at 6-9-months follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.10; 95% confidence interval (CI) 0.97 to 1.24; P = 0.13). For the co-primary rhythm control outcome, guideline adherence was 21.4% and 20.4% at baseline and 33.9% and 22.9% at follow-up for the intervention and control groups, respectively (adjusted risk ratio 1.51; 95% CI 1.04 to 2.18; P = 0.03). The secondary outcome of patient-reported integrated AF management showed a 5.1% improvement in the intervention group compared with the control group (95% CI 1.4% to 8.9%; P = 0.01). Thus, while the education of healthcare professionals improved substantial gaps in implementation for rhythm control, it had no significant effect on stroke prevention. ClinicalTrials.gov registration: NCT04396418 .

Atrial fibrillation (AF) is the most common arrhythmia, significantly increasing the risk of adverse events such as stroke, heart failure, and cognitive impairment. catheter ablation is a first-line treatment for AF, with pulmonary vein isolation (PVI) as a common procedure. Although studies have reported sex-based differences in complication rates following PVI, these findings remain controversial. This study aimed to explore sex differences and identify independent risk factors associated with complications after PVI in non-valvular AF patients. This retrospective cohort study included 1092 patients with non-valvular AF who underwent PVI at the First Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2021. The patients were divided into male and female groups, with propensity score matching used to reduce baseline differences. Data on clinical characteristics, intraoperative variables, and postoperative complications were collected. The primary outcome was the occurrence of complications after PVI, categorized into overall, mild, and major complications. Multivariate logistic regression analysis was performed to identify independent risk factors for complications. The study found that female patients experienced a higher incidence of postoperative complications compared to male patients (30.38% vs 19.89%, P = .001). The female group had significantly higher rates of pericardial effusion (20.17% vs 12.71%, P = .007) and mild complications, such as vagal hyperactivity (3.87% vs 1.38%, P = .036). Multivariate logistic regression revealed that female sex, obesity, New York Heart Association functional class ≥ II, and ablation of non-pulmonary veins were significantly associated with overall and mild complications. Sex differences significantly influence the occurrence of postoperative complications after PVI in non-valvular AF patients, with female patients at a higher risk. Targeted interventions considering these risk factors may improve patient outcomes. Further research is required to explore the underlying mechanisms driving these differences.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, and it is associated with substantial morbidity, mortality, and economic burden. Effective management of AF remains a critical focus in contemporary medicine, given its complex and multifaceted nature. In the present paper, we provide the essential updates for everyday clinical practice from the 2024 European Society of Cardiology (ESC) guidelines for AF management. We highlight seven key areas encompassing the adoption of the CHA₂DS₂-VA score for thromboembolic risk stratification, changes in bleeding risk assessment, expanded indications for catheter ablation, promotion of the multidisciplinary AF-CARE pathway for patient management, new recommendations for left atrial appendage closure, updates on clinical decision-making for atrial high-rate episodes, and considerations on the future role of artificial intelligence in advancing predictive analytics. We also compare the new recommendations proposed by the ESC 2024 AF guidelines with the ESC 2021 edition and the 2023 guidelines published by the American College of Cardiology/American Heart Association (ACC/AHA), reflecting regional perspectives and advancements in the field. By presenting these practical updates and their implications for routine practice, this paper aims to guide clinicians in adopting the latest evidence-based approaches to optimize AF patients' care.

The occurrence and development of atrial fibrillation (AF) are influenced by the autonomic nervous system and inflammation. Acupuncture is an effective treatment for AF. This study explored the protective effects of acupuncture in a rat model of paroxysmal AF and investigated its mechanisms.

Male Sprague-Dawley rats (n = 130) were randomly divided into blank control (Con), sham operation (Sham), AF, and acupuncture treatment (Acu) groups. A paroxysmal AF model was established by rapid atrial pacing through the jugular vein. Rats in the Acu group were immobilized to receive acupuncture treatment at Neiguan acupoint (PC6) for 20 min daily for seven days. The other groups were immobilized for the same duration over the treatment period but did not receive acupuncture. The AF induction rate, AF duration, cardiac electrophysiological parameters, and heart rate variability were evaluated by monitoring surface electrocardiogram and vagus nerve discharge signals. After the intervention, the rats were euthanized, and atrial morphology was assessed using haematoxylin and eosin staining. The expression of macrophage F4/80 antigen (F4/80) and cluster of differentiation (CD) 86 in atrial myocardial tissue was detected using immunohistochemistry, immunofluorescence and flow cytometry. The expression levels or contents of interleukin (IL)-1β, IL-6, tumor necrosis factor-α (TNF-α), α7 nicotinic acetylcholine receptor (α7nAChR), phosphorylated Janus kinase 2 (p-JAK2), and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in atrial myocardial tissue were detected using Western blotting, reverse transcription-quantitative polymerase chain reaction, or enzyme-linked immunosorbent assay. The role of α7nAChR in acupuncture treatment was verified by intraperitoneal injection of the α7nAChR antagonist methyllycaconitine (MLA).

Compared with the AF group, acupuncture significantly reduced AF duration and induction rate, improved cardiac electrophysiology by enhancing vagus nerve activity and regulating autonomic balance. It also decreased the pro-inflammatory M1 macrophage proportion, alleviating myocardial injury and infiltration. MLA weakened acupuncture's electrophysiological improvement and anti-inflammatory effect. Results suggest that acupuncture triggers the α7nAChR-JAK2/STAT3 pathway and exerts cardioprotection via neuroimmune regulation.

Acupuncture significantly reduced the AF induction rate, shortened AF duration, improved cardiac electrophysiological parameters, enhanced vagus nerve activity, and decreased the expression of pro-inflammatory M1 macrophages and inflammatory factors in rats with paroxysmal AF. Its positive effects are related to the activation of the α7nAChR-mediated JAK2/STAT3 signalling pathway, indicating that the interaction between cardiac vagus nerve and macrophages may be a potential target for acupuncture in the prevention and treatment of AF. Please cite this article as: Li ZH, Yang WM, Huang Q, Shi GX, Liu CZ, Zhang YQ. Acupuncture activates vagus nerve-macrophage axis and improves cardiac electrophysiology and inflammatory response in rats with atrial fibrillation via α7nAChR-JAK2/STAT3 pathway. J Integr Med. 2025; Epub ahead of print.

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist, contributing to cardiovascular risk, possibly through shared inflammatory pathways. The specific role of inflammatory markers in patients with AF and OSA is not well established.

This study aimed to determine whether markers of inflammation and immune activation are elevated in patients with paroxysmal AF and OSA, assess the effects of continuous positive airway pressure (CPAP) and pulmonary vein isolation (PVI) on these markers, and evaluate their association with clinical outcomes, such as AF recurrence and thromboembolic risk.

We studied 143 patients with paroxysmal AF and moderate to severe OSA (apnea-hypopnea index ≥15). Of these, 99 were randomised to receive CPAP plus standard care (n = 51) or standard care alone (n = 48). A comparison group of 19 patients with paroxysmal AF and mild/no OSA (AHI <15) and 22 healthy controls were also included. Inflammatory markers related to leukocyte activation, vascular inflammation, and extracellular matrix remodelling were assessed at baseline, 6 months and 12 months follow-up.

Patients with OSA and paroxysmal AF had higher levels of NGAL, PTX-3, GDF-15, MMP-9, VCAM1 and ANGP2 than healthy controls. These markers correlated poorly with AF and OSA severity. There was no modifying effect of CPAP on any marker. PTX3 was associated with AF recurrence and a high-risk score for thromboembolic stroke.

Moderate to severe OSA and AF are associated with elevated inflammatory markers. However, CPAP therapy did not significantly affect these levels. PTX-3 may hold prognostic value for AF recurrence and thromboembolic risk.

Statins may prevent myocardial dysfunction associated with aging, and consequent atrial fibrillation (AF) and heart failure (HF). STAREE-HEART is a randomized, double-blind, placebo-controlled clinical trial assessing atorvastatin on markers of cardiovascular aging in a healthy older population. This ancillary study is nested in the STAtins in Reducing Events in the Elderly (STAREE) primary prevention trial.

Participants ≥ 70 years (n=369) have been randomized to atorvastatin or placebo. Assessment at baseline and 3-years includes echocardiogram, electrocardiography and blood collection for biomarker assessment. The primary endpoint is change in global longitudinal strain (GLS), a measure of left ventricular systolic function. An estimated 184 participants per group enables detection of mean GLS at 3 years in the placebo group being 2.0 percentage points lower than mean GLS in the statin group at 3 years, assuming SD=5 percentage points and a 15% attrition rate, with power >90%. We present summary statistics describing participants at baseline.

The mean age of the 369 STAREE-HEART participants was 73.0 years (SD 3.4). Mean left ventricular (LV) ejection fraction was 64.0% (SD 6.1), and mean GLS was 19.2% (SD 2.2). Mean GLS was similar between females and males (19.4 vs 19.0%) and slightly higher in those aged 70-74 compared to ≥75 years (19.4 vs 18.6%). AF was detected on screening in 4.5% of participants.

The STAREE-HEART ancillary study will provide mechanistic detail concerning myocardial dysfunction and its consequences, to determine if atorvastatin affects left ventricular systolic function associated with aging. Clinical trial registration clinicaltrials.gov Unique identifier NCT04536870.

Catheter ablation by pulmonary vein isolation (PVI) has a class IA recommendation for patients with atrial fibrillation (AF) resistant or intolerant to antiarrhythmic drug therapy to reduce symptoms, recurrence and progression of AF. However, the symptomatic effect of catheter ablation is difficult to quantitate in the absence of a double-blind trial with a sham procedure control. The PVI-SHAM-AF trial aims to compare the effects of catheter ablation versus a sham procedure on patient-reported outcomes using standardized AF questionnaires.

The PVI-SHAM-AF trial is a multicentre, prospective, randomized, sham-controlled, double-blinded clinical trial. The trial plans to enrol 260 patients. Patients eligible for PVI are randomly assigned in a 2:1 ratio to receive either PVI or a sham procedure. The Sham procedure involves introducing a venous sheath under deep analgosedation, maintained for at least 60 minutes; electrical cardioversion is performed if atrial fibrillation is present. Follow-up assessments are planned at 3-, 6-, and 12-months post-baseline, focusing on AF symptoms, quality of life assessments assessed by the AFEQT, SF-36, EQ-5D questionnaires, and clinical outcomes such as AF burden and NT-proBNP levels. The primary objective is the change in quality of life (measured by a standardized questionnaire) from baseline to 6 months of follow-up, compared to the sham procedure.

The PVI-SHAM AF trial will assess the true (sham-controlled) effect of catheter ablation for AF on quality of life.

People with chronic heart failure have an increased risk of thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principal oral antithrombotic agents. Many people with heart failure in sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulation (OAC) has become a standard in the management of heart failure with atrial fibrillation. However, uncertainty regarding the appropriateness of OAC in heart failure with sinus rhythm remains. This is an update of a review previously published in 2016.

To assess the effects of OAC versus antiplatelet agents for all-cause mortality, non-fatal cardiovascular events and risk of major bleeding in adults with heart failure (either with reduced or preserved ejection fraction) who are in sinus rhythm.

In April 2025, we updated the searches of CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) portal. We searched the reference lists of papers and abstracts from cardiology meetings and contacted study authors for further information. We did not apply any language restrictions.

We included randomised controlled trials (RCTs) comparing antiplatelet therapy versus OAC in adults with chronic heart failure in sinus rhythm. Treatment had to last for at least one month. We compared oral antiplatelets (aspirin, ticlopidine, clopidogrel, prasugrel, ticagrelor, dipyridamole) versus OAC (coumarins, warfarin, non-vitamin K oral anticoagulants).

Three review authors independently assessed trials for inclusion and assessed the benefits and harms of antiplatelet therapy versus OAC by calculating risk ratios (RRs) with 95% confidence intervals (CIs). We used GRADE criteria to assess the certainty of evidence.

This update did not identify additional studies for inclusion, so the evidence base remains unchanged since the previous review version (published in 2016). We included four RCTs with 4187 eligible participants. All studies compared warfarin with aspirin. One RCT additionally compared warfarin with clopidogrel. All included RCTs studied people with heart failure with reduced ejection fraction. Analysis of all outcomes for warfarin versus aspirin was based on 3663 participants from four RCTs. Warfarin and aspirin probably both reduce all-cause mortality, with little to no difference between their risks: 21.9% for warfarin, 21.9% for aspirin (RR 1.00, 95% CI 0.89 to 1.13; 4 studies, 3663 participants; moderate-certainty evidence). OAC probably reduces the risk of non-fatal cardiovascular events (6.6% for warfarin, 8.3% for aspirin), which included non-fatal stroke, myocardial infarction, pulmonary embolism, peripheral arterial embolism (RR 0.79, 95% CI 0.63 to 1.00; 4 studies, 3663 participants; moderate-certainty evidence). Warfarin probably increases the risk of major bleeding events: 5.6% for warfarin, 2.8% for aspirin (RR 2.00, 95% CI 1.44 to 2.78; 4 studies, 3663 participants; moderate-certainty evidence). We considered the risk of bias of the included studies to be low. Analysis of warfarin versus clopidogrel was based on one RCT (N = 1064). With little to no difference between their risks, warfarin and clopidogrel may both reduce all-cause mortality: 17.0% for warfarin, 18.3% for clopidogrel (RR 0.93, 95% CI 0.72 to 1.21; 1 study, 1064 participants; low-certainty evidence) and non-fatal cardiovascular events slightly, 4.6% for warfarin, 5.4% for clopidogrel (RR 0.85, 95% CI 0.50 to 1.45; 1 study, 1064 participants; low-certainty evidence). Warfarin may increase the risk of major bleeding events slightly: 4.9% for warfarin, 2.0% for clopidogrel (RR 2.47, 95% CI 1.24 to 4.91; 1 study, 1064 participants; low-certainty evidence). We considered the risk of bias for this to be low.

There is some evidence from RCTs that OAC with warfarin compared to platelet inhibition with aspirin probably has little to no effect on mortality in people with systolic heart failure in sinus rhythm (moderate-certainty evidence). Treatment with warfarin probably reduces non-fatal cardiovascular events but probably increases the risk of major bleeding complications (moderate-certainty evidence). We saw a similar pattern of results for the warfarin versus clopidogrel comparison (low-certainty evidence). At present, there are no data on the role of OAC versus antiplatelet agents in heart failure with preserved ejection fraction in sinus rhythm. Also, there were no data from RCTs on the utility of non-vitamin K antagonist oral anticoagulants compared to antiplatelet agents in heart failure with sinus rhythm.

Despite guideline recommendations supporting catheter ablation for typical atrial flutter (AFL), there is a paucity of literature reporting the utilization and outcomes of ablation in tactical athletes. This study aims to characterize military personnel diagnosed with typical AFL and investigate the rates of catheter ablation and personnel returning to normal activities.

Military personnel diagnosed with typical AFL from 2016 to 2022 were analyzed and the management was reviewed. Typical AFL diagnoses were confirmed by electrocardiogram and electrophysiology study with entrainment or activation mapping.

Forty personnel (mean age, 40.7±10.7 years; 98% male; mean BMI 28.3±4.2 kg/m2; mean left ventricular ejection fraction [LVEF] 58.3%±7.7) were diagnosed with typical AFL. 34/40 (85%) of service members diagnosed with typical AFL were retained on military status after diagnosis. Electrophysiology study and successful ablation was performed in 27/40 (67.5%) of personnel with no complications. 26/27 (96.3%) service members who underwent ablation were retained, whereas only 8/13 (61.2%) service members who did not receive ablation were retained (P = .001, Figure 1).

Military tactical athletes with typical AFL receive safe and effective ablations. Ablation is associated with increases in military retention rates and return to normal activity when compared to treatment without ablation. These data support the use of ablation as first-line treatment for athletic populations with typical AFL. Future studies with a larger sample size should be performed to confirm these findings.

Atrial fibrillation (AF), the most prevalent clinically significant cardiac arrhythmia, is characterized by chaotic atrial electrical activity and currently affects an estimated 2.5-3.5% of the global population. Its pathogenesis involves ion channel dysfunction, inflammatory cascades, and structural remodeling processes, notably fibrosis. Angiogenesis, the physiological/pathological process of new blood vessel formation, plays a multifaceted role in AF progression. This review synthesizes evidence highlighting angiogenesis's dual role in AF pathogenesis: while excessive or dysregulated angiogenesis promotes atrial remodeling through fibrosis, and electrical dysfunction via VEGF, ANGPT, and FGF signaling pathways, compensatory angiogenesis exerts protective effects by improving tissue perfusion to alleviate ischemia and inflammation. Therapeutically, targeting angiogenic pathways-particularly VEGF-represents a promising strategy for modulating structural remodeling; however, non-selective VEGF inhibition raises safety concerns due to cardiovascular toxicity, necessitating cautious exploration. Emerging evidence highlights that anti-cancer agents (e.g., ibrutinib, bevacizumab) impair endothelial homeostasis and elevate AF risk, underscoring the need for cardio-oncology frameworks to optimize risk-benefit ratios. Preclinical studies on angiogenesis inhibitors and gene therapies provide mechanistic insights, but clinical validation remains limited. Future research should prioritize elucidating mechanistic complexities, developing biomarker refinement, and implementing interdisciplinary strategies integrating single-cell sequencing with cardio-oncology principles. This review emphasizes the imperative to clarify angiogenic mechanisms, optimize therapeutic strategies, and balance pro-arrhythmic versus compensatory angiogenesis, in pursuit of personalized AF management.

Background/Objectives: Atherosclerotic cardiovascular diseases (ASCVDs) remain the leading cause of morbimortality worldwide. The objectives of this study were to update the prevalence rates of ASCVDs and to evaluate their relationship with cardiovascular-kidney-metabolic (CKM) disorders. Methods: This cross-sectional observational study included 6588 adults selected through a simple random population-based sample from the Health Service database of the Madrid Region (Spain). Adjusted prevalence rates were calculated by the direct method, according to Spanish population data from the National Institute of Statistics. The relationships of CKM disorders with coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and ASCVD were assessed by bivariate and multivariate analyses. Results: The age- and sex-adjusted prevalence rates among overall adults with CHD, stroke, PAD, and ASCVD were 3.8%, 3.0%, 1.8%, and 7.3%, respectively, and they reached 5.6%, 4.4%, 2.6%, and 10.8%, respectively, among people aged 40 years and older. The prevalence rates were higher in men than women aged over 40 years for CHD and ASCVD, between 50 and 69 years for stroke, and aged over 60 years for PAD. The mean ages of women and men with ASCVD were 74.9 and 70.2 years, respectively. Hypertension, heart failure (HF), hypercholesterolaemia, diabetes, low eGFR, atrial fibrillation (AF), prediabetes, and low HDL-c were independently associated with ASCVD, highlighting hypertension and HF for all of them, in addition to hypercholesterolaemia for CHD and stroke, and specifically, AF for stroke. Conclusions: More than one in ten people aged over 40 suffer from CHD, stroke, or PAD. Hypertension, HF, hypercholesterolaemia, diabetes, and low eGFR are the major CKM disorders associated with ASCVD.

Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective, and faster procedures.

The peQasus study is a large European multicentre study set up to assess safety, acute efficacy, and outcomes of temperature-controlled HPSD-based PVI. The primary endpoints were safety, efficacy, and 12-month freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90 W for 4 s) only and a hybrid approach (HPSD with maximum of 50 W and vHPSD) were compared. A total of 1023 AF patients in 15 centres from nine European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%), the vHPSD-only approach (vHPSD group) and in 324/ (31.7%) patients, the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4 ± 37.4 min (vHPSD: 88.2 ± 34.9 min, hybrid: 117.4 ± 32.7 min, P < 0.001). The first-pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, P = 0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, P = 0.746). Twelve-month arrhythmia-recurrence-free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, P = 0.241).

In this large multicentre study, temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time, no differences in terms of safety and freedom from arrhythmia recurrence were found irrespective of utilizing vHPSD or the hybrid approach.

Left atrial thrombus (LAT) poses a significant risk for stroke and other thromboembolic complication in patients with atrial fibrillation (AF). This study aimed to evaluate the incidence and predictors of LAT in patients with paroxysmal AF, utilizing machine learning techniques based on data from the Chinese Atrial Fibrillation study.

A large-scale multi-center retrospective study was conducted involving patients diagnosed with non-valvular paroxysmal AF. LAT incidence was assessed, and potential risk factors were analyzed. Machine learning algorithms, including decision tree, random forest, AdaBoost, k-Nearest Neighbor, and logistic regression, were employed to develop a predictive model for LAT.

Of the 49,515 patients with paroxysmal AF, 1,058 patients (2.1%, 95% CI 2.0%-2.3%) were identified with LAT. Sixty-one variables were initially included to train machine learning models, with the random forest algorithm demonstrating the best predictive performance (AUC 0.833, 95%CI 0.730-0.924). The final model, refined to include nine essential features, achieved an AUC of 0.787 (95%CI 0.670-0.883). Calibration analysis indicated no significant difference between predicted and observed values (p = 0.181). The median predicted probabilities of LAT across quintiles were 2.3%, 7.0%, 11.8%, 16.6%, and 21.5%.

This simplified prediction model effectively identifies the risk of LAT in patients with paroxysmal AF, providing a valuable tool for clinical decision-making. Further studies are needed to explore AF management and risk stratification in other AF subtypes.

Emerging evidence suggests a link between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiac arrhythmia. This study aims to investigate the potential relationship between MASLD and atrial fibrillation (AF).

This retrospective cohort study included 8511 participants (age > 65 years) without a history of cardiovascular diseases, cancer, or severe kidney dysfunction. MASLD was diagnosed using hepatic ultrasound in the presence of at least one cardiometabolic risk factor. Poisson regression models were employed to estimate the relative risk (RR) of AF, adjusting for potential confounders.

Participants were categorized into MASLD (n = 3,926) and non-MASLD (n = 4,585) groups. During a mean follow-up period of 3.65 ± 1.20 years, 307 participants with MASLD developed AF, however, the number in the non-MASLD group was 144 (incidence rate 7.82 % vs. 3.14 %). After adjusting for multiple cardiovascular risk factors, MASLD was associated with increased risk of AF (RR = 1.55, 95 %, confidence interval (CI): 1.12-2.13). Positive correlations were observed between age, body mass index (BMI), systolic and diastolic blood pressure, low-density lipoprotein levels, and AF risk. Subgroup analysis revealed a stronger association between MASLD and AF in participants with BMI < 24 kg/m2 (P < 0.01).

This study highlights a significant association between MASLD and an increased risk of developing AF. The elevated risk in patients with MASLD may involve mechanisms extending beyond traditional cardiometabolic factors, particularly in individuals with lower BMI. Further experimental research is warranted to elucidate the underlying pathways linking MASLD and AF.

Heart failure with preserved ejection fraction (HFpEF) is defined by heart failure (HF) with a left ventricular ejection fraction (LVEF) of at least 50%. HFpEF has a complex and heterogeneous pathophysiology with multiple co-morbidities contributing to its presentation. Establishing the diagnosis of HFpEF can be challenging. Two algorithms, the 'Heavy, 2 or more Hypertensive drugs, atrial Fibrillation, Pulmonary hypertension, Elderly age >60, elevated Filling pressures' (H2FPEF) and the 'Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final aetiology' (HFA-PEFF), can help to determine the likelihood of HFpEF in individuals with symptoms of HF. Phenotype clusters defined largely by the total number and types of co-morbidities may delineate groups of patients with HFpEF with different management needs. It is important to recognize alternative diagnoses or HFpEF mimics such as infiltrative cardiomyopathies, coronary artery disease, lung disease, anxiety, depression, anaemia, severe obesity, and physical deconditioning, among others. Treatment with sodium-glucose co-transporter 2 inhibitors (dapagliflozin and empagliflozin) is recommended for all patients with HFpEF unless contraindicated. Future research should consider alternative approaches to guide the initial diagnosis and treatment of HFpEF, including phenotype clustering models and artificial intelligence, and consider whether LVEF is the most useful distinguishing feature for categorizing HF. Ongoing clinical trials are evaluating novel pharmacological and device-based approaches to address the pathophysiological consequences of HFpEF.