Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation: The ALONE-AF Randomized Clinical Trial.

Importance: Data from randomized clinical trials on a long-term anticoagulation strategy for patients after catheter-based ablation for atrial fibrillation (AF) are lacking.

Objective: To evaluate whether discontinuing oral anticoagulant therapy provides superior clinical outcomes compared with continuing oral anticoagulant therapy in patients without documented atrial arrhythmia recurrence after catheter ablation for AF.

Design, Setting, And Participants: A randomized clinical trial including 840 adult patients (aged 19-80 years) who were enrolled and randomized from July 28, 2020, to March 9, 2023, at 18 hospitals in South Korea.

The optimal lookback period for estimating incidence and temporal trends in atrial fibrillation.

Background: Accurate measurement of atrial fibrillation (AF) incidence using secondary data is challenging due to variation in lookback period definitions used to distinguish incident from prevalent cases. As the choice of lookback period critically influences incidence estimates, establishing an appropriate duration is essential for sustained surveillance of AF trends.

Objectives: This study aimed to identify a reproducible definition of the lookback period and analyze trends in the incidence rate and prevalence of AF in Korea.

Racial differences in bleeding risks among patients with atrial fibrillation: An ecological epidemiological study comparing Korea and UK population.

Background: Racial differences in the propensity to bleeding may be evident, with a higher risk of bleeding in Asian populations. This study aimed to assess racial differences in bleeding risk among patients with atrial fibrillation (AF) using an ecological epidemiological approach.

Methods: We included patients with AF from the Korean National Health Insurance Service-Health Screening and UK Biobank who underwent health check-ups between 2006 and 2010.

Artificial intelligence-estimated electrocardiographic sex as a recurrence predictor after atrial fibrillation catheter ablation.

Aims: We explored whether artificial intelligence (AI)-enabled electrocardiographic (ECG) sex discrepancy would predict atrial fibrillation (AF) recurrence after catheter ablation for paroxysmal AF.

Methods And Results: The AI-ECG sex prediction model was developed from the MIMIC-IV and externally validated on CODE-15% (AUC 0.89) and UK Biobank (AUC 0.

Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort study.

Background: Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian populations.

Methods: This population-based retrospective cohort study included patients with incident AF diagnosed between 2005 and 2016 from the Korean National Health Insurance Service.

Metabolic Status and Atrioventricular Block Risk: The Role of Physical Activity.

Background: The relationship between metabolic status as a possible risk factor and predictor of response to moderate-to-vigorous physical activity (MVPA) in atrioventricular block (AVB) remains unclear.

Methods: A total of 82,365 UK Biobank participants without a history of AVB or pacemaker implantation, and who were involved in accelerometer work-up, were chosen for the study population. Metabolic status was classified into two categories, healthy and unhealthy, using modified criteria for metabolic syndrome from the International Diabetes Federation.

Proteomic Signatures for Risk Prediction of Atrial Fibrillation.

Background: Proteomic signatures might improve disease prediction and enable targeted disease prevention and management. We explored whether a protein risk score derived from large-scale proteomics data improves risk prediction of atrial fibrillation (AF).

Methods: A total of 51 680 individuals with 1459 unique plasma protein measurements and without a history of AF were included from the UKB-PPP (UK Biobank Pharma Proteomics Project).

Tissue characterization using cardiac magnetic resonance imaging and response to cardiac resynchronization therapy.

Aims: Cardiac magnetic resonance (CMR) imaging for tissue characterization offers valuable insights for risk stratification among patients with cardiomyopathy. This study aimed to assess the prognostic value of CMR-based tissue characterization in predicting response to cardiac resynchronization therapy (CRT) in patients with non-ischaemic cardiomyopathy (NICM).

Methods And Results: Retrospective analysis was performed on CMR data from NICM patients before CRT implantation.

Apixaban outcomes in atrial fibrillation patients with a single-dose reduction criterion: ASPIRE 1-year results.

Aims: This study, using a prospective cohort, evaluated the effectiveness and safety of off-label reduced-dose apixaban vs. the on-label dose in atrial fibrillation (AF) patients meeting a single-dose reduction criterion.

Methods And Results: The efficAcy and Safety of aPixaban In REal-world practice in Korean frail patients with AF (ASPIRE) study is a multicentre, prospective observational cohort involving AF patients who met a single-dose reduction criterion of apixaban.

Safety and Performance of the Micra VR Leadless Pacemaker in a South Korean Cohort: A Comparison to Global Studies.

Background And Objectives: The Micra leadless pacemaker demonstrated a favorable safety and efficacy profile in global trials, but its performance and safety in a South Korean-specific population are unknown.

Methods: The prospective, single-arm Micra Acute Performance South Korean registry was designed to study the performance of the Micra VR leadless pacemaker in patients from South Korea. The primary objectives were to characterize the rate of acute (30 days) and longer-term (12 months) major complications.

Clinical and Genetic Risk Factors Predict Atrial Fibrillation on the Basis of Hypertrophic Cardiomyopathy.

Background: Clinical and genetic predispositions are significant in predicting atrial fibrillation (AF); however, their role in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aims to elucidate the impact of clinical and genetic risk factors on the development of AF in patients with and without HCM.

Methods And Results: This retrospective analysis involved data from the UK Biobank cohort.

Early Rhythm Control for Atrial Fibrillation in Patients With End-Stage or Chronic Kidney Disease.

Objective: To investigate the benefits and risks of early rhythm control (ERC) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD).

Patients And Methods: This population-based cohort study included 5224 patients with AF (58.2% male, median age 70 years) with end-stage kidney disease (ESKD; n=1660) and CKD stage 3 to 4 (n=3564), who underwent ERC or rate control between January 1, 2005, and December 31, 2015.

Extended Period Outcomes of Posterior Box Isolation in 4 Randomized Atrial Fibrillation Catheter Ablation Trials.

Background: Catheter-based electrical posterior box isolation (POBI) and circumferential pulmonary vein isolation (CPVI) do not improve the rhythmic outcomes of atrial fibrillation catheter ablation in previous studies with 12 to 24 months of follow-up.

Objectives: The authors analyzed the long-term rhythm outcomes of our 4 previously conducted randomized controlled trials comparing CPVI alone vs CPVI plus additional POBI using the intention-to-treat principle.

Methods: The authors analyzed 575 AF patients included in our 4 previous randomized controlled trials.

Racial differences and similarities in atrial fibrillation epidemiology and risk factors in UK Biobank and Korean NHIS-HEALS cohort studies.

Background: The increasing prevalence of atrial fibrillation (AF) requires efforts to understand racial differences in disease distribution and risk factors.

Objective: We aimed to compare associations between risk factors and AF in White Europeans from the UK Biobank and Asians from the Korean National Health Insurance Service-Health Screening (NHIS-HEALS) study.

Methods: This study included participants from the Korean NHIS-HEALS and UK Biobank.

Associations of accelerometer-derived moderate-to-vigorous physical activity and atrioventricular block in a healthy elderly population.

Background: There is limited information on protective factors related to atrioventricular (AV) block.

Objective: This study examines the association between accelerometer-derived moderate-to-vigorous physical activity (MVPA) and AV block in healthy elderly individuals.

Methods: A total of 23,590 UK Biobank participants ≥60 years of age involved in a wrist-worn accelerometer study with no history of hypertension, diabetes mellitus, dyslipidemia, and coronary heart disease were analyzed.

Novel algorithm for non-invasive estimation of left atrial pressure in patients with atrial fibrillation.

Aims: Determining elevated left atrial (LA) pressure is crucial in patients with atrial fibrillation (AF), yet non-invasive estimation using echocardiography remains unclear. This study aimed to identify useful echocardiographic indices for identifying elevated LA pressure in patients with AF.

Methods And Results: Patients with paroxysmal or persistent AF referred for catheter ablation at two tertiary hospitals were prospectively enrolled.

Cryoballoon Pulmonary Vein Isolation With Versus Without Additional Right Atrial Linear Ablation for Persistent Atrial Fibrillation: The CRALAL Randomized Clinical Trial.

Background: Pulmonary vein isolation (PVI) alone is less effective in patients with persistent atrial fibrillation (AF) compared with those with paroxysmal AF. We investigate whether additional linear ablation from the superior vena cava to the right atrial septum and cavotricuspid isthmus ablation improves the rhythm outcome of patients with persistent AF undergoing cryoballoon PVI (Cryo-PVI).

Methods: In this investigator-initiated, multicenter, randomized clinical trial, 289 patients with persistent AF refractory to antiarrhythmic drug therapy were randomized 1:1 to either Cryo-PVI with additional right atrium (RA) linear ablation or Cryo-PVI alone.

Artificial intelligence-derived electrocardiographic aging and risk of atrial fibrillation: a multi-national study.

Background And Aims: Artificial intelligence (AI) algorithms in 12-lead electrocardiogram (ECG) provides promising age prediction methods. This study investigated whether the discrepancy between ECG-derived AI-predicted age (AI-ECG age) and chronological age, termed electrocardiographic aging (ECG aging), is associated with atrial fibrillation (AF) risk.

Methods: An AI-ECG age prediction model was developed using a large-scale dataset (1 533 042 ECGs from 689 639 participants) and validated with six independent and multi-national datasets (737 133 ECGs from 330 794 participants).

Using Electrocardiogram to Assess Diastolic Function and Prognosis in Mitral Regurgitation.

Background: The determination of left ventricular diastolic function (LVDF) in patients with significant (≥moderate) mitral regurgitation (MR) poses a complex challenge. We recently validated an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to estimate LVDF.

Objectives: This study sought to evaluate the risk of all-cause mortality across AI-ECG LVDF-derived myocardial disease (MD) grades in MR.

Using computed tomography atrial myocardial thickness maps in cryoballoon pulmonary vein isolation: the UTMOST AF II randomized clinical trial.

Aims: Whether adjusting the duration of ablation based on left atrial wall thickness (LAWT) provides extra benefits for pulmonary vein (PV) isolation for atrial fibrillation (AF) is uncertain. We studied the safety and efficacy of tailored cryoballoon PV isolation (CB-PVI) based on LAWT for paroxysmal AF.

Methods And Results: Two hundred seventy-seven patients with paroxysmal AF refractory to anti-arrhythmic drug were randomized 1:1 to either LAWT-guided CB-PVI (n = 135) and empirical CB-PVI (n = 142).

Clinical implication of electrocardiogram change in patients experiencing lung transplantation with end stage lung disease.

Introduction: End-stage lung disease causes cardiac remodeling and induces electrocardiogram (ECG) changes. On the other way, whether lung transplantation (LTx) in end-stage lung disease patients are associated with ECG change is unknown. The object of this study was to investigate ECG changes before and after LTx in end-stage lung disease patients and whether these changes had clinical significance.

Clinical outcomes of Asian patients with newly diagnosed atrial fibrillation and previously diagnosed atrial fibrillation: Insights from the CODE-AF Registry.

Background: Atrial fibrillation (AF) may have different clinical features in its early phase.

Objective: The purpose of this study was to compare the characteristics and clinical outcomes of early-phase AF with later-phase AF using a large multicenter prospective registry (CODE-AF [COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation]).

Methods: Patients enrolled between June 2016 and March 2021 were divided into 2 groups based on AF duration: (1) newly diagnosed (AF duration ≤90 days); and (2) previously diagnosed (AF duration >90 days).

Clinical usefulness of digital twin guided virtual amiodarone test in patients with atrial fibrillation ablation.

It would be clinically valuable if the efficacy of antiarrhythmic drugs could be simulated in advance. We developed a digital twin to predict amiodarone efficacy in high-risk atrial fibrillation (AF) patients post-ablation. Virtual left atrium models were created from computed tomography and electroanatomical maps to simulate AF and evaluate its response to varying amiodarone concentrations.

Do extra-pulmonary triggers or autonomic neural activity affect rhythm control by anti-arrhythmic drugs in patients with post-ablation atrial fibrillation recurrence?

Background: The role of anti-arrhythmic drugs (AADs) in recurrent atrial fibrillation (AF) after catheter ablation (CA) is not fully understood. The aim of this study was to explore the effects of AADs in patients who recurred after AFCA depending on extra-pulmonary vein triggers (ExPVTs) and post-ablation heart rate variability (HRV) parameters.

Methods: We analyzed 2,036 patients who underwent de-novo AFCA and 486 patients with post-AFCA recurrence who underwent rhythm control with AADs.