Social Determinants of Health and Disparities in Diagnosis-to-Ablation Time for Atrial Fibrillation.

Background: Social determinants of health (SDOH) significantly influence health care access and outcomes, but their impact on atrial fibrillation (AF) diagnosis-to-ablation time (DAT) and anticoagulation prescription rates is unknown.

Objective: The goal of this study was to assess the associations between SDOH, measured by using the Area Deprivation Index (ADI), and DAT and anticoagulation prescription rates in patients undergoing AF ablation.

Methods: Data from the Hopkins AF Ablation Registry (2014-2023) were analyzed retrospectively.

Prognostic Role of Myocarditis-Like Episodes and Their Treatment in Patients With Pathogenic Desmoplakin Variants.

Background: Inflammatory, myocarditis-like episodes precede and are associated with higher risk of sustained ventricular arrhythmias and heart failure in patients with pathogenic or likely pathogenic desmoplakin (DSP) variants. Whether the recurrence and treatment of myocarditis-like episodes influence the outcomes in this population is unknown. This study aimed to assess the prognostic impact of the recurrence and treatment of myocarditis-like episodes in patients with pathogenic or likely pathogenic DSP variants.

Catheter ablation of atrial fibrillation in patients with heart failure: Insights from the NCDR atrial fibrillation ablation registry.

Background: Catheter ablation (CA) for atrial fibrillation (AF) is a widely used treatment strategy in patients with and without heart failure (HF).

Objective: To evaluate patient characteristics, ablation strategies, and complications of CA for AF by HF status.

Methods: We conducted a retrospective analysis of patients undergoing CA between 2016 and 2022 from the National Cardiovascular Data Registry.

Catheter ablation as first line therapy for atrial fibrillation.

The treatment for atrial fibrillation has evolved significantly over time. Previously, medication management was the mainstay of treatment. As we have developed more robust technologies and modalities for catheter ablation, these treatment recommendations have changed.

Diagnostic Criteria and Disease Staging for Desmoplakin Cardiomyopathy.

Background: Desmoplakin (DSP) cardiomyopathy, caused by variants in the gene , is a unique subtype of cardiomyopathy distinct from typical dilated or arrhythmogenic right ventricular cardiomyopathies. Specific diagnostic and disease staging criteria have yet to be developed for DSP cardiomyopathy.

Objective: Utilizing a large cohort of DSP cardiomyopathy patients and their genotype-positive family members, this study aims to develop diagnostic and disease staging criteria for DSP cardiomyopathy.

Post-mortem cardiomegaly descriptor: Call for consistent criteria.

Although the post-mortem descriptor of cardiomegaly is an important component of understanding a sudden death, there is no unified definition. A recent survey reported the usage of heart weight correction models of Molina or Kitzman, for example, or simple step cutoffs such as 350, 400, 450, or 500 g in common use. The goal of the present study was to determine how a diagnosis of cardiomegaly relates to these definitions and heart weight using a database of sudden deaths using 1071 autopsy reports from across the USA in which the heart weight and the presence (n = 373) or not (n = 698) of cardiomegaly were recorded.

Machine Learning Models Enhance Prediction of Arrhythmogenic Right Ventricular Cardiomyopathy.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a leading contributor to sudden cardiac death worldwide, yet its diagnosis remains complex, expensive and time-consuming. Machine-learning (ML) classifiers offer a practical solution by delivering rapid, scalable predictions that can lessen dependence on expert interpretation and speed clinical decision-making. Here, we benchmarked eight ML algorithms for ARVC detection using area-under-the-curve (AUC) and accuracy as primary metrics.

Family Screening in Relatives at Risk for Plakophilin-2-Associated Arrhythmogenic Right Ventricular Cardiomyopathy.

Background: Penetrance and risk of ventricular arrhythmias (VAs) in arrhythmogenic right ventricular cardiomyopathy (ARVC) are increasingly recognized as being genotype specific. Therefore, genotype-informed family screening protocols may lead to safer and more personalized recommendations than the current one-size-fits-all screening recommendations. We aimed to develop a safe, evidence-based plakophilin-2 ()-specific longitudinal screening algorithm.

Premature Ventricular Complexes After Ablation for Paroxysmal Atrial Fibrillation and Recurrent Atrial Arrhythmias: The admIRE Subanalysis.

Background: Premature ventricular complexes (PVCs) have been reported to independently predict incident atrial fibrillation in the general population. The prognostic importance of PVCs after catheter ablation for paroxysmal atrial fibrillation (PAF) is unknown.

Objectives: In patients undergoing catheter ablation for PAF, we assessed whether postablation PVCs influence the risk for recurrence.

Digital twins enable stratification of persistent atrial fibrillation patients for ablation diminishing unnecessary heart damage.

Pulmonary vein isolation (PVI), the standard-of-care for atrial fibrillation (AF), is effective even in some persistent AF (PsAF) patients despite atrial fibrosis proliferation, suggesting that PVI could not only be isolating triggers but diminishing arrhythmogenic substrates. Left atrial (LA) posterior wall isolation is the prevalent adjunctive strategy aiming to address PsAF arrhythmogenesis, however, its outcomes vary widely. To explore why current PsAF ablation treatments have limited success and under what circumstances each treatment is most effective, we utilized patient-specific heart digital twins of PsAF patients incorporating fibrosis distributions to virtually implement versions of PVI (individual ostial to wide antral) and posterior wall isolation.

NAXCARE: a clinical outcome registry for Naxos disease and related cardiocutaneous syndromes.

The NAXCARE (NAXos disease and Cardiocutaneous Assessment and Registry for Evaluation) is a global initiative designed to collect, store, and analyze clinical outcomes data on patients with Naxos disease and related cardiocutaneous syndromes (CCS). This registry aims to fill the gaps in clinical knowledge, enhance treatment approaches, and improve patient outcomes by systematically documenting disease progression, genetic profiles, and patient care pathways. The following methodology outlines the registry's design, data collection protocols, management, security measures, and anticipated contributions to research and clinical practice.

Patient Centered mobile Health TECHnology Enabled Atrial Fibrillation Management (mTECH Afib): A Pilot Randomized Controlled Trial.

Background: Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF).

Objectives: This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification.

Methods: Patients with AF were enrolled from outpatient clinics.

Pulsed Field Ablation for Persistent Atrial Fibrillation: 1-Year Results of ADVANTAGE AF.

Background: Pulsed field ablation (PFA) has gained prominence for pulmonary vein isolation (PVI) to treat atrial fibrillation, but there are limited outcome data on PFA to treat persistent atrial fibrillation (PerAF).

Objectives: This study sought to determine the safety and efficacy of PVI + posterior wall ablation (PWA) with PFA in PerAF.

Methods: ADVANTAGE AF (A Prospective Single Arm Open Label Study of the FARAPULSE Pulsed Field Ablation System in Subjects with Persistent Atrial Fibrillation) is a prospective, single-arm, multicenter pivotal investigational device exemption study of PerAF patients undergoing PVI+PWA with the pentaspline PFA catheter.

Safety and effectiveness of a novel balloon-in-basket pulsed-field ablation catheter for the treatment of paroxysmal and persistent AF: Volt-AF IDE trial acute results.

Background: Increasing use of Pulsed Field Ablation (PFA) to treat atrial fibrillation (AF) has led to concerns related to tissue contact, hemolysis, and electroanatomic mapping integration. A novel balloon-in-basket PFA catheter offers form and function to address these concerns.

Objective: The VOLT-AF Investigational Device Exemption (IDE) study is a prospective, single-arm global IDE study designed to demonstrate the Volt PFA system (Abbott Laboratories, Chicago, Illinois) is safe and effective for the treatment of paroxysmal AF (PAF) and persistent AF (PersAF).

Long-Term Follow-Up Data on Flecainide Use as an Antiarrhythmic in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multicenter Study.

Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy associated with a high risk of ventricular arrhythmia (VA). Several animal models have been used to postulate a therapeutic role of the inhibition of the ryanodine 2 receptor via the use of flecainide for this disease. Clinical data describing its use are scarce, however, especially in patients without implantable cardioverter-defibrillators or with left ventricular (LV) involvement.

Sequencing in over 50,000 cases identifies coding and structural variation underlying atrial fibrillation risk.

Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LMNA, PKP2, FAM189A2 and KDM5B.

Predicted Risk of Ventricular Arrhythmias in a Genome-First Population With Genetic Risk for Arrhythmogenic Right Ventricular Cardiomyopathy.

Background: Population genomic screening for desmosome variants associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) may facilitate early disease detection and protective intervention. The validated ARVC risk calculator offers a novel means to risk stratify individuals with diagnosed ARVC, but predicted risk in the context of genomic screening identification has not been explored.

Methods: Individuals harboring a pathogenic/likely pathogenic variant in a desmosome gene (, , , or ) were identified through the Geisinger MyCode Genomic Screening and Counseling program.

Natural History, Phenotype Spectrum, and Clinical Outcomes of Desmin ()-Associated Cardiomyopathy.

Background: Pathogenic/likely pathogenic (LP) desmin () variants cause heterogeneous cardiomyopathy and skeletal myopathy phenotypes. Limited data suggest a high incidence of major adverse cardiac events (MACEs), including cardiac conduction disease, sustained ventricular arrhythmias (VA), and heart failure (HF) events (HF hospitalization, left ventricular assist device/cardiac transplant, HF-related death) in patients with pathogenic/LP variants. However, pleiotropic presentation and small cohort sizes have limited clinical phenotype and outcome characterization.

Causes TRPV4-Mediated Autosomal Recessive Arrhythmogenic Cardiomyopathy.

Background: Arrhythmogenic cardiomyopathy (ACM) is one of the leading causes of sudden cardiac death in children, young adults, and athletes and is characterized by the fibro-fatty replacement of the myocardium, predominantly of the right ventricle. Sixty percent of patients with ACM have a known genetic cause, but for the remainder, the pathogenesis is unknown. This lack of mechanistic understanding has slowed the development of disease-modifying therapies, and children with ACM have a high degree of morbidity and mortality.

Arrhythmic Risk Stratification of Carriers of Filamin C Truncating Variants.

Importance: Filamin C truncating variants (FLNCtv) are a rare cause of cardiomyopathy with heterogeneous phenotypic presentations. Despite a high incidence of life-threatening ventricular arrhythmias and sudden cardiac death (SCD), reliable risk predictors to stratify carriers of FLNCtv are lacking.

Objective: To determine factors predictive of SCD/major ventricular arrhythmias (MVA) in carriers of FLNCtv.

Early versus late atrial fibrillation recurrence after pulsed field ablation: insights from the admIRE trial.

Aims: Studies have shown correlations between early recurrence (ER) and late recurrence (LR) of atrial arrhythmia after ablation with thermal technologies. This admIRE trial (NCT05293639) subanalysis aims to analyse ER vs. LR in patients with paroxysmal atrial fibrillation (PAF) undergoing pulsed field ablation (PFA).