Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: a win ratio analysis of the NOAH-AFNET 6 trial.

Aims: Patients with device-detected atrial fibrillation (DDAF) have a lower stroke risk than those with ECG-diagnosed AF, requiring careful evaluation of oral anticoagulation benefits vs. its inherent bleeding risk.

Methods And Results: An unmatched win ratio analysis was performed of the NOAH-AFNET 6 trial dataset, using components of the primary efficacy and safety outcomes of the trial.

Bayesian framework for atrial LAT estimation in ECGI.

Local activation time (LAT) mapping computed on ECGI signals offers a comprehensive representation of the electrical propagation in the heart. However, traditional methods for LAT estimation based on invasive mapping systems produce artefacts when applied on ECGI signals. This study aims to introduce and evaluate a novel Bayesian framework for estimating LATs using ECGI.

Noninvasive assessment of the ventricular arrhythmogenic substrate using electrocardiographic imaging during sinus rhythm: The NIAVAS study.

Background: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) identifies structural properties associated with ventricular tachycardia (VT) but lacks functional information. Noninvasive identification of slow conduction regions using electrocardiographic imaging (ECGI) could complement LGE-CMR to aid VT risk stratification.

Objective: This study aimed to evaluate the relationship between ventricular arrhythmogenic substrate and regional ECGI markers during sinus rhythm in patients with ischemic cardiomyopathy (ICM).

Head-to-head comparison of pulsed-field ablation, high-power short-duration ablation, cryoballoon and conventional radiofrequency ablation by MRI-based ablation lesion assessment.

Background: Novel concepts for pulmonary vein isolation (PVI) like pulsed-field ablation (PFA) or high-power short-duration ablation (HPSD) promise favorable profiles of safety and efficacy. However, clinical comparisons of those novel concepts with conventional ablation approaches regarding ablation lesions are lacking. To systematically investigate lesion characteristics of novel ablation concepts, we performed a prospective head-to-head comparison using late gadolinium enhancement (LGE)-CMR.

Education of healthcare professionals to improve guideline adherence in atrial fibrillation: the STEEER-AF cluster-randomized clinical trial.

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.

Non-Endocardial Radiofrequency Ablation of Premature Ventricular Complexes (NERA-PVC): Safety, Efficacy and Outcome.

Background: Radiofrequency (RF) ablation of premature ventricular complexes (PVCs) is a well-established treatment for patients high PVCs burden, even when arising from epicardial/intramural localization. Consistent data about safety of using high power RF is lacking in the literature in these regions.

Aim: The aim of this study is to investigate the safety of different RF power settings, efficacy and outcome of non-endocardial PVCs ablation.

Clinical Response to Resynchronization Therapy: Conduction System Pacing vs Biventricular Pacing: The CONSYST-CRT Trial.

Background: Randomized studies comparing conduction system pacing (CSP) with biventricular pacing (BiVP) are scarce and do not include clinical outcomes.

Objectives: The CONSYST-CRT (Conduction System Pacing vs Biventricular Resynchronization Therapy in Systolic Dysfunction and Wide QRS) trial aimed to test the noninferiority of CSP as compared with BiVP in patients with an indication for cardiac resynchronization therapy, with respect to a combined clinical endpoint at 1-year follow-up.

Methods: A total of 134 patients with cardiac resynchronization therapy indication were randomized to BiVP or CSP and followed up for 12 months.

From moderate to strenuous training: unravelling mechanistic contributors and biomarkers for atrial fibrillation in exercise.

Aims: The impact of the transition from moderate to strenuous exercise on atrial fibrillation (AF) risk and its underlying mechanisms remain poorly understood. We aimed to analyse biatrial remodelling after moderate and strenuous exercise, compare it with pathological atrial damage, and non-invasively identify strenuous exercise insults.

Methods And Results: Young male Wistar rats were trained at a moderate (MOD) or high-intensity (INT) load; sedentary rats served as controls.

Assessing heart rate fragmentation to predict atrial fibrillation in the general population aged 65: the PROOF-AF study.

Aims: Screening the general population aged 65 for atrial fibrillation (AF) has been proposed as a preventive measure against potential complications. Metrics derived from heart rate variability (HRV) that depict heart rate fragmentation (HRF) have been suggested to reflect autonomic nervous system dysfunction. The aim of the study was to assess the predictive capacity of HRV markers, including HRF, for AF occurrence over an 18-year follow-up and to develop a predictive score for AF onset among the general population aged 65 at the study's inception.

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System.

Rapid, safe, and effective cardiac mapping is critical for the management of complex arrhythmias, yet current methods face significant limitations. The 12-lead electrocardiogram (ECG), while essential for initial diagnosis, lacks the spatial resolution and depth needed to guide advanced procedures such as catheter ablation or cardiac resynchronization therapy device implantation. On the other hand, invasive mapping techniques provide detailed electrical activity but require multiple catheter placements, increasing procedural risks and complexity.

Eighteen-year analysis of anaesthetic management in Brugada syndrome: The BRUGANAES study.

Background: Brugada syndrome (BrS) is a genetic disorder that increases the risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). Certain drugs (propofol, local anaesthetics), fever, bradycardia, increased vagal tone and electrolyte imbalances can trigger or worsen BrS arrhythmias.

Objective: To evaluate the incidence of malignant ventricular arrhythmias during the perioperative period in patients with BrS, hypothesising that common anaesthetic drugs may be safe to use during daily clinical practice.

Lateral Atrial Expression Patterns Provide Insights into Local Transcription Disequilibrium Contributing to Disease Susceptibility.

Background: Transcriptional dysregulation, possibly affected by genetic variation, contributes to disease etiology. Due to dissimilarities in development, function, and remodeling during disease progression, transcriptional differences between the left atrium (LA) and right atrium (RA) may provide insight into diseases such as atrial fibrillation.

Methods: Lateral differences in atrial transcription were evaluated in CATCH ME (Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly) using a 2-stage discovery and replication design.

Assessment of Antitachycardia Pacing in Primary Prevention Patients: The APPRAISE ATP Randomized Clinical Trial.

Importance: The emergence of novel programming guidelines that reduce premature and inappropriate therapies along with the availability of new implantable cardioverter-defibrillator (ICD) technologies lacking traditional endocardial antitachycardia pacing (ATP) capabilities requires the reevaluation of ATP as a first strategy in terminating fast ventricular tachycardias (VTs) in primary prevention ICD recipients.

Objective: To assess the role of ATP in terminating fast VTs in primary prevention ICD recipients with contemporary programming.

Design, Setting, And Participants: This global, prospective, double-blind, randomized clinical trial had an equivalence design with a relative margin of 35%.

Improving electrocardiographic imaging solutions: A comprehensive study on regularization parameter selection in L-curve optimization in the Atria.

Background: In electrocardiographic imaging (ECGI), selecting an optimal regularization parameter (λ) is crucial for obtaining accurate inverse electrograms. The effects of signal and geometry uncertainties on the inverse problem regularization have not been thoroughly quantified, and there is no established methodology to identify when λ is sub-optimal due to these uncertainties. This study introduces a novel approach to λ selection using Tikhonov regularization and L-curve optimization, specifically addressing the impact of electrical noise in body surface potential map (BSPM) signals and geometrical inaccuracies in the cardiac mesh.

Surgical skill simulation training to proficiency reduces procedural errors among novice cardiac device implanters: a randomized study.

Aims: In cardiac device implantation, having both surgical skills and ability to manipulate catheter/lead/wire is crucial. Few cardiologists, however, receive formal surgical training prior to implanting. Skills are mostly acquired directly on-the-job and surgical technique varies across institutions; suboptimal approaches may increase complications.

Biomarker-based prediction of sinus rhythm in atrial fibrillation patients: the EAST-AFNET 4 biomolecule study.

Background And Aims: In patients with atrial fibrillation (AF), recurrent AF and sinus rhythm during follow-up are determined by interactions between cardiovascular disease processes and rhythm control therapy. Predictors of attaining sinus rhythm at follow-up are not well known.

Methods: To quantify the interaction between cardiovascular disease processes and rhythm outcomes, 14 biomarkers reflecting AF-related cardiovascular disease processes in 1586 patients in the EAST-AFNET 4 biomolecule study (71 years old, 45% women) were quantified at baseline.

Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial.

Background: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear.

Methods And Results: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial.

Representation of obesity in contemporary atrial fibrillation ablation randomized controlled trials.

Background: The prevalence and impact of obesity on outcomes of atrial fibrillation (AF) ablation randomized controlled trials (RCTs) have not been well studied.

Objective: To examine the proportion of participants with obesity enrolled in RCTs of AF ablation and outcomes of ablation when subgroup analysis of participants with obesity were available.

Methods: We systematically searched PubMed and EMBASE for AF ablation RCTs published between January 1, 2015 to May 31, 2022.

PITX2 deficiency leads to atrial mitochondrial dysfunction.

Aims: Reduced left atrial PITX2 is associated with atrial cardiomyopathy and atrial fibrillation (AF). PITX2 is restricted to left atrial cardiomyocytes (aCMs) in the adult heart. The links between PITX2 deficiency, atrial cardiomyopathy, and AF are not fully understood.

Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).

Aims: The concept of "atrial cardiomyopathy" (AtCM) had been percolating through the literature since its first mention in 1972. Since then, publications using the term were sporadic until the decision was made to convene an expert working group with representation from four multinational arrhythmia organizations to prepare a consensus document on atrial cardiomyopathy in 2016 (EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication). Subsequently, publications on AtCM have increased progressively.