2025 THRS Expert Consensus of Imaging Assessment in Atrial Fibrillation. .

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in the elderly population with a high lifetime risk after the age of 45 years, leading to a major impact on the public health from elicited left atrial (LA) thrombogenesis and cardioembolic stroke. Imaging in the AF population plays a crucial role, not only in assessing LA size but also in delineating the underlying cardiac structural and functional features to reach a more specific diagnosis. Contemporary clinical practice guideline recommended anticoagulation therapy based on annual thromboembolic event risk using a validated clinical risk score.

Artificial Intelligence-Enabled Short-Term Ambulatory Monitoring ECG during Sinus Rhythm for Prediction of Hidden Atrial Fibrillation.

Background: Screening of asymptomatic/occult atrial fibrillation (AF) remains challenging. This study aimed to use a deep learning model to predict hidden AF in patients who showed normal sinus rhythm (SR) during 24-h Holter monitoring.

Methods: This was a retrospective cohort study that enrolled 934 patients receiving 24-h ambulatory Holter monitoring.

Right ventricular outflow tract aneurysm in arrhythmogenic right ventricular cardiomyopathy: The mechanism of ventricular tachycardia.

Background: Regional aneurysms of the right ventricular (RV) free wall, identified through imaging, are a major criterion for arrhythmogenic RV cardiomyopathy (ARVC). The electrophysiological characteristics of patients with RV outflow tract (RVOT) aneurysms remain unclear.

Objective: This study aimed to determine the characteristics of ventricular tachycardia (VT) in patients with ARVC with RVOT aneurysms.

Long-term outcome of lesion size index-guided high-power ablation with high-density mapping for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

Introduction: Data on the long-term outcomes and procedural details of the lesion size index-guided high-power ablation strategy (HP-LSI) are limited.

Methods: Eighty patients were retrospectively assigned to the high-power with time-restricted ablation strategy (fixed at 10 s per lesion), while 67 patients were assigned to the high power LSI-guided strategy (anterior wall LSI at least 5.0, posterior wall LSI 4.

Impact of Recurrence-to-Repeat Ablation Time on Long-Term Efficacy and Safety of Patients With Paroxysmal Atrial Fibrillation: Time Matters.

Background: Rhythm control with catheter ablation has been established in the management of atrial fibrillation (AF), but the recurrence of AF remains significant. Several studies have demonstrated the benefits of repeat catheter ablation in patients with recurrent AF. However, the optimal timing for repeat ablation to minimize adverse atrial remodeling following recurrence has not been adequately investigated.

Efficacy and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation and kidney failure under hemodialysis: A meta-analysis of controlled randomized trials.

Background: Atrial fibrillation (AF)-related strokes are associated with disability and mortality. Stroke prevention with non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) is the cornerstone of holistic management of AF. However, the safety and efficacy of NOACs in patients with AF on hemodialysis remain uncertain.

Electrocardiographic Characteristics of Ventricular Arrhythmias Originating From High Right Ventricular Outflow Tract and Pulmonary Artery.

Background: Ventricular arrhythmias (VAs) may originate from the right ventricular outflow tract (RVOT) below the pulmonary sinus cusps (PSCs) or from the pulmonary artery (PA) above the PSCs. However, the electrocardiographic (ECG) characteristics of these VAs are not well defined.

Objective: This study aimed to investigate the ECG characteristics of VAs originating from the high RVOT and PA.

Reappraisal of the clinical and anatomic characteristics of idiopathic outflow tract ventricular arrhythmias with an R wave pattern break in precordial lead: A multi-center study.

Background: Idiopathic outflow tract ventricular arrhythmia (OT-VA) with a pattern break (PB) in the precordial leads is challenging to treat and is associated with low success rates.

Objective: Describe the anatomic characteristics and outcomes of patients with PB idiopathic OT-VA underwent catheter ablation.

Methods: We retrospectively reviewed the electronic medical records of idiopathic OT-VA patients underwent catheter ablation at Taipei Veterans General Hospital, Taiwan, and Makiminato Central Hospital, Japan.

Long-term trajectories of apolipoprotein A1 and major adverse cardiovascular events and mortality in a community cohort.

Background: Apolipoprotein A1 (ApoA1) is a major component of high-density lipoprotein cholesterol and plays a critical role in reverse cholesterol transport. Dynamic changes in ApoA1 levels may be associated with major adverse cardiovascular events. This study aimed to evaluate the impact of ApoA1 trajectories over three early assessments.

Renal function and clinical outcomes in survivors of out-of-hospital cardiac arrest.

Background: Comprehensive studies about renal-function changes in the context of out-of-hospital cardiac arrest (OHCA) have been lacking. Therefore, we investigated the impact of renal function on clinical outcomes among patients with OHCA.

Method: This retrospective cohort study enrolled consecutive patients with OHCA between June 2017 and December 2021.

Percutaneous VT Ablation Via RA-to-LV Access in Patients With Double Mechanical Valves: A Multicenter Registry.

Background: In patients with mechanical aortic and mitral valves requiring catheter ablation of ventricular tachycardia (VT), a technique for access from the right atrium (RA) to the left ventricle (LV) via puncture of the inferoseptal process of the LV was previously described in a single-center series.

Objectives: This study sought to report the multicenter experience of VT ablation using this novel LV access approach.

Methods: We assembled a multicenter registry of patients with double mechanical valves who underwent VT ablation with RA-to-LV access.

Rhythm Control Better Prevents Stroke than Rate Control in Patients with Concomitant Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Nationwide Population Based Cohort Study with Long-Term Follow-Up.

Background: Atrial fibrillation (AF) increases the risks of stroke and mortality. It remains unclear whether rhythm control reduces the risk of stroke in patients with AF concomitant with hypertrophic cardiomyopathy (HCM).

Methods: We identified AF patients with HCM who were ≥ 18 years old in the Taiwan National Health Insurance Database.

Identifying the presence of atrial fibrillation during sinus rhythm using a dual-input mixed neural network with ECG coloring technology.

Background: Undetected atrial fibrillation (AF) poses a significant risk of stroke and cardiovascular mortality. However, diagnosing AF in real-time can be challenging as the arrhythmia is often not captured instantly. To address this issue, a deep-learning model was developed to diagnose AF even during periods of arrhythmia-free windows.

Performance of the novel ANTWERP score in predicting heart function improvement after atrial fibrillation ablation in Asian patients with heart failure.

Background: Previous research has demonstrated that atrial fibrillation (AF) ablation improves heart function variably among patients. We proposed that the ANTWERP score, which was validated in a European group of patients with low left ventricular ejection fraction (LVEF) who had AF ablation, would be valid in an Asian group as well. The purpose of the study is to examine how well a new scoring system (the ANTWERP score) can predict heart function improvement after atrial fibrillation ablation in Asian patients with heart failure.

Multistep Algorithm to Predict RVOT PVC Site of Origin for Successful Ablation Using Available Criteria: A Two-Center Cross-Validation Study.

Background: Predicting premature ventricular contraction (PVC) origin pre-ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates.

Objective: To compare nine published ECG criteria to differentiate between RVOT and non-RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success.

Methods: Two centers were involved in this study, the derivation group and the validation group.

ECG-based machine learning model for AF identification in patients with first ischemic stroke.

Background: The recurrence rate of strokes associated with atrial fibrillation (AF) can be substantially reduced through the administration of oral anticoagulants. However, previous studies have not demonstrated a clear benefit from the universal application of oral anticoagulants in patients with embolic stroke of undetermined source. Timely detection of AF remains a challenge in patients with stroke.

Three-dimensional mapping and superior approach for catheter ablation in patients without inferior vena cava access.

Catheter ablation for tachyarrhythmia via superior approach has been used in patients without possible inferior vena cava access such as in cases of venous occlusion or complex anomaly. Difficulty in catheter manipulation, instability, number of required vascular access, and radiation exposure of operator had been described in the procedure. Application of three-dimensional (3-D) mapping system in catheter ablation via superior approach could navigate the guiding catheter and provide more precise ablation.

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.