Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Optimal Ablation Strategies for Persistent Atrial Fibrillation With Heart Failure: Three-Year Follow-Up of a Prospective Multicenter Randomized Trial.","authors":"Kaige Li, Xinhua Wang, Mu Qin, Ping Ye, Bing Han, Weifeng Jiang, Yu Zhang, Qidong Zheng, Anjing Ji, Menghe Zhang, Yanzhe Wang, Shaohui Wu, Kai Xu, Changhao Xu, Xu Liu, Xumin Hou","doi":"10.1161/CIRCEP.125.014394","DOIUrl":"10.1161/CIRCEP.125.014394","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined.</p><p><strong>Methods: </strong>In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (ejection fraction ≤40%) and HF with preserved ejection fraction (ejection fraction >40%, including mid-range ejection fraction [ejection fraction 41% to 50%]), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic-guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden <1%, New York Heart Association class improvement (≥1 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction.</p><p><strong>Results: </strong>At 36 months, the extensive electro-anatomic-guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall <i>P</i>=0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%; <i>P</i>=0.039) groups. Consistent improvements were observed for AF burden <1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups.</p><p><strong>Conclusions: </strong>Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT07153718.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014394"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epicardial-to-Endocardial Activation Gradients and Conduction Block During Atrial Fibrillation in the Human Left Atrial Posterior Wall.","authors":"Christopher X Wong, Xiang Wen Lee, Nitish Badhwar, Chikezie K Alvarez, Anson M Lee, Christopher E Woods, Thomas A Dewland, Edward P Gerstenfeld, Ramin E Beygui, Randall J Lee","doi":"10.1161/CIRCEP.125.014151","DOIUrl":"10.1161/CIRCEP.125.014151","url":null,"abstract":"<p><strong>Background: </strong>Although emerging evidence supports 3-dimensional myocardial activation during atrial fibrillation (AF), human studies remain limited. We thus characterized the endocardial and epicardial left atrial posterior wall (LAPW) in humans to assess the prevalence of asynchronous endocardial-epicardial LAPW conduction during AF.</p><p><strong>Methods: </strong>Patients with symptomatic nonparoxysmal AF who had unsuccessful antiarrhythmic or catheter ablation therapy referred for hybrid epicardial-endocardial AF ablation and left atrial appendage ligation underwent high-density mapping of LAPW with Grid catheters, including simultaneous endocardial-epicardial mapping.</p><p><strong>Results: </strong>Twenty-seven patients (19 men, median 69 years, 55% long-standing persistent AF) were included. There was significantly greater epicardial compared with endocardial LAPW bipolar voltages during AF. In areas of low endocardial bipolar voltage, normal endocardial unipolar voltage corresponded to normal epicardial bipolar voltage. Asynchronous endocardial-epicardial LAPW AF activation during simultaneous endocardial-epicardial mapping was universal. Furthermore, more rapid epicardial compared with endocardial LAPW AF activity was observed during simultaneous endocardial-epicardial mapping in AF. Conduction block between the endocardial and epicardial LAPW surfaces was also common during organized AF, with instances of isolated or multiple blocked beats, Wenckebach conduction, and sustained endocardial LAPW entrance block with ongoing epicardial AF observed. Epicardial-to-endocardial entrance block was also infrequently observed during sinus rhythm. At 12-month follow-up, freedom from atrial arrhythmias was 68%.</p><p><strong>Conclusions: </strong>Endocardial-epicardial LAPW asynchrony may be observed during human persistent AF and is characterized by: (1) greater epicardial compared with endocardial bipolar voltages, (2) more frequent epicardial-to-endocardial activation gradients during AF, and (3) conduction block commonly seen between the epicardial and endocardial surfaces during AF. Although the study was predominantly descriptive in nature, the observations suggest a dynamic 3-dimensional arrhythmogenicity of the LAPW and the potential importance of the epicardial layer, with implications for ablation therapies. Future prospective studies are required to determine the significance of these findings to clinical ablation outcomes.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014151"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of Rare Variants in Racial and Ethnic Minorities With Atrial Fibrillation.","authors":"Michael C Hill, Brandon Chalazan, Shashank Sandu, Joshua H Arnold, Peter Boxley, Anish S Shah, Siddharth Bhayani, Hajwa Kim, Victor Qiao, Ashwini Deshpande, Mahmud Arif Pavel, David S Tofovic, Dawood Darbar","doi":"10.1161/CIRCEP.125.014641","DOIUrl":"10.1161/CIRCEP.125.014641","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014641"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemolysis Profile of a Novel Balloon-Filled Basket Pulsed Field Ablation Catheter.","authors":"Jed Overmann, Mayara Marques, Chris Lafean, Catherine Pipenhagen, Boyce L Moon, Jeffrey M Fish, Atul Verma","doi":"10.1161/CIRCEP.125.014233","DOIUrl":"10.1161/CIRCEP.125.014233","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014233"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Chronic Atrial Lesion Formation With a Large-Tip, Contact-Force-Sensing Multipolar Pulsed Field Ablation Catheter: Effect of Application Number in a Porcine Beating Heart Model.","authors":"Luigi Di Biase, Jacopo Marazzato, Marco Schiavone, Fengwei Zou, Taylor Spangler, Rahul Bhardwaj, Jonathan Hsu, Assaf Govari, Andreas Altman, Kevin Okarski, Tushar Sharma, Paras Parikh, Christopher Beeckler, Terrence Troutman, Qi Chen, Hiroshi Nakagawa, William Maddox, Devi Nair, Sanghamitra Mohanty, Vincenzo Mirco La Fazia, Domingo Ynoa, Aung Lin, Andrea Natale, Xiaodong Zhang","doi":"10.1161/CIRCEP.125.014473","DOIUrl":"10.1161/CIRCEP.125.014473","url":null,"abstract":"<p><strong>Background: </strong>Integration of catheter-tissue contact force with pulsed field ablation (PFA) dosing is essential for achieving safe and durable lesion formation with contact force sensing catheters in ventricular models. However, data on the use of these catheters for atrial ablation remain limited. This study evaluated the procedural safety and 30-day lesion characteristics of atrial PFA delivered with the OMNYPULSE ablation catheter in a porcine model.</p><p><strong>Methods: </strong>Twelve pigs were randomized to receive either 6 (×6 or Group A) or 12 (×12 or group B) PFA applications per ablation. Following 3-dimensional electroanatomic mapping, PFA was delivered to the right superior and inferior pulmonary veins, cavotricuspid isthmus, right atrial posterior wall, left atrial roof, and mitral annulus. Procedural safety was assessed acutely, and lesion characteristics were evaluated on 30-day histology. Maximum transmurality extent (MTE) was defined as >80% of the lesion span exhibiting continuous endocardial-to-epicardial fibrosis within representative histological sections.</p><p><strong>Results: </strong>Adequate catheter-tissue contact was achieved during PFA delivery (contact force, 28±15 g). No acute procedural complications were observed. At 30 days, PVs and right atrial sites (ie, cavotricuspid isthmus and right atrial posterior wall) demonstrated near-complete MTE regardless of PFA dosing. In contrast, MTE was significantly lower at the mitral annulus and LA roof compared with other sites (44±30% and 21±26%, respectively; <i>P</i><0.001). Increasing the number of PFA applications (×12) resulted in a remarkable improvement in MTE at these locations, with MTE increases of up to 68% compared with ×6 dosing at these sites.</p><p><strong>Conclusions: </strong>Atrial PFA using the OMNYPULSE catheter was feasible and safe in a porcine model. However, lesion transmurality varied by atrial location and was dose-dependent at select sites, underscoring the need for site-specific PFA dosing strategies. Further studies are warranted to define optimal PFA parameters for consistent atrial lesion formation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014473"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lesion Durability of the Second Generation Pentaspline Pulsed Field Ablation Catheter <i>NAVIGATE-PF</i> Phase 2 Results.","authors":"Vivek Y Reddy, Jan Petru, Moritoshi Funasako, Silvia Canepa, Camille Metzdorff, Brynn Okeson, Evripidis Mikos, Tobias Oesterlein, Sarah R Gutbrod, Brendan E Koop, Petr Neuzil","doi":"10.1161/CIRCEP.125.014477","DOIUrl":"10.1161/CIRCEP.125.014477","url":null,"abstract":"<p><strong>Background: </strong>Remapping studies have evaluated chronic lesion durability of the first-generation pentaspline pulsed field ablation (PFA) catheter that did not have integrated electroanatomical mapping. By invasive remapping, this first-in-human study evaluated the durability of lesions facilitated by the integration of the navigation-enabled pentaspline PFA catheter and mapping system in patients with atrial fibrillation.</p><p><strong>Methods: </strong>The <i>NAVIGATE-PF Phase 2</i> trial evaluated the second-generation, mapping-integrated pentaspline PFA catheter. Lesion durability was assessed by invasive remapping 60 days post index procedure.</p><p><strong>Results: </strong>After index ablation in 20 patients with the pentaspline PFA catheter, remaps were performed 60 days later in 17 patients, demonstrating a high rate of lesion durability in the pulmonary veins (95%) and posterior wall (86%).</p><p><strong>Conclusions: </strong>By facilitating real-time visualization of catheter positioning and acute lesion estimation through tags, the second-generation map-and-ablate pentaspline PFA catheter and integrated mapping system may enhance procedural success.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT06175234.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014477"},"PeriodicalIF":9.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Favorable Neurological Outcomes Following Atrioesophageal Fistula After Radiofrequency Catheter Ablation for Atrial Fibrillation: A Subanalysis of the POTTER-AF Study.","authors":"Kohei Ukita, Sorin Stefan Popescu, Vanessa Schmidt, Helmut Pürerfellner, Philipp Sommer, Christian Sohns, Christian Veltmann, Daniel Steven, K R Julian Chun, Philippe Maury, Estelle Gandjbakhch, Stephan Willems, Thomas Beiert, Leon Iden, Anna Füting, Raphael Spittler, Sergio Richter, Anja Schade, Malte Kuniss, Carsten Wunderlich, Dong-In Shin, Dirk Grosse Meininghaus, Marc Bonsels, David Reek, Uwe Wiegand, Alexander Bauer, Andreas Metzner, Lars Eckardt, Olaf Krahnefeld, Christian Sticherling, Michael Kühne, Dinh Quang Nguyen, Laurent Roten, Dominik Linz, Pepijn van der Voort, Bart A Mulder, Johan Vijgen, Alexandre Almorad, Charles Guenancia, Laurent Fauchier, Serge Boveda, Yves De Greef, Antoine Da Costa, Pierre Jais, Antoine Milhem, Laurence Jesel, Rodrigue Garcia, Hervé Poty, Ziad Khoueiry, Julien Seitz, Julien Laborderie, Alexis Mechulan, Francois Brigadeau, Alexandre Zhao, Yannick Saludas, Olivier Piot, Nikhil Ahluwalia, Claire A Martin, Jian Chen, Bor Antolic, Georgios Leventopoulos, Emin Evren Özcan, Hikmet Yorgun, Serkan Cay, Kivanc Yalin, Maichel Sobhy Botros, Ewa Jędrzejczyk-Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, John N Catanzaro, Vivek Reddy, Andrea Natale, Hermann Blessberger, Bing Yang, Julia Vogler, Karl-Heinz Kuck, José Luis Merino, Ardan M Saguner, Ahmad Keelani, Christian-H Heeger, Roland Richard Tilz","doi":"10.1161/CIRCEP.125.014579","DOIUrl":"10.1161/CIRCEP.125.014579","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014579"},"PeriodicalIF":9.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Clinical Experience With Reversible Electroporation Mapping in Atrial Flutter.","authors":"María Cespón-Fernández, Kazutaka Nakasone, Luigi Pannone, Juan Sieira, Domenico G Della Rocca, Alexandre Almorad, Ingrid Overeinder, Gezim Bala, Erwin Ströker, Ivan Eltsov, Anna Padisák, Giampaolo Vetta, Pedro Brugada, Gian-Battista Chierchia, Carlo de Asmundis, Andrea Sarkozy","doi":"10.1161/CIRCEP.125.014359","DOIUrl":"10.1161/CIRCEP.125.014359","url":null,"abstract":"<p><strong>Background: </strong>Reversible pulsed field ablation (PF_REV) can temporarily block cardiomyocyte conduction, potentially identifying critical target sites before creating definitive lesions. However, PF_REV local capture might interfere with the tachycardia mechanism. The aim of the study was to characterize the responses of nontriggered PF_REV pulses to serve as a novel clinical mapping tool in reentrant atrial flutter.</p><p><strong>Methods: </strong>PF_REV pulses were delivered in and outside of the circuit using a 9-mm lattice-tip catheter in 30 reentrant atrial tachycardias in 26 patients. The presence of local capture and responses to PF_REV pulses was characterized.</p><p><strong>Results: </strong>Out of 163 PF_REV pulses analyzed, 56 (34.4%) showed atrial capture and propagation. Propagated versus Nonpropagated PF_REV cohorts were compared. The coupling interval of propagated PF_REV pulses was significantly longer (195.3±69.2 msec versus 98.9±77.2 msec; <i>P</i><0.001). Globally, 4 responses were observed: tachycardia termination (11.0%), stable tachycardia cycle length (TCL) prolongation (9.8%), transient irregular TCL variations (3.1%), and no change in activation sequence and TCL (76.1%). Propagation was only associated with irregular TCL variations (8.9% versus 0%, <i>P</i>=0.002). Tachycardia termination or TCL prolongation occurred only when PF_REV was delivered in the reentry circuit (100% specificity). Termination occurred exclusively in the critical isthmus (100% specificity regardless of propagation), and stable TCL prolongation occurred in 93.8% and 6.2% of the cases in the isthmus and outer loop, respectively (100% specificity for nonpropagated and 83.3% specificity for propagated PF_REV to localize the isthmus). Sensitivity of termination or stable TCL prolongation for identifying the critical isthmus was moderate (38.8%) and influenced by isthmus width (11.7±1.7 mm versus 22.9±2.1 mm; <i>P</i><0.001). Reproducibility of PF_REV pulses, determined by consecutive pulses delivered at the same site producing identical responses, was high (82.9%).</p><p><strong>Conclusions: </strong>PF_REV mapping is a novel, feasible, and reproducible tool for identifying critical sites in reentrant atrial tachycardia with narrow isthmuses that may be improved through optimized triggering and dose titration.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014359"},"PeriodicalIF":9.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Serum Metabolomics and Polygenic Risk Scores in a Novel Risk Stratification Tool for the Prediction of Incident Atrial Fibrillation.","authors":"Subhanik Purkayastha, Joseph Park, Sebastian E Beyer, Arun Chandra, Steven M Markowitz, Bruce B Lerman, Olivier Elemento, Jan Krumsiek, James C Lo, Jim W Cheung","doi":"10.1161/CIRCEP.125.013858","DOIUrl":"10.1161/CIRCEP.125.013858","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with substantial morbidity and mortality. We sought to investigate the predictive value of serum metabolomics for 5-year incident AF in the context of clinical and polygenic risk score (PRS) stratification tools.</p><p><strong>Methods: </strong>We studied a cohort of 240 628 patients UK Biobank participants with proton nuclear magnetic resonance spectroscopy measurements of 170 serum metabolites at enrollment. Five-year incidence of AF was assessed using Cox proportional hazards models. Cohorts for Heart and Aging Research in Genomic Epidemiology-AF (CHARGE-AF) and AF polygenic risk score (AF-PRS) scores were used as benchmark risk models for comparison. Models were trained on 80% of the cohort, and performances were validated on the remaining 20% cohort. Performance of clinical, AF-PRS, and combined metabolomics models was evaluated using time-dependent area under the receiver operating characteristic curve, net reclassification improvement, and relative integrated discrimination improvement analysis.</p><p><strong>Results: </strong>During follow-up, 4174 (1.7%) participants developed AF. After training a model on the full metabolomics panel in addition to Cohorts for Heart and Aging Research in Genomic Epidemiology-AF and AF-PRS, the final model retained 8 metabolites. Creatinine level was associated with increased risk (hazard ratio, 1.01 per 1 SD log-transformed value [95% CI, 1.00-1.03]) while linoleic acid level (hazard ratio, 0.985 [0.979-0.994]) was associated with decreased risk of AF. The addition of metabolomics to the CHARGE-AF+AF-PRS model improved risk prediction (5-year time-dependent area under the receiver operating characteristic curve, 0.789 [0.776-0.802] versus 0.755 [0.738-0.772]; <i>P</i><0.05) and stratification on the validation set (NRI_cases: 11.1%, NRI_controls: 3.1%, IDI_relative: 11.6%). A model using only age, sex, metabolomics, and AF-PRS had fair risk prediction on the validation set (5-year time-dependent area under the receiver operating characteristic curve, 0.787 [0.773-0.801]).</p><p><strong>Conclusions: </strong>The addition of metabolomics to clinical and genomic risk scores improves the prediction of 5-year incident AF. A risk stratification tool using age, sex, and serum metabolomics and AF-PRS provides excellent AF risk prediction. Mechanisms by which specific metabolites reflect AF risk require further exploration.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013858"},"PeriodicalIF":9.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NURSE-Led Care in Patients Undergoing Catheter Ablation for Atrial Fibrillation: The NURSECAT-AF Randomized Trial.","authors":"Alba Cano-Valls, Maria Antonia Martinez Monblan, Esther Carro-Fernández, Mireia Niebla, Rebeca Domingo, Sara Hevia-Puyo, Montserrat Venturas-Nieto, Roger Borras, José María Tolosana, Andreu Porta-Sánchez, Jean-Baptiste Guichard, Till F Althoff, Ivo Roca-Luque, Lluis Mont, Eduard Guasch","doi":"10.1161/CIRCEP.125.014149","DOIUrl":"10.1161/CIRCEP.125.014149","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with reduced quality of life and frequent hospitalizations. Integrated nurse-led care (NLC) has proven beneficial in unselected AF patients, but evidence specific to patients undergoing catheter ablation is limited. We aimed to assess the impact of a structured nurse-led intervention in patients undergoing first-time AF ablation.</p><p><strong>Methods: </strong>NURSECAT-AF was a single-center prospective randomized clinical trial comparing usual care with NLC, which incorporated an AF educational program, peri-procedural support, and risk factor management. Consecutive patients without heart failure referred for first-time AF ablation were randomized to NLC or usual care. NLC visits were scheduled at 15 days preablation, 15 days, and 6 months postablation. The primary end point was quality of life at 12 months postablation using the arrhythmia-specific scale in tachycardia and arrhythmia. Secondary outcomes included arrhythmia recurrence, readmissions and emergency visits, and symptom burden at 1 year and AF knowledge and satisfaction at 3 months.</p><p><strong>Results: </strong>Of 116 patients screened, 66 were randomized (33 per group; mean age 63±10 years; 67% male). At 12 months, the NLC group showed statistically significant better quality of life (baseline-adjusted arrhythmia-specific scale in tachycardia and arrhythmia difference +4 points [95% CI, 1.8-6.3]; <i>P</i>=0.0007) than usual care, and presented with less arrhythmia recurrences (odds ratio, 0.2 [95% CI, 0.05-0.78]) and emergency visits (odds ratio, 0.2 [95% CI, 0.06-0.66]). Patients assigned to NLC also presented with a lower symptom burden, higher satisfaction, and greater disease knowledge. Risk factor profile was improved in the NLC group, with higher rates of smoking cessation, engagement in regular physical activity, and weight optimization. Nurse-led management enabled more frequently diagnosing obstructive sleep apnea.</p><p><strong>Conclusions: </strong>Nurse-led, integrated care for patients undergoing AF ablation improves the quality of life, clinical outcomes, and risk factor management at 1 year postprocedure. These findings support the incorporation of structured nurse-led interventions in the peri-ablation care pathway.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05333445.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014149"},"PeriodicalIF":9.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}