Europace最新文献

{"title":"Apixaban in Subclinical Atrial Fibrillation: Stroke-Driven Value Amid Economic Uncertainty.","authors":"Chung-Hsin Yeh, Shiuan-Chih Chen","doi":"10.1093/europace/euaf262","DOIUrl":"https://doi.org/10.1093/europace/euaf262","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299286","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":"Adherence to oral thromboprophylaxis in atrial fibrillation: An overview for clinicians.","authors":"Tatjana Potpara, Bogdan Markovic, Marek Grygier, Simonetta Genovesi, Apostolos Tzikas, Serge Boveda, Jens Erik Nielsen-Kudsk, Giuseppe Boriani, Gregory Y H Lip, A John Camm","doi":"10.1093/europace/euaf250","DOIUrl":"https://doi.org/10.1093/europace/euaf250","url":null,"abstract":"<p><p>In most patients with atrial fibrillation, effective stroke prevention necessitates long-term (often lifelong) oral anticoagulant therapy (OAC). However, the effectiveness of OAC therapy in a clinical setting (i.e., outside the controlled environment of randomized clinical trials) is strongly influenced by patients' adherence and persistence with prescribed therapy. However, suboptimal adherence to OAC remains a substantial problem in routine practice - available evidence suggests that patients do not take their OAC one out of every four days, and approximately one in three to four patients is poorly adherent to OAC. In addition, around 15% of high-risk OAC-eligible patients with AF refuse to take OAC for a variety of patient-specific reasons. Poor adherence to OAC therapy is associated with adverse clinical outcomes (such as stroke or systemic embolism, hospitalization, mortality, bleeding [particularly with Vitamin K antagonist therapy]) and increased economic costs. In this overview, we summarize important aspects of the adherence to medication concept, including the definition and measurement of adherence, the determinants and prevalence of OAC non-adherence, the clinical importance of achieving and maintaining good adherence, strategies to improve adherence to OAC, and alternative treatment options for effective thromboprophylaxis in patients with AF who are non-adherent to OAC therapy.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285984","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":"Preclinical evaluation of a compliant and absorbable CIED antibacterial envelope.","authors":"Robert D Schaller, Suneet Mittal, Mauro Biffi, Matteo Ziacchi, Nicole Kirchhof, Aldo Ferrari, Alexander Breitenstein","doi":"10.1093/europace/euaf260","DOIUrl":"https://doi.org/10.1093/europace/euaf260","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257626","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":"Letter on 'Circumferential pulmonary vein isolation (CPVI) with adjunctive linear ablation Vs. CPVI alone for long-standing persistent atrial fibrillation: A randomized pilot study'.","authors":"Jing Wei","doi":"10.1093/europace/euaf261","DOIUrl":"https://doi.org/10.1093/europace/euaf261","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257638","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":"A review on wearable cardioverter-defibrillators in clinical practice for sudden cardiac death prevention and heart failure management.","authors":"David Duncker, Rodrigue Garcia, Diana Bonderman, Giancarlo Casolo, Michał Farkowski, Carsten Israel, Eloi Marijon","doi":"10.1093/europace/euaf257","DOIUrl":"https://doi.org/10.1093/europace/euaf257","url":null,"abstract":"<p><p>Sudden cardiac death (SCD) remains a predominant mode of death in cardiovascular mortality. Despite advancements in guideline-recommended medical therapy (GRMT) and risk stratification, accurately identifying patients who would benefit most from implantable cardioverter-defibrillator (ICD) therapy over the long term remains a significant challenge. The wearable cardioverter-defibrillator (WCD) has emerged as a non-invasive bridge to either ICD implantation or recovery of left ventricular function. This expert review presents a comprehensive and up-to-date summary of clinical evidence on WCD use for SCD prevention and heart failure (HF) management. Specifically, it will address: 1) The concept and mechanism of the WCD. 2) Evidence from randomized and observational studies regarding efficacy, safety, and cost-effectiveness. 3) Integration of the WCD into HF management. 4) Knowledge gaps and priorities for future research.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257618","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":"Discordance between left atrial pressure and risk scores in assessment of heart failure with preserved ejection fraction in patients with atrial fibrillation undergoing catheter ablation.","authors":"Monika Gawałko, Zarina Habibi, Dominique Verhaert, Jerremy Weerts, Bouke Adriaans, Sevasti-Maria Chaldoupi, Rachel M A Ter Bekke, Dennis W Den Uijl, Justin G L M Luermans, Vanessa P M Van Empel, Ulrich Schotten, Kevin Vernooy, Dominik Linz","doi":"10.1093/europace/euaf245","DOIUrl":"https://doi.org/10.1093/europace/euaf245","url":null,"abstract":"<p><strong>Background: </strong>Identifying risk or probability of heart failure with preserved ejection fraction (HFpEF) in patients with atrial fibrillation (AF) is challenging.</p><p><strong>Purpose: </strong>To assess the prevalence and factors associated with elevated LAP in AF patients undergoing catheter ablation and to evaluate the concordance between elevated LAP and HFpEF risk scores.</p><p><strong>Methods: </strong>This study included 336 symptomatic AF patients (median age 65 years, 41% female) undergoing catheter ablation. Elevated LAP was defined as a mean LAP≥15 mmHg. High HFpEF probability was defined by H2FPEF≥6 and/or HFA-PEFF≥5.</p><p><strong>Results: </strong>Elevated LAP was present in 37% (n=125) of patients, and factors associated with elevated LAP included higher body mass index (BMI; OR 1.21, 95% CI 1.11-1.31) and lower LA reservoir strain (OR 0.97, 95% CI 0.94-0.99). General anaesthesia and non-sinus rhythm were linked to higher LAP but not independently; AF type showed no effect. Among 204 eligible patients, 36% had a high HFpEF probability. Over 12 months, AF recurrence (26% vs 24%, p=0.775) and repeat ablations (11% vs 7.2%, p=0.230) were similar regardless of LAP status, but severe adverse events (death, life-threatening situations, hospitalizations or persistent disability) were more common in those with elevated LAP (6.7% vs. 1.7%, p=0.044).</p><p><strong>Conclusions: </strong>Over one-third of ablation patients had elevated LAP. Poor agreement with HFpEF scores suggests limited utility in AF patients.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250147","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":"Low-intensity pulsed ultrasound attenuates atrial remodeling and atrial fibrillation after myocardial infarction: an experimental pre-clinical study.","authors":"Hongjie Yang, Yugang Hu, Bin Kong, Caijie Shen, Wei Shuai","doi":"10.1093/europace/euaf258","DOIUrl":"https://doi.org/10.1093/europace/euaf258","url":null,"abstract":"<p><strong>Aims: </strong>Post-infarct atrial remodeling creates a substrate for atrial fibrillation (AF), yet no cardiac-specific, non-invasive therapy targets this process. Low-intensity pulsed ultrasound (LIPUS) limits ventricular remodeling in pre-clinical models, but its impact on atrial remodeling and AF after myocardial infarction (MI) is unknown.</p><p><strong>Methods and results: </strong>MI was induced in rats by surgical ligation of the left coronary artery, whereas a separate AF rat model was created by daily tail-vein injections of acetylcholine/CaCl₂ for 28 days. LIPUS treatment did not cause significant structural, functional or electrophysiological changes in the atrial tissue of healthy rats. In MI rats, LIPUS markedly attenuated atrial electrical remodeling, fibrosis, and inflammation, thereby reducing AF susceptibility. Transcriptomic analysis demonstrated a potential role of Adam19/TGF-β/Smad2/3 signaling in response to LIPUS treatment, whereas activation of Adam19/TGF-β/Smad2/3 signaling worsened fibrosis, and abolished the anti-arrhythmic benefit of LIPUS. Similar antifibrotic and antiarrhythmic effects were reproduced in the acetylcholine/CaCl₂ AF model, underscoring LIPUS as a promising non-invasive approach to attenuate AF after MI.</p><p><strong>Conclusions: </strong>In preclinical post-MI models, LIPUS attenuated atrial structural and electrical remodeling and lowered AF susceptibility, plausibly via modulation of an Adam19/TGF-β/Smad2/3 signaling cascade. These findings are promising but preliminary; priorities include determining whether the atrial effects are direct or secondary to ventricular remodeling and altered hemodynamics, confirming mechanisms across models, defining dose-response and safety, and validating efficacy and translational relevance in large-animal studies and early-phase trials before any clinical application.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250100","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":"Prevalence and severity of atrial cardiomyopathy in patients with recently diagnosed AF and stroke risk factors and its association with early rhythm control: A secondary analysis of EAST-AFNET 4.","authors":"Andreas Goette, Marc D Lemoine, Katrin Borof, Ulrich Schotten, Günter Breithardt, A John Camm, Harry J G M Crijns, Lars Eckardt, Andreas Metzner, Stephan Willems, Antonia Zapf, Renate B Schnabel, Larissa Fabritz, Paulus Kirchhof","doi":"10.1093/europace/euaf256","DOIUrl":"https://doi.org/10.1093/europace/euaf256","url":null,"abstract":"<p><strong>Aims: </strong>Observational data suggest that atrial cardiomyopathy can precede the clinical diagnosis of atrial fibrillation (AF) and that severe forms of atrial cardiomyopathy render rhythm control therapy futile. The aim was to quantify atrial cardiomyopathy in patients with recently diagnosed AF and to determine possible interactions between atrial cardiomyopathy and early rhythm control therapy in the EAST-AFNET 4 trial.</p><p><strong>Methods and results: </strong>This prespecified analysis of the EAST - AFNET 4 trial quantified baseline atrial cardiomyopathy using left atrial size, PR interval, and NT-proBNP. Outcomes were compared between atrial cardiomyopathy categories.Interactions between early rhythm control, the randomized therapy in EAST-AFNET 4, and atrial cardiomyopathy were determined. Outcomes included the primary outcome of EAST-AFNET 4 (cardiovascular death, stroke, hospitalization for heart failure or acute coronary syndromes), recurrent AF, and safety outcomes (serious adverse events of special interest or all-cause death). In an exploratory analysis, angiopoietin-2 (ANGPT2) as well as bone morphogenetic protein 10 (BMP10) were assessed to predict atrial cardiomyopathy. Most patients showed signs of atrial cardiomyopathy at baseline (69% with at least mildly elevated LA size, 23% with prolonged PR interval (≥200 ms), 56% with NT-proBNP > 365 pg/ml). Severe atrial cardiomyopathy, defined as the highest tertile of LA size, PR interval, and NT-proBNP, was associated with higher rates of first primary outcome (HR 7.97 (2.32, 27.37); p<0.001). early rhythm control was effective with and without atrial cardiomyopathy (pinteraction=0.160). While ANGPT2 levels showed an association to LA diameter and to atrial cardiomyopathy severity/stage, BMP 10 was not associated with atrial cardiomyopathy.</p><p><strong>Conclusion: </strong>Most patients have signs of atrial cardiomyopathy in the first year after AF diagnosis. Patients with advanced stages of atrial cardiomyopathy had a higher rate of primary outcome events and more recurrent AF. Nevertheless, early rhythm control therapy retains its efficacy across the spectrum of atrial cardiomyopathy severities. Consequently, atrial cardiomyopathy severity should not be a reason to withhold rhythm control therapy.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250266","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":"Feasibility and Accuracy of Wearable ECG Monitoring in Adult Congenital Heart Disease.","authors":"Florine Runge, Jonas Brügger, Francisco Javier Ruperti-Repilado, Behnam Subin, Fabian Jordan, Corinne Isenegger, Christian Sticherling, Michael Kühne, Felix Mahfoud, Daniel Tobler, Patrick Badertscher","doi":"10.1093/europace/euaf247","DOIUrl":"https://doi.org/10.1093/europace/euaf247","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250168","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":"Atrial cardiomyopathy delays the endothelialization process of left atrial appendage occluders.","authors":"Xiangwei Ding, Hao Jiang, Xiaohai Jiang, Kexin Wang, Yi Lu, Chuanmeng Zhang, Yin Ren, Gecai Chen, Bo Zhang, Ming Chu, Zhongbao Ruan, Li Zhu, Minglong Chen","doi":"10.1093/europace/euaf227","DOIUrl":"10.1093/europace/euaf227","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12510309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091496","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}