Europace最新文献

{"title":"Identification of a new genetic locus associated with atrial fibrillation in the Taiwanese population by genome-wide and transcriptome-wide association studies.","authors":"Guan-Wei Lee, Jien-Jiun Chen, Chih-Hsien Wang, Sheng-Nan Chang, Fu-Chun Chiu, Pang-Shuo Huang, Su-Kiat Chua, Eric Y Chuang, Chia-Ti Tsai","doi":"10.1093/europace/euaf042","DOIUrl":"https://doi.org/10.1093/europace/euaf042","url":null,"abstract":"<p><strong>Background: </strong>Genome-wide association studies (GWASs) identified common single nucleotide polymorphisms (SNPs) in more than 100 genomic regions associated with atrial fibrillation (AF). We aimed to identify novel AF genes in Taiwanese population by multi-stage GWAS.</p><p><strong>Methods: </strong>In exploratory stage, we did GWAS with whole genome genotypes (4,512,191 SNPs) in 516 AF Patients from National Taiwan University AF registry (NTUAFR) and 5160 normal sinus rhythm controls from Taiwan Biobank. Significant loci were replicated in 1002 independent patients and 2003 controls, and in UK biobank. Expression quantitative trait locus (eQTL) mapping and transcriptome-wide association study (TWAS) were performed to implicate functional significance.</p><p><strong>Results: </strong>Stage I GWAS revealed 3 loci associated with AF with genome-wide significance level, including one close to PITX2 gene (chromosome 4q25, rs2723329, minor allele frequency [MAF] 0.50 vs 0.41, P=1.53×10-10), another close to RAP1A gene (also to previous KCND3; chromosome 1p13.2, rs7525578, MAF 0.17 vs 0.07, P= 1.24×10-26) and one novel locus close to HNF4G gene (chromosome 8q21.13, rs2980218, MAF 0.44 vs 0.35, P=2.19×10-9). They were validated in stage II population. The eQTL analyses showed significant colocalization of 1p13.2 locus with RAP1A gene expression in fibroblasts and 8q21.13 locus with HNF4G expression in lymphocytes. There's significant association of RAP1A gene expression in fibroblasts and HNF4G in lymphocytes and brain with AF.</p><p><strong>Conclusions: </strong>GWAS in Taiwan revealed PITX2 and RAP1A/KCND3 loci and novel AF locus (HNF4G) with most significant locus in the RAP1A locus. RAP1A and HNF4G genes may implicate fibrosis, metabolic and neurogenic pathways in pathogenesis of AF.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556301","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":"External validation of a machine learning based classification algorithm for ambulatory heart rhythm diagnostics in pericardioversion atrial fibrillation patients using smartphone photoplethysmography: the SMARTBEATS-ALGO study.","authors":"Jonatan Fernstad, Emma Svennberg, Peter Åberg, Katrin Kemp Gudmundsdottir, Anders Jansson, Johan Engdahl","doi":"10.1093/europace/euaf031","DOIUrl":"https://doi.org/10.1093/europace/euaf031","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to perform an external validation of an automatic machine learning algorithm for heart rhythm diagnostics using smartphone photoplethysmography (PPG) recorded by patients with atrial fibrillation (AF) and atrial flutter (AFL) pericardioversion in an unsupervised ambulatory setting.</p><p><strong>Methods and results: </strong>Patients undergoing cardioversion for AF or AFL performed 1-min heart rhythm recordings peri-cardioversion at least twice daily for 4-6 weeks, using an iPhone 7 smartphone running a PPG application (CORAI Heart Monitor) simultaneously with a single-lead ECG recording (KardiaMobile). The algorithm uses support vector machines (SVM) to classify heart rhythm from smartphone-PPG. The algorithm was trained on PPG recordings made by patients in a separate cardioversion cohort. Photoplethysmography recordings in the external validation cohort were analysed by the algorithm. Diagnostic performance was calculated by comparing the heart rhythm classification output to the diagnosis from the simultaneous ECG recordings (gold standard).In total 460 patients performed 34 097 simultaneous PPG and ECG recordings, divided into 180 patients with 16 092 recordings in the training cohort and 280 patients with 18 005 recordings in the external validation cohort. Algorithm classification of the PPG recordings in the external validation cohort diagnosed AF with sensitivity, specificity and accuracy of 99.7/99.7/99.7%, and AF/AFL with sensitivity, specificity and accuracy of 99.3/99.1/99.2%.</p><p><strong>Conclusion: </strong>A machine learning based algorithm demonstrated excellent performance in diagnosing atrial fibrillation and atrial flutter from smartphone-PPG recordings in an unsupervised ambulatory setting, minimizing the need for manual review and ECG verification, in elderly cardioversion populations.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440388","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":"Persistent Atrial Fibrillation Ablation: Glimpsing the Light Ahead?","authors":"Xiaofeng Hu, Luigi Di Biase, Xumin Hou, Xu Liu","doi":"10.1093/europace/euaf037","DOIUrl":"https://doi.org/10.1093/europace/euaf037","url":null,"abstract":"<p><p>Current ablation strategies for persistent atrial fibrillation (AF) remain suboptimal, with success rates around 50%. Pulmonary vein isolation (PVI) serves as the cornerstone of ablation, yet adjunctive strategies have shown inconsistent results in randomized controlled trials. This review critically examines the outcomes and limitations of these approaches while identifying key barriers to success, including incomplete understanding of AF mechanisms, patient heterogeneity, technical challenges in achieving durable lesions, and the absence of standardized procedural endpoints. A novel electro-anatomically guided ablation protocol is proposed, integrating advanced mapping techniques and procedural endpoints aimed at achieving AF termination. Furthermore, it discusses emerging technologies such as pulsed field ablation (PFA), which hold promise for enhancing safety and long-term outcomes. These insights provide a framework for future research and the optimization of persistent AF ablation strategies.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440391","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":"Lactobacillus gasseri prevents ibrutinib-associated atrial fibrillation through butyrate.","authors":"Ling Shi, Yu Duan, Ning Fang, Ning Zhang, Sen Yan, Kunna Wang, Te Hou, Zhiqi Wang, Xiaohui Jiang, Qianhui Gao, Song Zhang, Yue Li, Yun Zhang, Yongtai Gong","doi":"10.1093/europace/euaf018","DOIUrl":"10.1093/europace/euaf018","url":null,"abstract":"<p><strong>Background: </strong>Ibrutinib, a widely used anti-cancer drug, is known to significantly increase the susceptibility to atrial fibrillation (AF). While it is recognized that drugs can reshape the gut microbiota, influencing both therapeutic effectiveness and adverse events, the role of gut microbiota in ibrutinib-induced AF remains largely unexplored.</p><p><strong>Method: </strong>Utilizing 16S rRNA gene sequencing, faecal microbiota transplantation, metabonomics, electrophysiological examination, and molecular biology methodologies, we sought to validate the hypothesis that gut microbiota dysbiosis promotes ibrutinib-associated AF and to elucidate the underlying mechanisms.</p><p><strong>Result: </strong>We found that ibrutinib administration pre-disposes rats to AF. Interestingly, ibrutinib-associated microbial transplantation conferred increased susceptibility to AF in rats. Notably, ibrutinib induced a significantly decrease in the abundance of Lactobacillus gasseri (L. gasseri), and oral supplementation of L. gasseri or its metabolite, butyrate (BA), effectively prevented rats from ibrutinib-induced AF. Mechanistically, BA inhibits the generation of reactive oxygen species, thereby ameliorating atrial structural remodelling. Furthermore, we demonstrated that ibrutinib inhibited the growth of L. gasseri by disrupting the intestinal barrier integrity.</p><p><strong>Conclusion: </strong>Collectively, our findings provide compelling experimental evidence supporting the potential efficacy of targeting gut microbes in preventing ibrutinib-associated AF, opening new avenues for therapeutic interventions.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002455","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":"Evoked delayed potential ablation for post-myocardial infarction ventricular tachycardia: results from a large prospective multicentre study.","authors":"Marta de Riva, Reinder Evertz, Peter Lukac, Lukas R C Dekker, Yuri Blaauw, Rachel M A Ter Bekke, Yoshitaka Kimura, Rypko J Beukema, Alexandre Ouss, Bart A Mulder, Kevin Vernooy, Adrianus P Wijnmaalen, Katja Zeppenfeld","doi":"10.1093/europace/euaf003","DOIUrl":"10.1093/europace/euaf003","url":null,"abstract":"<p><strong>Aims: </strong>The optimal substrate ablation approach for post-myocardial infarction (MI) ventricular tachycardia (VT) is unknown. Proposed ablation targets are prone to individual interpretation making the ablation outcome potentially operator dependent. Evoked delayed potentials (EDPs) are a well-defined target. Evoked delayed potential ablation was effective in preventing post-MI VT recurrence in a prior study. The aims of this study were to assess long-term outcomes of EDP ablation in a large multicentre cohort of post-MI patients and to compare ablation outcomes between centres with and without prior experience in EDP ablation.</p><p><strong>Methods and results: </strong>Patients with post-MI VT undergoing ablation in one centre performing EDP ablation since 2013 and five centres without prior experience in EDP ablation were prospectively included. A uniform mapping protocol including right ventricular extra-stimulation aiming to EDP identification was followed. Ablation endpoints were EDP elimination and VT non-inducibility. Patients were followed for VT recurrence, mortality, heart transplant, and left ventricular assist device implantation. In total, 130 patients were included. The protocol was successfully performed in 99%, and in 94%, EDPs were identified and ablated. In total, 78% of patients were rendered non-inducible. Ventricular tachycardia-free survival was 78% [95% confidence interval (CI) 71-85] and 71% (95% CI 63-80) at 6 and 12 months, respectively. No difference in VT-free survival was observed among centres with and without prior experience in EPD ablation.</p><p><strong>Conclusion: </strong>In a large multicentre prospective cohort of patients with post-MI VT, EDP ablation resulted in good long-term outcomes. Importantly, VT recurrence rates did not differ among centres with and without prior experience in EDP ablation, indicating that this approach can be easily reproduced by operators previously not familiar with the technique.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 2","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482507","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":"Pulmonary vein reconnection rates after pulse field ablation: time for a reality check?","authors":"Alessio Gasperetti, Luigi Di Biase","doi":"10.1093/europace/euaf014","DOIUrl":"10.1093/europace/euaf014","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002608","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":"Comparative analysis of anaesthesia modalities in pulmonary vein isolation: insights from a prospective multicentre registry.","authors":"Eias Massalha, Amer Dakka, Avi Sabbag, Anat Berkovitch, Ibrahim Marai, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, Alexander Omelchenko, Avishag Laish-Farkash, Mahmoud Suleiman, Eran Leshem, Eyal Nof, Roy Beinart","doi":"10.1093/europace/euae301","DOIUrl":"10.1093/europace/euae301","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF), the most common sustained arrhythmia in adults, is increasing in prevalence globally. Catheter ablation (CA), particularly pulmonary vein isolation (PVI), is a key treatment option. Pulmonary vein isolation can be performed using different energy sources, including cryoballoon ablation (CBA), radiofrequency ablation (RFA), or pulse field ablation. Anaesthesia modalities for these procedures include general anaesthesia (GA), deep sedation (DS), and conscious sedation (CS). However, the optimal anaesthesia modality remains unclear, as previous studies have shown mixed outcomes. This study aims to compare the safety and efficacy of different anaesthesia modalities in PVI.</p><p><strong>Methods and results: </strong>This prospective, multicentre study, based on the Israeli Catheter Ablation Registry, evaluated the impact of different anaesthesia modalities on procedural outcomes and safety in AF ablation. Data from 1002 patients who underwent PVI between January 2019 and December 2021 across 14 centres were analysed. Patients were stratified by anaesthesia modality-CS vs. GA, with the latter encompassing DS. Key outcomes, including AF recurrence, procedural complications, and success rates, were evaluated over a 24-month follow-up period. Additionally, a sensitivity analysis was performed for the subgroup of patients who underwent CBA. Of the 1002 patients, 53% received GA, 6.3% DS, and 40% CS, with CBA used in 84% of cases. Complete PVI was achieved in 91% of patients, with comparable success rates observed between CS and GA groups. No significant differences were found between CS and GA modalities in terms of AF recurrence rates at 12 months (15% vs. 16%) and 24 months (19.5% vs. 21.2%), or in 12-month rehospitalization rates (19.8% vs. 16.5%). Sensitivity analysis of the CBA subgroup yielded similar results, with no significant differences in AF recurrence, complications, or procedural duration between CS and GA modalities.</p><p><strong>Conclusion: </strong>Conscious sedation is as safe and effective as general anaesthesia in AF ablation, particularly with cryoablation. The choice of anaesthesia appears to be driven by patient characteristics and institutional factors without affecting long-term outcomes such as AF recurrence or complication rates.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 2","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432816","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":"Early versus late atrial fibrillation recurrence after pulsed field ablation: insights from the admIRE trial.","authors":"Luigi Di Biase, Vivek Y Reddy, Marwan Bahu, David Newton, Christopher F Liu, William H Sauer, Sandeep Goyal, Vivek Iyer, Devi Nair, Jose Osorio, Moussa Mansour, Hugh Calkins, Oussama Wazni, Andrea Natale","doi":"10.1093/europace/euaf007","DOIUrl":"10.1093/europace/euaf007","url":null,"abstract":"<p><strong>Aims: </strong>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).</p><p><strong>Methods and results: </strong>Patients with symptomatic paroxysmal atrial fibrillation and ≥1 transtelephonic monitoring transmission during the blanking period were included (n = 169). ER was defined as documented recurrence in the blanking period (days 1-90), and LR as recurrence in the evaluation period (days 91-365). Freedom from 12-month recurrence was estimated using Kaplan-Meier method. A Cox proportional-hazards regression model, with ER as the primary factor, and adjusted for age, sex, and body mass index, was used to estimate hazard ratios (HRs) and 95% CI. ER was observed in 20.1% (31/169) of patients (66.1 ± 7.1 years, 35.5% female, 46.6 ± 48.4-month PAF history). Time to first documented ER was 49 (37-61) days. Occurrence of LR was 16.7% (23/138) in patients without ER, 71.0% (22/31) in those with ER, and 87.0% (20/23) in patients whose ER onset occurred within the first 2 months. Twelve-month freedom from documented recurrence was significantly lower in patients with ER at 29.0% (95% CI, 13.1-45.0%) vs. 82.5% (95% CI, 75.9-89.1%) in those without ER (adjusted HR, 7.9; 95% CI, 4.1-15.1; P < 0.001).</p><p><strong>Conclusion: </strong>This admIRE subanalysis demonstrated that PAF patients who experience ER after PFA are at a substantially higher risk for LR. The optimal duration of the blanking period post-PFA needs further assessments.</p><p><strong>Clinicaltrials.gov identifier: </strong>NCT05293639.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002512","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":"Atrial fibrillation screening for stroke prevention: an instrumental variables meta-analysis addressing varying participation rates.","authors":"Carl Bonander, Niklas Jakobsson, Katrin Kemp Gudmundsdottir, Emma Svennberg, Johan Engdahl","doi":"10.1093/europace/euaf030","DOIUrl":"10.1093/europace/euaf030","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425128","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":"Correction to: Acute and mid-term outcomes of ablation for atrial fibrillation with VISITAG SURPOINT: the Japan MIYABI registry.","authors":"","doi":"10.1093/europace/euae261","DOIUrl":"10.1093/europace/euae261","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"27 2","pages":""},"PeriodicalIF":7.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398724","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}