Europace最新文献

{"title":"Development and validation of the GLORIA-AF Stroke Weighted Risk Score for patients with atrial fibrillation.","authors":"Yifan Xie, Wenhui Li, Yanda Meng, Tianjin Huang, Yalin Zheng, Menno V Huisman, Giuseppe Boriani, Tze-Fan Chao, Gregory Y H Lip","doi":"10.1093/europace/euag236","DOIUrl":"10.1093/europace/euag236","url":null,"abstract":"<p><strong>Aims: </strong>Accurate stroke risk stratification is central to anticoagulation decision-making in patients with atrial fibrillation (AF), but conventional scores may not fully capture risk heterogeneity. We aimed to develop and externally validate an interpretable weighted score using a time-to-event framework.</p><p><strong>Methods and results: </strong>GLORIA-AF Phase II/III data were used to evaluate 17 baseline predictors using LASSO-penalized Cox regression with stability selection; coefficients were converted into integer weights. Performance was assessed using discrimination, calibration, integrated discrimination improvement (IDI), continuous net reclassification improvement (NRI), and decision curve analysis. External validation was performed in EORP-AF and APHRS-AF registries. Among 20 517 patients included in the derivation cohort [mean (SD) age, 69.9 (10.3) years; 9196 women (44.8%)], 487 (2.4%) had stroke, and 17 397 (84.8%) were receiving anticoagulation at baseline. Ten selected predictors formed a 0-23-point score. The derived score achieved a C-index of 0.661 (95% CI, 0.636-0.685), higher than CHA2DS2-VA (0.626; P < 0.001), CHA2DS2-VASc (0.615; P < 0.001), and the unweighted score (P = 0.016), with no significant difference from the full Cox or machine learning models. In external validation (8309 patients; 147 strokes), the C-index was 0.652 (95% CI, 0.614-0.690) vs. 0.616 for CHA2DS2-VA (95% CI, 0.598-0.634; P < 0.001). IDI/NRI, calibration, and decision curve analyses supported improved risk differentiation, close calibration, and generally greater net benefit than CHA2DS2-VA. The score retained higher discrimination than CHA2DS2-VA among patients without baseline anticoagulation (P < 0.001).</p><p><strong>Conclusion: </strong>The GLORIA-AF Stroke Weighted Risk Score provides risk refinement beyond CHA2DS2-VA while retaining discrimination consistent with more complex models. External validation supports its transportability and potential adjunctive role in guideline-directed thromboembolic risk assessment.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849925","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":"Subcutaneous and extravascular implantable cardioverter-defibrillators: a clinical framework for breast surgery, pregnancy, lactation, radiation therapy, and breast imaging.","authors":"Kamala P Tamirisa, Ian Crozier, Lucas Boersma, Jodie L Hurwitz, Amin Al-Ahmad, Mark S Link, Miral Amin, Devika Adusumilli, Luigi DiBiase, Sana M Al-Khatib, Andrea M Russo","doi":"10.1093/europace/euag274","DOIUrl":"10.1093/europace/euag274","url":null,"abstract":"<p><p>The subcutaneous implantable cardioverter-defibrillator and extravascular implantable cardioverter-defibrillator do not require intravascular, intracardiac, or epicardial leads, making them attractive alternatives to transvenous implantable cardioverter-defibrillators in patients without bradycardia pacing or cardiac resynchronization therapy indications. These systems are especially useful for patients with venous access challenges and those at risk for endovascular infections, including patients with renal failure or those who are immunocompromised. Women with prior or anticipated breast surgery, such as mastectomy or breast reconstruction surgery, or those who are lactating present unique anatomic, procedural, and post-operative quality-of-life considerations. This commentary provides a practical, scenario-based framework for managing this unique patient group. Key considerations include individualized incision and pulse generator planning, proactive multidisciplinary coordination, procedure-specific management, and shared decision-making in patients with prior or anticipated breast augmentation or reduction, pregnancy, lactation, mastectomy, radiation therapy, and breast imaging.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080037","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":"Nanosecond pulsed field ablation for paroxysmal atrial fibrillation: feasibility, safety, and skeletal muscle activation.","authors":"Wenjie Li, Fanghui Li, Mingyang Tang, Xianjin Hu, Bangjiaxin Ren, Aobo Gong, Ying Cao, Zexi Li, Yifan Zhou, Qiancheng Zhao, Zulu Wang, Shuyan Li, Shaowen Liu, Guitang Yang, Rui Zeng","doi":"10.1093/europace/euag262","DOIUrl":"10.1093/europace/euag262","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976193","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: Outcomes of simplified left atrial appendage occlusion using the WATCHMAN FLX device: the ROSE-FLX study.","authors":"","doi":"10.1093/europace/euag287","DOIUrl":"10.1093/europace/euag287","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"28 10","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192194","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":"Outcomes of leadless pacing with the Micra VR beyond 10 years.","authors":"Constanze Puschmann, Hermann Blessberger, Justin Lacher, Hannah Rohringer, Jakob Bötscher, Julian Maier, Michael Gundendorfer, Stefan Schwarz, Christian Reiter, Jörg Kellermair, Juergen Kammler, Thomas Lambert, Karim Saleh, Clemens Steinwender","doi":"10.1093/europace/euag271","DOIUrl":"10.1093/europace/euag271","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":"28 10","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13650481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135575","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":"Elimination of epicardial late potentials by endocardial ablation in arrhythmogenic right ventricular cardiomyopathy.","authors":"Alexis Hermida, Chiara Pavone, Romain Sauve, Géraldine Vedrenne, Denis Amet, Matthieu Gras, Bruno Degand, Cyrus Moini, Guillaume Duthoit, Mikael Laredo, Nicolas Badenco, François Lesaffre, Antoine Lepillier, Françoise Hidden Lucet, Estelle Gandjbakhch, Xavier Waintraub","doi":"10.1093/europace/euag231","DOIUrl":"10.1093/europace/euag231","url":null,"abstract":"","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839740","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":"Nav1.5 Beyond Genetics: Loss of Cardiac Sodium-Channel Function in Brugada Syndrome.","authors":"Luigi Anastasia, Giuseppe Ciconte, Alessandro Fuga, Dudie Gjeci, Tiziano Dallavilla, Marco Piccoli, Federica Cirillo, Alessia Vuturo, Raffaele Salerno, Davide Morciano, Antonio Izzo, Marcello Manfredi, Carlo Pappone","doi":"10.1093/europace/euag261","DOIUrl":"https://doi.org/10.1093/europace/euag261","url":null,"abstract":"<p><p>Brugada syndrome is usually interpreted through SCN5A genetics, yet many patients with a Brugada phenotype carry no clearly pathogenic SCN5A variant and penetrance among carriers is incomplete. Cardiac sodium-channel function is therefore not a direct readout of coding sequence but an integrated property shaped by the channelosome, transcriptional and epigenetic control, post-translational modification, metabolic state, and inflammatory signaling. Through these routes, oxidative stress, altered glycosylation, and Nedd4-2-dependent ubiquitination can reduce peak sodium current in experimental systems, potentially lowering conduction reserve; inflammatory mediators may additionally modify the regional substrate through other ionic pathways without altering the SCN5A coding sequence in the experimental system, converging on the loss-of-function phenotype that characterizes Brugada syndrome, in contrast to the late-current gain of function of long QT syndrome type 3. Epicardial adipose tissue may provide a regional context for such signals at the right ventricular outflow tract, where conduction reserve is low and the substrate preferentially localizes, and anti-Nav1.5 autoantibodies provide a humoral route to reduced channel availability. We examine sequence-independent modifiers that may dynamically reduce Nav1.5 function and define the experimental framework needed to establish their clinical weight.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001469","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":"Early rhythm control in patients with atrial fibrillation and cancer: A subgroup analysis of the EAST-AFNET 4 trial.","authors":"Djemail Ismaili, Anna Suling, Katrin Borof, Andreas Goette, Günter Breithardt, A John Camm, Harry Crijns, Lars Eckardt, Arif Elvan, Larissa Fabritz, Isabelle van Gelder, Michele Gulizia, Laurent Haegeli, Hein Heidbuchel, Josef Kautzner, Marc Lemoine, G André Ng, Renate B Schnabel, Lukasz Szumowski, Sakis Themistoclakis, Panos Vardas, Karl Wegscheider, Stephan Willems, Antonia Zapf, Andreas Metzner, Andreas Rillig, Paulus Kirchhof","doi":"10.1093/europace/euag269","DOIUrl":"https://doi.org/10.1093/europace/euag269","url":null,"abstract":"<p><strong>Background and aims: </strong>Early rhythm-control improves cardiovascular outcomes in patients with atrial fibrillation (AF). Its effectiveness in patients with cancer is unclear. This study evaluated the effects of cancer history on early rhythm-control in the EAST-AFNET 4 trial.</p><p><strong>Methods: </strong>This secondary analysis of EAST-AFNET 4 compared patients with and without a history of cancer, including active cancer and cancer in remission. Outcomes included the primary outcome, a composite of cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome; the safety outcome, a composite of death, stroke, and serious adverse events related to rhythm-control; and rhythm at 24 months.</p><p><strong>Results: </strong>Cancer history was available in 2779/2789 patients (99.6%). Cancer history was present in 216/2779 (7.8%; 19 with active cancer; mean age, 73 years; 95 [44%] women; mean CHA2DS2-VASc score, 3.5). During a follow-up to 8.6 years, early rhythm control reduced the primary outcome in patients with and without a history of cancer (pinteraction = .23) with high rates of sinus rhythm at 24 months (cancer: 84.9%, without cancer: 81.8%; pinteraction = .60). In patients with a cancer history, there was a signal for more safety outcomes with early rhythm control (early rhythm control 36/116 [31%] patients with event, 22 deaths; usual care 20/100 [20%] patients with event, 18 deaths; pinteraction = .055).</p><p><strong>Conclusions: </strong>Early rhythm control therapy appears effective in patients with AF and a history of cancer but may be less safe than in patients without cancer, in this hypothesis-generating analysis. This could be play of chance but warrants further research into the safety and efficacy of rhythm control therapy in patients with a cancer history.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001461","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":"Yield of Atrial Fibrillation Screening according to Methodology and Patient Characteristics: An Individual Participant Data Meta-Analysis of 34,165 Individuals Screened for Atrial Fibrillation within the AFFECT-EU/AF-SCREEN Collaboration.","authors":"Lucas Y Xing, William F McIntyre, Johan Engdahl, Matthias Daniel Zink, Nikolaus Albert Helmut Marx, Emma Svennberg, Katrin Kemp Gudmundsdottir, Jelle C L Himmelreich, Giuseppe Boriani, Davide Antonio Mei, Daniel Engler, Steven R Steinhubl, Karl Georg Haeusler, Matthias Endres, Joan Montaner, Ben Freedman, Renate B Schnabel, Jeff S Healey, Jesper Hastrup Svendsen, Søren Zöga Diederichsen","doi":"10.1093/europace/euag256","DOIUrl":"https://doi.org/10.1093/europace/euag256","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>Atrial fibrillation (AF) screening may reduce adverse outcomes through early initiation of preventive treatment. However, more data are warranted to inform the yield of different screening strategies. This study aimed to evaluate how patient characteristics and screening methodologies influence screening yield.</p><p><strong>Methods: </strong>We conducted an individual participant data meta-analysis of 12 European and North American study cohorts, by using generalized linear mixed models with random intercept at study level.</p><p><strong>Results: </strong>In this meta-analysis of 34,165 participants screened for AF (age 73.4 ± 7.5 years and 53.5% female), the screening yield increased with more intensive approaches, ranging from 0.83% [95% confidence interval (CI): 0.24-2.87] in single-timepoint screening, to 5.06% [95% CI: 3.55-7.17] in intermittent (i.e. repeated single-timepoint) screening, 4.81% [95% CI: 3.79-6.08] in short-term continuous monitoring (≤30 days), and up to 30.39% [95% CI: 28.06-32.84] in long-term continuous monitoring (>30 days). Advanced age, male sex, hypertension, and heart failure (HF) were associated with detection. Significant interactions were observed between screening approach and age, sex, HF, CHADS2, and NT-proBNP. These risk factors had a stronger influence on AF detection with single-timepoint screening, compared with more intensive methods.</p><p><strong>Conclusions: </strong>In this meta-analysis, AF screening yield varied substantially by patient characteristics and screening approach. Advanced age, male sex, and HF were independently associated with greater AF detection, particularly in those having single-timepoint screening. Our findings support tailoring the screening approach to the individual target population in clinical practice. Further studies to assess clinical outcomes following screening are needed and underway.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":" ","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001563","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":"COnCOmitaNt pulsed field ablation-based pUlmonary vein isolation and lefT atrial appendage closure: the COCONUT study.","authors":"Christian-Hendrik Heeger, Laurent Roten, Domenico Della Rocca, Vedran Velagić, Dhiraj Gupta, Tom De Potter, Christian Sticherling, Lukas Urbanek, Boris Schmidt, Abdul Shokor Parwani, Ignacio Garcia-Bolao, Rocco Arancio, Amr Nawar, Shibu Mathew, Jennifer Beney, Henning Rolfes, Kolya Sievert, Serge Boveda, Antoine Lepillier, Marjorie Niro, Reza Wakili, Alexander Steger, Ahmad Awada, Vedran Pasara, Grégoire Massoullié, Andrija Nekic, Maarten Vanhaverbeke, Alexandre Almorad, Romain Eschalier, Maxim Didenko, Marco Contarini, Lorenz Räber, Jan-Per Wenzel, Manuel Rattka, Daniel Scherr, Roland Richard Tilz, Martin W Bergmann","doi":"10.1093/europace/euag198","DOIUrl":"10.1093/europace/euag198","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC) are increasingly performed as standalone procedures. Given that PVI and LAAC share the same access route, a combined approach of pulsed field ablation (PFA)-based PVI and LAAC might be beneficial. The COCONUT study focused on safety, efficacy, and outcomes combining PVI by PFA with LAAC in one procedure.</p><p><strong>Methods: </strong>This is a retrospective, multinational registry study. The primary endpoints were the following: (1) primary safety endpoint: serious adverse events; and (2) primary efficacy endpoint: success of PVI and LAA closure defined as the ability to isolate all pulmonary veins and the successful closure of the LAA. For secondary endpoints, peri-procedural data and follow-up data were collected.</p><p><strong>Results: </strong>A total of 155 patients from 22 centres of nine European countries were treated by concomitant pentaspline catheter PFA-based PVI and LAAC. The mean CHA2DS2-VA score was 3.1 ± 1.4. The primary efficacy endpoint was achieved at 97.4% with successful PVI at 100% and successful LAAC in 151/155 patients (97.4%). The primary safety endpoint was observed in 3/155 patients (1.9%). Transoesophageal echocardiography and/or CCTA 67 ± 26 days after the procedure showed no device embolization and no device-related thrombus, 24/151 (15.9%) patients showed peri-device gaps of <5 mm while gaps of >5 mm have been observed in 3/151 (2.0%). Among 137/155 patients with available arrhythmia, a follow-up >6 months at 78.1% showed sinus rhythm.</p><p><strong>Conclusion: </strong>In this large multicentre study, concomitant PFA-based AF ablation and LAA closure proved to be feasible, effective, and safe and overall procedure duration was short.</p>","PeriodicalId":11981,"journal":{"name":"Europace","volume":"28 9","pages":""},"PeriodicalIF":10.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911240","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}