Heart rhythm最新文献

{"title":"Temporal Changes in LGE-CMR Enhancement After Monopolar Biphasic Focal Pulsed Field Ablation for Pulmonary Vein Isolation.","authors":"Maximilian Moersdorf, Mathias Forkmann, Michel Abou-Khalil, Sonia Busch, Dominik Linz, Nassir Marrouche, Philipp Sommer, Christian Sohns, Christian Mahnkopf","doi":"10.1016/j.hrthm.2026.10.021","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.021","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) has emerged as a novel non-thermal ablation modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While chronic lesion formation after PFA has been described, data regarding acute lesion characteristics and lesion maturation remain limited.</p><p><strong>Objective: </strong>To characterize acute and chronic lesion formation following focal point-by-point PFA for PVI using serial late-gadolinium-enhancement cardiovascular-magnetic-resonance-imaging (LGE-CMR).</p><p><strong>Methods: </strong>Six consecutive patients with symptomatic paroxysmal or persistent AF underwent index PFA-guided PVI using the CENTAURI system and a focal point-by-point lesion delivery strategy. LGE-CMR was performed 1 day and 90±10 days after ablation. Quantitative assessment of regional and global left atrial (LA) enhancement was performed using a standardized segmentation protocol. Changes in enhancement burden and LA dimensions were analyzed between imaging timepoints.</p><p><strong>Results: </strong>Among six patients at mean age 65±7 years, five patients (83%) had paroxysmal AF. Acute PVI was achieved in all patients without procedural complications. Serial LGE-CMR demonstrated substantial temporal changes between acute and chronic imaging. Enhancement within the right pulmonary vein (PV) region decreased from 3.3±2.2% to 0.8±0.8%(p=0.030), while the proportion of enhanced tissue decreased from 24.1±13.5% to 5.7±5.8%(p=0.017). Similar reductions were observed around the left PVs (4.4±3.1%vs.1.4±1.2%, p=0.064). Posterior wall enhancement decreased from 2.4±1.1% to 0.3±0.3%(p=0.007) and global LA enhancement from 12.8±6.2% to 3.3±1.6%(p=0.013), while LA volume remained unchanged.</p><p><strong>Conclusion: </strong>Serial LGE-CMR demonstrated substantial enhancement reduction of acute lesions following focal point-by-point PFA for PVI, which remained largely confined to the PV antra and adjacent posterior wall, providing novel in-human insights into lesion maturation following focal PFA delivery.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Frequency Electrograms Abolition as a Valuable Target for Remap During Ventricular Tachycardia Ablation. The HF REMAP Study.","authors":"Filippo Maria Cauti, Daniele Valente, Michele Magnocavallo, Nicolò Martini, Danilo Ricciardi, Francesco Fioravanti, Nikita Tanese, Pietro Rossi, Domenico Giovanni Della Rocca, Andrea Radinovic, Lorenzo Rampa, Federico Calore, Giovanni Peretto, Alberto Barengo, Paolo Della Bella","doi":"10.1016/j.hrthm.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.020","url":null,"abstract":"<p><strong>Background: </strong>peak frequency (PF) analysis has recently emerged as a novel tool to assess electrogram properties through their frequency spectrum. PF is an indirect marker of local myocardial activity, and its reduction after radiofrequency ablation reflects effective tissue modification.</p><p><strong>Objective: </strong>our study aims to evaluate PF analysis as an objective method to validate lesion efficacy during ventricular tachycardia (VT) ablation.</p><p><strong>Methods: </strong>we retrospectively analyzed 43 (out of 247) consecutive patients who underwent VT ablation between January 2023 and December 2024, using the EnSite X mapping system with Advisor HD Grid catheter (Abbott, Minneapolis, USA). Complete pre- and post-ablation high-density sinus rhythm maps were obtained. PF analysis was applied offline to quantify the residual high-frequency (HF) electrogram burden, expressed as a percentage of the ablated area. Patients were stratified according to residual HF burden, and outcomes were assessed with Kaplan-Meier survival analysis and Cox regression analysis.</p><p><strong>Results: </strong>During a median follow-up of 372 days, 11 patients reached the primary endpoint (VT recurrence or arrhythmic storm). Patients with <70% residual HF post-ablation had significantly higher VT-free survival (≈90% at 12 months) compared to those with ≥70% residual HF (≈25%; log-rank p<0.001). Cox regression confirmed residual HF ≥70% as an independent predictor of recurrence (HR 13.36; 95% CI 3.52-50.7; p<0.001).</p><p><strong>Conclusion: </strong>PF analysis during re-mapping provides an operator-independent, reproducible tool to validate lesion efficacy. A low post-ablation residual HF burden is associated to a significantly increased VAs-free survival rate.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of Tined Leadless Pacemaker Implantation: Patient Selection, Implant Volume, Center Characteristics, and Safety Trends.","authors":"Jonathan P Piccini, Lucas Higuera, Yunshu Yang, George Crossley, Mikhael F El-Chami","doi":"10.1016/j.hrthm.2026.10.014","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.014","url":null,"abstract":"<p><strong>Background: </strong>As leadless pacing approaches a decade in clinical practice, we sought to assess how device complications have changed over time, and how variations in patient, implanter volume, and facility characteristics are associated with these changes.</p><p><strong>Objective: </strong>To examine rates of cardiac perforations after leadless pacemaker implantation over time, and the associations between patient, implanter volume, and facility characteristics with these outcomes, including the extent of variation attributable to implanters and facilities.</p><p><strong>Methods: </strong>Medicare claims linked to a manufacturer's device registration data were used to identify patients implanted with a tined leadless pacemaker from 2017 to 2024. Patient selection across implanters and facilities was evaluated by examining differences in patient characteristics and their impact on patient-adjusted model estimates. Random-intercept models were fitted to estimate variation attributable to implanters and facilities.</p><p><strong>Results: </strong>Among 46,698 implants, 19,446 (41.6%) were Micra AV; patients had a mean age of 80.4 years and a high Charlson Comorbidity Index (4.7±3.4). Cardiac perforation rates declined over time (adjusted Coefficient -0.13, 95% CI -0.19 - -0.06, p-value<0.01). Higher implanter volume was associated with fewer perforations (OR 0.93 per additional 10 implants, 95% CI 0.88-0.98; p-value<0.01). Differences in patient characteristics across providers and facilities were observed; however, adjustment for these differences did not materially alter the associations between implanters and facility and perforation rates.</p><p><strong>Conclusion: </strong>In Medicare patients with tined leadless pacemakers, cardiac perforation rates declined over time and were lower in those implanted by more experienced implanters. Variation in outcomes was more closely associated with implanters than facilities.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic liver disease phenotypes and stroke risk in patients with atrial fibrillation: A nationwide population-based cohort study.","authors":"Young-Hae Go, So-Ryoung Lee, Jae-Hyun Kim, Seokmoon Han, JungMin Choi, Kyung-Yeon Lee, Hyo-Jeong Ahn, Soonil Kwon, Bongseong Kim, Kyung-Do Han, Seil Oh, Gregory Y H Lip, Eue-Keun Choi","doi":"10.1016/j.hrthm.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.016","url":null,"abstract":"<p><strong>Background: </strong>The updated nomenclature of steatotic liver disease (SLD) recognizes distinct phenotypes, including Metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Although cardiovascular risk may differ across SLD phenotypes, their association with stroke risk in patients with atrial fibrillation (AF) remains unclear.</p><p><strong>Objective: </strong>This study aimed to investigate the association between SLD phenotypes and ischemic stroke risk in AF patients.</p><p><strong>Methods: </strong>AF patients diagnosed between 2010 and 2018 were identified from the Korean health insurance database. According to SLD phenotype, patients were categorized into No-SLD, MASLD, MetALD, and ALD. The primary outcome was ischemic stroke. Subgroup analyses were conducted by CHA₂DS₂-VA score.</p><p><strong>Results: </strong>Among 196,242 patients (No-SLD: 101,308; MASLD: 77,715; MetALD: 8,678; ALD: 8,541), median follow-up was 5.9 years. Compared with No-SLD, MASLD was not associated with stroke risk (adjusted hazard ratio and 95% confidence interval; 1.00, 0.97-1.04), whereas MetALD and ALD were associated with higher risk (1.09, 1.00-1.18 and 1.16, 1.08-1.26, respectively). In exploratory subgroup analyses, the higher risk associated with alcohol-related phenotypes appeared more apparent at lower CHA₂DS₂-VA scores; however, the 6-year absolute risk differences were approximately 1% or less, and these findings are regarded as hypothesis-generating.</p><p><strong>Conclusion: </strong>In patients with AF, stroke risk was significantly higher in the alcohol-related SLD phenotypes, MetALD and ALD, whereas MASLD was not associated with stroke risk. These findings are consistent with the current recommendations for comprehensive risk-factor management in AF, with particular attention to alcohol intake in patients with alcohol-related SLD phenotypes.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Air Pollution Exposure and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis.","authors":"Ethan J Cannon, Joel D Kaufman, Thomas R Austin, Jeffrey R Misialek, Susan R Heckbert, David R Jacobs, Pamela L Lutsey","doi":"10.1016/j.hrthm.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.013","url":null,"abstract":"<p><strong>Background: </strong>Consistent evidence indicates that air pollution negatively impacts cardiovascular health. However, the relationship between air pollution and atrial fibrillation (AF) is unclear, and exposure measurement error has been a significant concern for prior studies.</p><p><strong>Objective: </strong>This prospective cohort study aimed to evaluate the association of chronic air pollution exposure and risk of AF.</p><p><strong>Methods: </strong>We used data from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort study conducted in 6 U.S. metropolitan areas. Concentrations of 4 pollutants (PM_2.5, NO₂, NO_x, and O₃) were assessed from 2000-2018 using hierarchical spatiotemporal models that incorporated cohort-specific monitoring to estimate ambient exposure at participants' residences. In Cox regression models, pollution estimates were represented as time-varying exposures, with 2-year rolling averages updated every 30 days. In our primary model, we adjusted for demographics and health behaviors.</p><p><strong>Results: </strong>Our study included 6618 participants (mean age 62; 53% female). Over 16.5 years median follow-up, we identified 1055 AF events. In our primary model, an interquartile range increment of NO₂ (13.5 ppb) was associated with 29% higher risk of AF (hazard ratio 95% CI: 1.00, 1.67). Associations with PM_2.5, NO_x, and O₃ were weaker but also directionally consistent with higher risk.</p><p><strong>Conclusion: </strong>We found evidence linking air pollution exposure to risk of incident AF. These results can be used to inform policy and other public health efforts aimed at alleviating the burden of AF, especially given that NO₂ exposure estimates (median 17.3 ppb) fell well below the current U.S. Environmental Protection Agency annual standard of 53 ppb.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Approaches to Coronary Venous Ethanol Ablation for Refractory Ventricular Arrhythmias: Technique Selection and Clinical Outcomes.","authors":"Takeshi Mori, Miyabi Ishikawa, Kohei Kitamura, Mami Fukuju, Teppei Funasaka, Makito Kaneshiro, Nobuo Ishiguro, Akimitsu Tanaka, Miyuki Ando, Hiroko Goto, Shinjiro Miyata, Kazuo Kato","doi":"10.1016/j.hrthm.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.012","url":null,"abstract":"<p><strong>Background: </strong>Coronary venous ethanol ablation (CVEA) is a promising alternative for refractory ventricular arrhythmias (VAs); however, it has limited availability, lacks guideline support, and comprises heterogeneous procedural techniques.</p><p><strong>Objective: </strong>To evaluate the acute efficacy, safety, and long-term outcomes of CVEA in refractory VAs and outline practical techniques of CVEA.</p><p><strong>Methods: </strong>Consecutive patients undergoing VA ablation at our center between December 2017 and December 2025 were screened; CVEA was performed after unsuccessful endocardial RFA. We performed CVEA using either tip injection, conventional double-balloon, or modified double-balloon techniques based on venous anatomy.</p><p><strong>Results: </strong>Among 204 consecutive patients undergoing VA ablation, 55 had VAs refractory to endocardial RFA. Of these, 42 with a coronary venous electrogram preceding VA onset by >20 ms underwent CVEA, including 33 with premature ventricular contraction (PVC) and 9 with ventricular tachycardia (VT). Acute success was achieved in 32/33 patients with PVC and all patients with VT. During a median follow-up of 1,024 days, long-term success was achieved in 22 patients with PVC and 5 with VT. No association was observed between intraprocedural findings and long-term recurrence. CVEA-related procedural complications occurred in 13 patients, with no fatal events reported. Exploratory analyses suggested favorable outcomes for the modified double-balloon technique in anatomically selected cases and an association between higher ethanol volume and ethanol-related complications.</p><p><strong>Conclusion: </strong>In patients with VAs refractory to endocardial RFA, CVEA was associated with favorable acute and long-term outcomes, with no fatal complications. Technique selection should be tailored to the venous anatomy, with judicious ethanol volume adjustment.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unipolar Electrograms at the Pulmonary Vein Antrum: Spatial and Directional Heterogeneity with Distinct Postablation Morphologies.","authors":"Ungjeong Do, Gi-Byoung Nam","doi":"10.1016/j.hrthm.2026.10.018","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.018","url":null,"abstract":"<p><strong>Background: </strong>Disappearance of the near-field S-wave in the unipolar electrogram (U-EGM) is commonly used to assess lesion formation during pulmonary vein (PV) isolation; however, interpretation of U-EGMs in anatomically complex atrial regions remains uncertain.</p><p><strong>Objective: </strong>We aimed to characterize spatial, directional, and postablation changes in antral PV U-EGMs, and evaluate the limitations of conventional waveform interpretation.</p><p><strong>Methods: </strong>In 15 patients undergoing radiofrequency ablation for atrial fibrillation, U-EGMs were recorded at 116 antral PV sites during sinus rhythm and distal coronary sinus (CS) pacing before and after ablation. U-EGM morphology and R- and S-wave amplitudes were analyzed.</p><p><strong>Results: </strong>Baseline U-EGMs showed spatial heterogeneity, with a small r and deep S in the right anterior PV antrum transitioning to a positive-dominant morphology (Rs) in the left-lower PV antra. Distal CS pacing altered the activation sequence, causing direction-dependent changes, most prominently in the right PV antrum. After ablation, overall S-wave amplitude decreased from -0.94 ± 0.70 to -0.08 ± 0.55 mV (P<0.001). Residual negative deflections ≥0.5 mV persisted in 18.1% (21/116) of recordings, frequently in association with direction-dependent far-field activity. Newly developed positive deflections ≥1.0 mV were observed in 17/116 sites (14.7%; mean 1.42 ± 0.42 mV), predominantly in the right-sided antra.</p><p><strong>Conclusions: </strong>Antral PV U-EGMs frequently represent composites of near- and far-field signals with spatial heterogeneity and direction-dependent variation. Postablation responses are diverse, including S-wave disappearance, residual negativity, often reflecting contributions from overlapping far-field components, and newly developed positive deflections. PV-antral U-EGMs should be interpreted in the context of their composite nature.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent class analysis-derived patterns of comorbidities in patients with atrial fibrillation, adherence to integrated care and impact on long-term outcomes: an analysis from a prospective cohort.","authors":"Marta Mantovani, Marco Vitolo, Davide A Mei, Niccolò Bonini, Paola Trapanese, Enrico Tartaglia, Matteo Paolini, Manuela Orlandi, Jacopo F Imberti, Giuseppe Boriani","doi":"10.1016/j.hrthm.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.011","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) commonly coexists with multiple cardiovascular (CV) and non-CV comorbidities, which may cluster in distinct clinical phenotypes with different outcome implications.</p><p><strong>Objective: </strong>We aim to identify comorbidity-based phenotypes in AF using latent class analysis (LCA), characterize their clinical course and assess the association of integrated care adherence with outcomes across phenotypes.</p><p><strong>Methods: </strong>A LCA based on 11 conditions (CV and non-CV) was performed. The primary outcome was a composite of all-cause death, thromboembolic (TE) events, and acute coronary syndrome (ACS). Secondary outcomes were all-cause death and ACS/TE events.</p><p><strong>Results: </strong>We included 1233 AF patients (median age 75 [66-82] years, females 37.5%). Four clinical LCA-derived phenotypes were identified: \"Low comorbidity\" (31.5%); \"Cardio-metabolic\" (33.9%); \"Elderly comorbid\" (22.9%); and \"Atherosclerotic-HF\" (11.8%). During a median follow-up of 542 days, 234 patients (22.7%) experienced the primary outcome. Compared to \"Low comorbidity\", \"Cardio-metabolic\" (aHR 1.64, 95% CI 1.13-2.39), \"Elderly comorbid\" (aHR 1.62, 95% CI 1.09-2.42) and \"Atherosclerotic-HF\" (aHR 2.81, 95%CI 1.83-4.34) phenotypes were independently associated with a higher risk of the primary outcome. Adherence to integrated care varied across phenotypes and was associated with a lower risk of adverse events, with no evidence of significant heterogeneity across phenotypes (p int=0.157).</p><p><strong>Conclusions: </strong>Latent class analysis identified distinct AF clinical phenotypes characterized by specific patterns of comorbidities and associated with different risk of adverse outcomes. The absence of significant heterogeneity in the association between integrated care and outcomes across phenotypes supports its potential value across different levels of clinical complexity in AF patients.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Risk-Based Anticoagulation After Atrial Fibrillation Ablation: ALONE-AF Post-Hoc Analysis.","authors":"Young Shin Lee, Jae-Sun Uhm, Junbeom Park, Daehoon Kim, Pil-Sung Yang, Hee Tae Yu, Tae-Hoon Kim, Jaemin Shim, Eue-Keun Choi, Il-Young Oh, Jun Kim, Jum-Suk Ko, Kyoung-Min Park, Jung-Hoon Sung, Hyung Wook Park, Hyoung-Seob Park, Jong-Youn Kim, Ki-Woon Kang, Dongmin Kim, Jin-Kyu Park, Dae-Hyeok Kim, Jin-Bae Kim, Hui-Nam Pak, Young Soo Lee, Boyoung Joung","doi":"10.1016/j.hrthm.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Discontinuation of oral anticoagulant (OAC) in patients without recurrent atrial arrhythmia after ablation for atrial fibrillation (AF) has been demonstrated to reduce composite outcomes of stroke, systemic embolism, and major bleeding compared with continued OAC.</p><p><strong>Objective: </strong>This study aimed to evaluate the optimal OAC strategy according to baseline stroke risk and AF recurrence.</p><p><strong>Methods: </strong>In this post-hoc analysis of the Long-Term Anticoagulation Discontinuation after Catheter Ablation for Atrial Fibrillation (ALONE-AF) trial, patients were stratified according to CHA₂DS₂-VASc score ≤2 and ≥3. Within each stratum, outcomes were compared between the OAC discontinuation and continuation subgroups. The cumulative incidence of stroke, systemic embolism, and major bleeding at 2 years was estimated using the Kaplan-Meier method, with competing risk analysis accounting for AF recurrence.</p><p><strong>Results: </strong>Among 840 patients, 584 and 256 had a CHA₂DS₂-VASc score ≤2 (mean age 62.0±7.5 years, 15.9% female) and ≥3 (mean age 68.9±7.3 years, 45.3% female), respectively. In the CHA₂DS₂-VASc ≤2 stratum, the primary outcome occurred in one patient (0.4%) in discontinuation subgroup vs. six (2.4%) in continuation subgroup (absolute difference -1.9 percentage points, P=0.066). In the CHA₂DS₂-VASc ≥3 stratum, two events (1.8%) occurred in the continuation subgroup only (absolute difference -1.8 percentage points, P=0.172). All major bleeding events (n=5) occurred in the continuation subgroups. Competing risk analysis yielded consistent results.</p><p><strong>Conclusions: </strong>In this exploratory post-hoc analysis, no statistically significant differences in outcomes were observed between OAC strategies when stratified by CHA₂DS₂-VASc score, though event numbers were limited. Larger prospective trials are needed to confirm these observations.</p><p><strong>Trial registrations: </strong>ClinicalTrials.gov Identifier: NCT04432220.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Fibrosis as an Arrhythmogenic Substrate: Integrating Genetics, Imaging and Invasive Electrophysiology for Sudden Death Risk Stratification.","authors":"Raimondo Pittorru, Deni Kukavica, Nicola Pierucci, Joan Llevadot-Sesmilo, Pranav Bhagirath, Alessandro Trancuccio, Domenico Corrado, Andreu Porta-Sanchez, Ivo Roca-Luque","doi":"10.1016/j.hrthm.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.10.010","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}