Heart rhythm最新文献

{"title":"ERBB4 Activation as a New Therapy for Atrial Remodeling and Fibrillation.","authors":"Jens van Fraeyenhove, Michiel R L Tubeeckx, Bo Goovaerts, Yile Fu, Juan Zhang, Sven O Dekker, Arthur Bezerra, Tim De Coster, Julie Cools, Eike M Wülfers, Siel Van den Bogaert, Tine Bruyns, Bernard Thienpont, Samuel L Murphy, Antoine A F de Vries, Erik Fransen, Nele Vandersickel, Daniël A Pijnappels, Guido R Y De Meyer, Hein Heidbuchel, H Llewelyn Roderick, Vincent F M Segers, Gilles W De Keulenaer","doi":"10.1016/j.hrthm.2026.04.051","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.051","url":null,"abstract":"<p><strong>Background: </strong>The neuregulin-1 (NRG1)/ERBB signaling system is essential for cardiac embryonic development and function. Its activation during heart failure (HF) exerts compensatory effects by acting on cardiomyocytes and mitigating ventricular fibrosis.</p><p><strong>Objective: </strong>We investigated whether selective ERBB4 activation suppresses atrial fibrillation (AF) in minipigs and mice in the absence of heart failure, and assessed effects on atrial cardiomyocytes and atrial fibrosis. ERBB4 stimulation was achieved using JK07, a recombinant fusion protein consisting of a receptor-activating fragment of human NRG1 and a humanized antagonistic ERBB3 immunoglobulin G1 antibody.</p><p><strong>Methods: </strong>To increase AF susceptibility, minipigs were exposed to deoxycorticosterone acetate (DOCA) and mice were fed a high-fat diet (HFD). AF was induced by programmed electrical stimulation. Atrial fibrosis was quantified histologically, and transcriptomic profiling of atrial cardiomyocytes was performed in minipigs. Atrial cardiomyocyte-intrinsic anti-arrhythmic effects were evaluated in HFD mice and in human conditionally immortalized atrial myocytes (hiAMs) using optical voltage mapping.</p><p><strong>Results: </strong>JK07 significantly reduced AF inducibility and total AF duration in both DOCA minipigs and HFD mice, without affecting the atrial effective refractory period. In minipigs, JK07 attenuated atrial fibrosis, prevented conduction slowing, and reversed disease-associated atrial cardiomyocyte transcriptional remodeling. In contrast, HFD mice exhibited minimal atrial fibrosis, which was not affected by JK07, suggesting an atrial cardiomyocyte-intrinsic anti-arrhythmic mechanism. Consistently, JK07 completely suppressed pacing-induced re-entrant activity in hiAMs without affecting action potential duration or conduction velocity.</p><p><strong>Conclusion: </strong>ERBB4 activation by JK07 suppresses AF-inducibility in 2 independent models and has effects on both atrial structural remodeling and cardiomyocyte-intrinsic arrhythmogenic mechanisms.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837173","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":"Long-term outcomes among patients with and without psychiatric disorders following Out-of-Hospital Cardiac Arrest.","authors":"Carlo Alberto Barcella, Brian E Grunau, Meijiao Guan, May K Lee, Graham C Wong, Jim Christenson, Kristian H Kragholm, Karin H Humphries, Christopher B Fordyce","doi":"10.1016/j.hrthm.2026.04.057","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.057","url":null,"abstract":"<p><strong>Background: </strong>Current literature lacks comprehensive data on the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) in patients with psychiatric disorders.</p><p><strong>Objective: </strong>To assess the association between prehospital OHCA-characteristics and post-OHCA survival according to pre-OHCA psychiatric status.</p><p><strong>Methods: </strong>We classified adult patients with non-traumatic OHCA in the British Columbia Cardiac Arrest registry (2009-2016) according to whether they had a pre-OHCA psychiatric disorder. We used multiple logistic regression, examining the full cohort and within Utstein-defined subgroups.</p><p><strong>Results: </strong>Among 9173 OHCAs (median age 70 years, 67% male), 4438 (46%) had a pre-existing psychiatric disorder. In adjusted analyses, patients with psychiatric disorders were associated with lower odds of OHCA in public locations (OR: 0.64, 95% confidence interval [CI], 0.57-0.73), witnessed OHCA (OR: 0.75 [CI, 0.69-0.82]), bystander CPR (OR: 0.86 [CI, 0.79-0.95]), bystander applied AED (OR: 0.56 [CI, 0.41-0.77]) or initial shockable rhythm (OR: 0.54 [CI, 0.49-0.61]) compared with patients without psychiatric disorders. Psychiatric disorders were associated with lower odds of 30-day post-OHCA survival (OR: 0.72, [CI 0.63-0.82]) compared to patients without psychiatric disorders. However, among those with bystander witnessed OHCA who received CPR (OR: 1.04 [CI, 0.79-1.34]) and those with initial shockable rhythm who achieved return of spontaneous circulation upon hospital arrival (OR: 0.89 [CI, 0.70-1.13]), we did not detect an association between psychiatric disorders and 30-day survival.</p><p><strong>Conclusions: </strong>Pre-existing psychiatric disorders are associated with lower odds of 30-day OHCA survival, primarily due to unfavourable pre-hospital factors, including limited bystander intervention.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837226","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":"TWOSOME trial: Randomized comparison of single-shot versus single-tip pulsed field ablation for pulmonary vein isolation.","authors":"Stefan Hartl, Nico Reinsch, Anna Füting, Kars Neven","doi":"10.1016/j.hrthm.2026.04.049","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.049","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is an emerging technology to perform pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data between different PFA systems are scarce.</p><p><strong>Objectives: </strong>To provide the first head-to-head evaluation of two PFA technologies for index PVI.</p><p><strong>Methods: </strong>Paroxysmal AF patients were 1:1 randomized to single-shot (pentaspline catheter) or single-tip PFA (focal contact-force sensing ablation catheter). The primary endpoint was arrhythmia-free survival at 12 months; secondary endpoints included procedural characteristics, safety, and biomarker assessments.</p><p><strong>Results: </strong>One hundred patients were assigned to the single-shot or the single-tip PFA group. Baseline characteristics were comparable. Acute PVI was achieved in 100%. Single-shot PFA reduced total procedure time (44 ± 11 min vs. 119 ± 30 min, p <0.001) but required longer fluoroscopy time (14 ± 5 min vs. 4 ± 2 min, p <0.001). New onset arrhythmias (6%) could only be treated in the single-tip PFA group. Major complications included 1 non-PFA related stroke (single-shot group) and 1 pericardial tamponade during single-tip PFA. No permanent sequelae occurred. Troponin levels were higher with single-tip PFA. At 12 months, arrhythmia-free survival was 76% (single-shot group) and 82% (single-tip group), respectively (p = 0.46).</p><p><strong>Conclusions: </strong>Both PFA systems achieved high acute PVI rates with favorable 1-year clinical outcomes. Single-shot PFA was associated with shorter procedure times and longer fluoroscopy times, whereas single-tip PFA allowed adjunctive ablation when required and was associated with higher postprocedural troponin T levels.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837234","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":"Global Research Trends in Cancer-Associated Atrial Fibrillation: A Bibliometric Analysis of the Cardio-Oncology Interface.","authors":"Zongrong Lin, Xuehua Chen, Sicheng Chen, Yining Dai, Yang Liu, Xiaojuan Pei, Zhenyang Fu","doi":"10.1016/j.hrthm.2026.04.050","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.050","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is increasingly common in patients with cancer and is associated with higher risks of stroke, bleeding, and mortality. The growing intersection between cancer and AF presents important challenges for anticoagulation management and cardiovascular risk assessment in cardio-oncology.</p><p><strong>Objective: </strong>To systematically characterize the global research landscape, thematic structure, and developmental trajectory of cancer-AF research.</p><p><strong>Methods: </strong>A bibliometric analysis of studies published between 1995 and 2025 was conducted using WoSCC, PubMed, and Scopus. WoSCC served as the primary data source for analyses of publication trends, collaboration, thematic structure, journal co-citation, and citation pathways, while PubMed and Scopus were used for cross-database comparison.</p><p><strong>Results: </strong>Annual publication output increased markedly across all three databases. Research activity was concentrated in a limited number of highly productive countries, institutions, and author groups, with collaboration networks centered on major hubs. Thematic analyses identified a clinically oriented core focused on AF, cancer, stroke, anticoagulation, bleeding, and therapy-related cardiovascular risk. Temporal analyses showed a shift from early treatment-related cardiac complications toward risk stratification, targeted therapy safety, cardiotoxicity, and data-driven approaches. Journal analyses demonstrated sustained interdisciplinary exchange among oncology, cardiovascular medicine, and basic biomedical science.</p><p><strong>Conclusions: </strong>Cancer-AF research has evolved into a structured interdisciplinary subfield within cardio-oncology. This field is characterized by growing attention to anticoagulation management, therapy-associated arrhythmia risk, and precision-oriented care. These findings provide a reference framework for future research priorities and may support more integrated cardiovascular risk assessment and management in patients with cancer.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837170","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":"Use of rhythm control therapy for atrial fibrillation among Veterans in the Southeastern United States by rurality.","authors":"Anthony L Lin, William Bryan, Marc Pepin, Ricardo Pietrobon, Ryan Crossgrove, Kelli Allen, Jorge A Gutierrez, Jonathan P Piccini, Zak Loring","doi":"10.1016/j.hrthm.2026.04.048","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.048","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) affects up to 6 million adults, approximately 1 million of whom receive care through the Veterans Health Administration (VA). Considering advanced rhythm control interventions like catheter ablation are often limited to higher-resourced urban care settings, disparities may disproportionately affect the VA patient population given the 4.6 million Veterans who live in rural communities.</p><p><strong>Objective: </strong>To assess differences in use of or time to rhythm control therapy based on rurality.</p><p><strong>Methods: </strong>This was a retrospective study of 21,600 Veterans with AF and no preceding heart failure (HF) in the VA Mid-Atlantic Health Care Network. Utilization of diagnostic testing and therapeutic interventions were assessed by total use and time from AF diagnosis.</p><p><strong>Results: </strong>Mean age at AF diagnosis was 72 years, 97.9% were male, 79.8% self-identified as White, and 24.9% lived in rural communities. No differences were observed in the use of rhythm control therapies based on rurality (antiarrhythmic prescriptions 20.1%, 20.9%, and 20.6% and catheter ablation 2.2%, 1.6%, and 2.1% for urban, large rural, and isolated rural settings, respectively; p>0.05 for both comparisons). However, low utilization rates and delays in time to rhythm control therapy, including catheter ablation (median time 2.6 years), were appreciated across the rural-urban spectrum.</p><p><strong>Conclusions: </strong>No major clinical differences were revealed in use of or time to rhythm control therapy based on rurality in the VA. However, low utilization rates and delays to therapy across the rural-urban spectrum warrants additional investigation to identify systemic drivers that may disproportionately affect the VA patient population.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837244","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":"The Importance of Lead Management in the Transcatheter Tricuspid Valve Intervention Era.","authors":"Nicholas J Beccarino, Aditya Goyal, Zachary Ostreicher, James K Gabriels, Moussa Saleh, Elana Koss, Bruce Rutkin, Laurence M Epstein","doi":"10.1016/j.hrthm.2026.04.045","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.045","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous transcatheter tricuspid valve replacement (TTVR) has emerged as an effective treatment for severe tricuspid regurgitation (TR). Management of TR in the setting of transvenous leads is complex, requiring a multidisciplinary team-based approach. Transvenous lead extraction (TLE) may improve or worsen lead related TR and is important when considering TTVR to avoid \"jailing\" leads between the transcatheter and native tricuspid valve. Data and guidance in these settings are limited.</p><p><strong>Objective: </strong>Our objective was to describe the outcomes of a strategy using TLE in patients with severe TR and a lead crossing the tricuspid valve that were being considered for catheter based tricuspid valve intervention (TTVR or tTEER).</p><p><strong>Methods: </strong>This study included all patients who underwent TLE for TR between July 2020 and July 2025 at a single high volume extraction center. Demographic characteristics, procedural details, and clinical outcomes were analyzed.</p><p><strong>Results: </strong>The study included 24 patients, 14 (58.3%) women with a mean age of 73.7 years, with severe TR and transvenous leads being considered for tricuspid valve intervention. Complete TLE procedural success was achieved in all patients. Eleven patients (46%) experienced reduction in TR post extraction, eliminating the need for further tricuspid intervention in 8 patients (33%). Of the remaining patients, 12 (75%) underwent subsequent tricuspid valve intervention. There were three mortalities during the study, none of which were procedure related.</p><p><strong>Conclusion: </strong>In our series, TLE was a safe and efficacious approach to reduce the degree of TR or serve as a bridge to tricuspid intervention.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814368","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":"Alert Tone Perceptibility and MRI-Associated Dysfunction in S-ICDs: A Prospective Multicenter Study.","authors":"Jonas Wörmann, Clarissa Hausmann, Yuri Bocchini, Thomas Fink, Stjepan Jurisic, Alexander Breitenstein, Philipp Sommer, Vanessa Sciacca, Sebastian Dittrich, Henning Guthoff, Oliver Wilson, Jan Grobecker, Theodoros Maximidou, Jana Ackmann, Friederike Pavel, Jan-Hendrik van den Bruck, Jan-Hendrik Schipper, Daniel Steven, Jakob Lüker","doi":"10.1016/j.hrthm.2026.04.040","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.040","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814243","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":"Subcutaneous ICD Therapy in Patients with Prior Sternotomy: Feasibility and Long-Term Outcomes in a Propensity-Matched Analysis from a National Registry.","authors":"Luca Checchi, Laura Perrotta, Matteo Ziacchi, Federico Migliore, Stefano Viani, Berardo Sarubbi, Paolo De Filippo, Giovanni Bisignani, Carlo Lavalle, Valter Bianchi, Valeria Rella, Ennio C Pisanò, Luca Santini, Giuseppe Mascia, Domenico Pecora, Roberta Brambilla, Giovanni Luca Botto, Luca Ottaviano, Roberto Rordorf, Massimo S Silvetti, Pietro Francia, Gerardo Nigro, Antonio Bisignani, Raimondo Pittorru, Mariolina Lovecchio, Sergio Valsecchi, Mauro Biffi, Giuseppe Ricciardi","doi":"10.1016/j.hrthm.2026.04.041","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.041","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814249","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":"Dual-Chamber Pacing from a Single Leadless Device: Preclinical Implant and Retrieval Feasibility Study.","authors":"Jonathan P Piccini, Kaileigh Hayden, Alexander R Mattson, Kathryn Hilpisch, Kent Wika, Kyoko Soejima","doi":"10.1016/j.hrthm.2026.04.039","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.039","url":null,"abstract":"<p><strong>Background: </strong>Sequential atrioventricular pacing can be accomplished with separate atrial and ventricular devices. Integration of atrial and ventricular pacing within a single leadless device represents a novel approach to dual-chamber pacing.</p><p><strong>Objective: </strong>To demonstrate the feasibility of single device leadless dual-chamber pacing (DDD) in an ovine model by assessing implant safety, chronic electrical performance, and chronic device retrieval.</p><p><strong>Methods: </strong>Twelve sheep were implanted with a leadless DDD pacemaker in the triangle of Koch (TOK) via a jugular venous approach. Chronic electrical performance through 6-months was assessed using periodic cardiac monitoring. At 6-months, half of the devices were retrieved using a custom retrieval system, followed by attempted reimplantation of a new leadless DDD device in the TOK.</p><p><strong>Results: </strong>Device implantation was successful in all twelve sheep, with no major complications through 6-months. At 6-months, the mean capture threshold was 0.6±0.2V@0.24ms at 402±80Ω for atrial pacing and 1.2±0.2V@0.24ms at 531±258Ω for ventricular pacing. Average P-wave and R-wave amplitudes were 2.2±1.0mV and 4.9±3.7mV, respectively. All six leadless pacemakers were successfully retrieved without complication (mean retrieval time 20±3 minutes). All 6 animals were reimplanted with a new device in the TOK, with 5/6 achieving dual-chamber capture on the first attempt.</p><p><strong>Conclusion: </strong>This study demonstrates the proof-of-concept and feasibility of fully leadless DDD pacing via a single device implanted in the TOK, including chronic pacing efficacy, and successful retrieval through 6-months.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814270","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":"Identification of Clinical Risk Factors for Arrhythmia Recurrence in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Systematic review and Meta-analysis.","authors":"Kimmy W P Chan, Doris S F Yu, Joshua W K Ho, Cathy W Y Wong, Polly W C Li","doi":"10.1016/j.hrthm.2026.04.046","DOIUrl":"https://doi.org/10.1016/j.hrthm.2026.04.046","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmia recurrence after atrial fibrillation (AF) catheter ablation remains a substantial clinical challenge, but risk factors of arrhythmia recurrence are not well defined.</p><p><strong>Objective: </strong>This study aimed to elucidate baseline clinical risk factors for post-ablation recurrence and variations by AF phenotype and study heterogeneity.</p><p><strong>Methods: </strong>We systematically searched eight databases for prospective cohort studies assessing associations between clinical risk factors and post-ablation arrhythmia recurrence up to 31 December 2025. Study quality was evaluated using Newcastle-Ottawa scale. Multivariable-adjusted hazard ratios (aHRs) were pooled through random-effects meta-analyses with subgroup, meta-regression, and sensitivity analyses.</p><p><strong>Results: </strong>Among 152 studies involving 49,919 patients, 16 clinical risk factors were identified. In primary meta-analysis pooling aHRs, the strongest associations were observed for smoking (aHR:2.15 [1.49-3.10)]), periodontitis (aHR:2.04 [1.48-2.83]), metabolic syndrome (aHR:1.71 [1.12-2.62]), sleep apnea (aHR:1.65 [1.31-2.09]) and persistent AF (aHR:1.64 [1.53-1.76]), followed by chronic kidney disease, alcohol consumption, overweight/ obesity, diabetes mellitus, female sex, hypertension, AF history, left atrial enlargement and impaired left ventricular ejection fraction. Untreated sleep apnea (aHR:2.41 [1.51-3.86]) and uncontrolled hypertension (aHR:1.67 [1.12-2.40]) conferred heightened risks. Sensitivity analyses pooling adjusted odds ratios (aORs) additionally identified depression (aOR:2.86 [1.51-5.41]), anxiety (aOR:2.54 [1.59-4.04]). Subgroup analyses revealed no difference across AF phenotypes. Meta-regression identified ablation modality as a significant moderator for AF history, and geographic region for female sex, heart failure and diabetes.</p><p><strong>Conclusions: </strong>Expanded pre-ablation risk profiles with consistent effect across AF phenotypes substantiate personalized risk stratification for ablation candidacy and pre-procedural optimization.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814223","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}