Heart rhythm最新文献

{"title":"Consequences of electrocardiography screening for prolonged QTc in neonates - A systematic review.","authors":"Anna Leppänen, Emmi Helle, Ilari Kuitunen","doi":"10.1016/j.hrthm.2025.02.045","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.02.045","url":null,"abstract":"<p><strong>Background: </strong>An ongoing discussion has been the effectiveness of neonatal ECG screening for long QT syndrome (LQTS).</p><p><strong>Objective: </strong>T0 assess the consequences of ECG screening for prolonged corrected QT (QTc) interval in infants under one month of age.</p><p><strong>Methods: </strong>We searched the PubMed, Scopus, and Web of Science databases in June 2024. The incidence rates of prolonged QTc, defined as >450ms, were calculated per 1,000 neonates. Prolonged QTc cases, including normalization during follow-up, LQTS diagnosis, or sudden infant death syndrome (SIDS), were analyzed.</p><p><strong>Results: </strong>Eight studies were included. Five studies using a cutoff QTc >450ms reported incidences ranging from five (95 % confidence interval (CI: 5-6) to 79 (CI: 60-102) per 1,000 neonates. Six studies with a cutoff of >460ms reported incidences ranging from one (CI: 1-2) to 53 (CI: 50-57). Five studies (cutoff QTc >470ms) had incidences varying from 1 (CI 0-1) to 28 (CI 21-35). In six studies, QTc normalization during follow-up occurred in 57.1% to 95.2% of neonates with prolonged QTc. The diagnosis of LQTS was reported in four studies, with 21 out of 51,817 (0.04%) neonates later diagnosed with LQTS. Two studies reported SIDS outcomes, finding prolonged QTc in 8/24 and 3/3 of SIDS cases.</p><p><strong>Conclusion: </strong>The incidence of prolonged QTc varied widely across studies. Only a small proportion of neonates with prolonged QTc were diagnosed with LQTS during follow-up. Further research with standardized study factors and comprehensive genetic analysis is needed to determine the utility of and indications for neonatal ECG screening.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572805","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":"Prevalence and cardiac risk of Familial ST-depression Syndrome: A study of 12 million electrocardiograms.","authors":"Rasmus Frosted, Kathrine Kold Sørensen, Mikkel Porsborg Andersen, Christoffer Polcwiartek, Chaoqun Zheng, Helle Collatz Christensen, Kristian Hay Kragholm, Claus Graff, Christian Torp-Pedersen, Alex Hørby Christensen","doi":"10.1016/j.hrthm.2025.02.048","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.02.048","url":null,"abstract":"<p><strong>Background: </strong>Familial ST-depression Syndrome (Fam-STD) is a recently identified inherited cardiac disease characterized by a distinct electrocardiographic phenotype and occurrence of arrhythmias and heart failure.</p><p><strong>Objective: </strong>We aimed to investigate the electrocardiographic prevalence of the Fam-STD and its association with cardiac events in a large, nationwide cohort.</p><p><strong>Methods: </strong>We used a Danish nationwide ECG database containing 11,952,430 ECGs, from 2,485,987 unique individuals. We excluded ECGs from children <15 years and ECGs with likely secondary causes of ST-segment deviations. The Fam-STD phenotype prevalence was assessed according to the original (Fam-STD-2018) and revised (Fam-STD-2022 probands/relatives) proposed diagnostic criteria. Through linkage with national registries, we evaluated the risk of a composite cardiac endpoint (new-onset atrial fibrillation, ventricular arrhythmias, heart failure, cardiac device implantation) and all-cause mortality using cox proportional hazard models.</p><p><strong>Results: </strong>A total of 6,352,104 ECGs (1,890,184 individuals; 55% females; 3.4 ECGs per individual) remained after application of the exclusion criteria. We found 56 (3/100,000) individuals fulfilling Fam-STD-2018, 173 (9/100,000) fulfilling Fam-STD-2022-probands, and 4,975 (263/100,000) fulfilling Fam-STD-2022-relatives criteria. During a mean follow-up of 2.4±3.4 years we observed increased risks of the composite cardiac endpoint (hazard ratio (HR) 4.4[CI:1.2-15.9], 3.6[CI:2-6.5], 2.21[CI:2-2.5]) and all-cause mortality (HR 6.2[CI:3.6-10.6], 3.1[CI:1.7-1.9], 1.8[CI:1.7-1.9]), for Fam-STD-2018, Fam-STD-2022-probands and Fam-STD-2022-relatives, respectively, compared to matched controls without ST-deviation.</p><p><strong>Conclusion: </strong>The Fam-STD ECG proband phenotype is rare and has a prevalence in Denmark of 3-9/100,000, fairly similar to estimates of other inherited arrhythmia syndromes. The increased risk of cardiac events and mortality highlights the importance of early identification to allow preventive interventions.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572760","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":"Incidence of Arrhythmias in Chronic Obstructive Pulmonary Disease, Obstructive Sleep Apnea and Overlap Syndrome: A Retrospective Cohort Study.","authors":"Hoang Nhat Pham, Christopher Kanaan, Ramzi Ibrahim, Mahmoud Abdelnabi, Sabrina Soin, George Bcharah, Eiad Habib, Omar Baqal, Juan Farina, Jiang Xie, Amitoj Singh, Chadi Ayoub, Reza Arsanjani, Justin Z Lee, Hicham El Masry, Dan Sorajja, Anwar A Chahal","doi":"10.1016/j.hrthm.2025.02.042","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.02.042","url":null,"abstract":"<p><strong>Background: </strong>New-onset arrhythmias are common in patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). However, scarce data exists regarding arrhythmia risk in overlap syndrome (OS), encompassing COPD and OSA.</p><p><strong>Objective: </strong>We compared the incidence of new onset atrial and ventricular arrhythmias in patients with COPD, OSA, and OS.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX Network, comprising >140 million patients to identify patients with COPD, OSA, and OS. Patients with pre-existing arrhythmias were excluded. Propensity score matching (PSM) was used to adjust for demographics, comorbidities, and medications. Adjusted odds ratios (aORs) were estimated to compare incidence of arrhythmias across cohorts.</p><p><strong>Results: </strong>Between 2010-2020, a total of 2,438,454 patients with COPD-only, 1,960,845 with OSA-only, and 440,018 with OS (age≥18 years) were identified. After PSM, we included 359,496 patients per cohort for the OS versus OSA-only comparison and 399,235 patients per cohort for the OS versus COPD-only comparison. Over a mean follow-up of 5.3 years, new-onset atrial fibrillation/flutter incidence was 10.0% in OS vs. 7.0% in COPD (aOR 1.472, 95%CI 1.449-1.496) and 6.4% in OSA (aOR 1.568, 95%CI 1.541-1.595). Patients with OS had higher incidence of new-onset ventricular tachycardia and cardiac arrest than those with COPD (aOR 1.442 and 1.189, respectively) and OSA (aOR 1.645 and 1.777, respectively). Patients with COPD preceding OSA diagnosis had higher odds of new-onset arrhythmias.</p><p><strong>Conclusion: </strong>Patients with OS have a higher incidence of new-onset atrial fibrillation/flutter, ventricular tachycardia, and cardiac arrest compared to those with OSA and COPD alone.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566919","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":"Risk scores inconsistently predict sudden death and ventricular arrhythmias in repaired tetralogy of Fallot.","authors":"Jayant Kakarla, Ayako Ishikita, Adrian Suszko, Rachel Wald, Krishnakumar Nair","doi":"10.1016/j.hrthm.2025.02.041","DOIUrl":"https://doi.org/10.1016/j.hrthm.2025.02.041","url":null,"abstract":"<p><strong>Background: </strong>Risk scores designed to predict adverse events (AE) including sudden death and ventricular arrhythmias can guide heightened surveillance and defibrillator (ICD) implantation. Variability in risk stratification derived from differing scores and guidelines has not been examined in repaired tetralogy of Fallot (rTOF).</p><p><strong>Objectives: </strong>To determine the consistency in AE risk prediction across published scoring systems in rTOF patients without a secondary prevention ICD indication.</p><p><strong>Methods: </strong>We undertook a retrospective review of rTOF patients without a secondary prevention ICD indication or severe left ventricular impairment from an institutional database. Predicted AE was calculated across five published scores and three clinical management guidelines. The prediction of a \"high-risk\" cohort, using a 4% predicted AE threshold, was compared across the scoring criteria. Observed AE, ICD implantation and device complications were recorded.</p><p><strong>Results: </strong>156 patients (median 32, IQR 25 - 46 years; 53% female) had four AEs (three sustained VT, one sudden death) over a median of 24 months (IQR 15 - 36 months). In total, 41% of patients (n=64) had risk score variability impacting assignment of high-risk status. Heterogeneity in the predicted AE risk was associated with moderate or worse RV impairment or significant late gadolinium enhancement (p<0.001). No criteria predicted all AE with two events only predicted by one score. Seven ICD implants treated three sustained VT episodes with three device related complications.</p><p><strong>Conclusion: </strong>Risk scores are heterogeneous and imperfect for determination of those at high risk of AE in rTOF. Use of multiple criteria alongside adjuvant stratification strategies and multidisciplinary discussion remains necessary.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566920","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":"Decisional conflict and defibrillator implantation choices among Black women and men with chronic systolic heart failure","authors":"Lonnie T. Sullivan II MD ,&nbsp;Andrew J. Maul MD, MBA ,&nbsp;Rebecca Young MS ,&nbsp;Brian C. Boursiquot MD, MS ,&nbsp;Apurva Khedagi MD ,&nbsp;Brooke Alhanti PhD ,&nbsp;Larry R. Jackson II MD, MHSc ,&nbsp;Kevin L. Thomas MD","doi":"10.1016/j.hrthm.2024.07.026","DOIUrl":"10.1016/j.hrthm.2024.07.026","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 627-628"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727055","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":"Late gadolinium enhancement in early repolarization syndrome","authors":"Hiroshi Morita MD, PhD ,&nbsp;Saori Asada MD, PhD ,&nbsp;Satoshi Nagase MD, PhD ,&nbsp;Akira Ueoka MD, PhD ,&nbsp;Takuro Masuda MD ,&nbsp;Masakazu Miyamoto MD, PhD ,&nbsp;Koji Nakagawa MD, PhD ,&nbsp;Nobuhiro Nishii MD, PhD ,&nbsp;Shinsuke Yuasa MD, PhD","doi":"10.1016/j.hrthm.2024.07.116","DOIUrl":"10.1016/j.hrthm.2024.07.116","url":null,"abstract":"<div><h3>Background</h3><div>In patients with Brugada syndrome, myocardial fibrosis can be identified through epicardial biopsy or cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). However, the myocardial alterations in patients with early repolarization syndrome (ERS) remain poorly elucidated.</div></div><div><h3>Objective</h3><div>The objective of this study was to investigate the presence of myocardial fibrosis in patients with ERS by LGE in CMR.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated 20 patients with ERS, all of whom exhibited J waves in the contiguous 2 leads. The location of J waves was classified as in the septum (V₁-V₂), anterior (V₃-V₄), lateral (I, aVL, V₅-V₆), inferior (II, III, aVF), or posterior (V₇-V₉) regions. To compare the distribution of LGE on CMR imaging with J waves, sections on short-axis view of the left ventricle (LV) were categorized as located in the septum, anterior, lateral, inferior, and posterior regions.</div></div><div><h3>Results</h3><div>Overall, 85% of ERS patients displayed LGE, which was more prevalent in the septum and posterior regions, followed by the inferior and lateral regions. The presence or absence of J waves and LGE coincided in 61% of LV areas, whereas discordance between the distributions of J waves and LGE was observed in 38%. LGE was most frequent in the septum (75%), where its reflection in J waves may be less robust. The appearance of LGE was not associated with symptoms, electrical storm, or ventricular fibrillation occurrence during follow-up.</div></div><div><h3>Conclusion</h3><div>LGE is common in patients with ERS, and the distribution of J waves and LGE coincides in approximately 60% of LV areas.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 767-775"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878571","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":"Detection of cardiac sarcoidosis with the artificial intelligence–enhanced electrocardiogram","authors":"Jose F. de Melo Jr. MD ,&nbsp;Kathryn E. Mangold PhD ,&nbsp;Julia Debertin MPH ,&nbsp;Andrew Rosenbaum MD ,&nbsp;John P. Bois MD ,&nbsp;Zachi I. Attia PhD ,&nbsp;Paul A. Friedman MD ,&nbsp;Abhishek J. Deshmukh MBBS ,&nbsp;Suraj Kapa MD ,&nbsp;Leslie T. Cooper MD ,&nbsp;Omar F. Abou Ezzeddine MD, MS ,&nbsp;Konstantinos C. Siontis MD","doi":"10.1016/j.hrthm.2024.08.013","DOIUrl":"10.1016/j.hrthm.2024.08.013","url":null,"abstract":"","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 859-861"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912434","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":"Management of ultrarare inherited arrhythmia syndromes","authors":"Thomas M. Roston MD, PhD ,&nbsp;Vassilios J. Bezzerides MD, PhD ,&nbsp;Jason D. Roberts MAS, MD ,&nbsp;Dominic J. Abrams MBBS, MD, MBA","doi":"10.1016/j.hrthm.2024.08.023","DOIUrl":"10.1016/j.hrthm.2024.08.023","url":null,"abstract":"<div><div>Ultrarare inherited arrhythmia syndromes are increasingly diagnosed as a result of increased awareness as well as increased availability and reduced cost of genetic testing. Yet by definition, their rarity and heterogeneous expression make development of evidence-based management strategies more challenging, typically employing strategies garnered from similar genetic cardiac disorders. For the most part, reliance on anecdotal experiences, expert opinion, and small retrospective cohort studies is the only means to diagnose and to treat these patients. Here we review the management of specific ultrarare inherited arrhythmic syndromes together with the genetic and molecular basis, which will become increasingly important with the development of targeted therapies to correct the biologic basis of these disorders.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 832-843"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999785","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":"Incidence and outcomes of cardiovascular implantable electronic device infections in patients with end-stage kidney disease","authors":"Sania Jiwani MBBS ,&nbsp;Wan-Chi Chan MBBS ,&nbsp;Akshaya Gadre MBBS ,&nbsp;Seth Sheldon MD, FHRS ,&nbsp;Jinxiang Hu PhD ,&nbsp;Rhea Pimentel MD, FHRS ,&nbsp;Amit Noheria MBBS, SM ,&nbsp;Kamal Gupta MBBS","doi":"10.1016/j.hrthm.2024.09.016","DOIUrl":"10.1016/j.hrthm.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>End-stage kidney disease (ESKD) patients are prone to bloodstream infections that may result in a higher risk of cardiac implantable electronic device (CIED) infections.</div></div><div><h3>Objective</h3><div>The objective of this study was to assess the incidence, risk predictors, management strategies, and long-term outcomes of CIED infections in ESKD patients undergoing de novo CIED implantation.</div></div><div><h3>Methods</h3><div>This is a retrospective study using the United States Renal Data System. ESKD patients with de novo CIED implantation between January 1, 2006, and September 30, 2014, were included. Patients were observed until death, kidney transplantation, end of Medicare coverage, or September 30, 2015, to assess incidence of CIED infection. Management approach was determined from procedure codes for lead extraction within 60 days of CIED infection diagnosis. Patients with CIED infection were observed until December 31, 2019, to assess long-term outcomes.</div></div><div><h3>Results</h3><div>Of 15,515 ESKD patients undergoing de novo CIED implantation, incidence of CIED infection was 4.8% during a median follow-up of 1.3 years. The presence of a defibrillator (adjusted hazard ratio [aHR], 1.48), higher body mass index (aHR, 1.01), and younger age (aHR, 0.96) were independent risk factors for CIED infection. Lead extraction occurred in only 50.71% of patients by 60 days. After propensity score matching, the 3-year mortality was higher in those who did not undergo lead extraction compared with those who did (80.3% vs 72.3%) and time to mortality was shorter (0.3 vs 0.6 year). Only 13.8% of patients underwent reimplantation with a new CIED after lead extraction.</div></div><div><h3>Conclusion</h3><div>CIED infections occur frequently in ESKD patients and are associated with a high mortality. Early lead extraction is not performed routinely but is associated with improved survival.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 744-751"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early vs later non–vitamin K antagonist oral anticoagulants in patients with acute ischemic stroke and atrial fibrillation: A meta-analysis and systematic review of randomized trials","authors":"Linghua Fu MD, PhD ,&nbsp;Jinzhu Hu MD, PhD ,&nbsp;Pingping Yang MD, PhD ,&nbsp;Qi Chen MD, PhD","doi":"10.1016/j.hrthm.2024.12.008","DOIUrl":"10.1016/j.hrthm.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>There are conflicting published data on the optimal timing of non–vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with acute ischemic stroke.</div></div><div><h3>Objective</h3><div>To compare the efficacy and safety of early initiation of NOACs with later initiation of NOACs in those patients, we conducted a meta-analysis of phase 3 or phase 4 randomized controlled trials.</div></div><div><h3>Methods</h3><div>We systematically searched the Cochrane Library, PubMed, and Embase databases. A random effects model was selected to pool the effect measurement estimates (risk ratios [RRs] and 95% confidence intervals [CIs]).</div></div><div><h3>Results</h3><div>Three randomized controlled trials with 6442 enrolled patients with AF and acute ischemic stroke were included. Compared with later NOAC therapy, early NOAC therapy was associated with nonsignificant reductions in the risk of primary outcomes (RR, 0.82; 95% CI, 0.65–1.05). Subgroup analysis found that in reducing risk of primary outcomes, early anticoagulation may benefit female patients more than male patients (0.54 [0.35–0.83] vs 0.97 [0.63–1.50]; <em>P</em> for interaction, .06). Numerically lower rates of recurrent ischemic stroke (RR, 0.80; 95% CI, 0.56–1.15), death (RR, 0.96; 95% CI, 0.81–1.15), and systemic embolism (RR, 0.43; 95% CI, 0.16–1.11) were observed in early initiation of NOACs in comparison with later initiation of NOACs. There was no difference in major bleeding (RR, 0.98; 95% CI, 0.55–1.74), symptomatic intracranial hemorrhage (RR, 0.93; 95% CI, 0.43–1.96), or major extracranial bleeding (RR, 0.73; 95% CI, 0.28–1.95) between groups.</div></div><div><h3>Conclusion</h3><div>In AF patients with acute ischemic stroke, early initiation of NOACs is not inferior to later initiation of NOACs in reducing composite events, without increased hazard of bleeding, especially in female patients.</div></div>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":"22 3","pages":"Pages 629-636"},"PeriodicalIF":5.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822022","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}