Journal of Arrhythmia最新文献

{"title":"Device-Specific Responses to Pacemaker-Mediated Arrhythmia in Patients With Prolonged Ventriculoatrial Conduction: A Comparative Simulation Study.","authors":"Mitsuru Tsunomori, Teruhiko Imamura, Daisuke Nagamine, Satoshi Okino, Hitomi Iio, Kuniaki Sato, Naoya Kataoka, Keisuke Uchida, Koichiro Kinugawa","doi":"10.1002/joa3.70344","DOIUrl":"https://doi.org/10.1002/joa3.70344","url":null,"abstract":"<p><strong>Background: </strong>Pacemaker-mediated tachycardia (PMT) triggered by prolonged ventriculoatrial conduction (VAC) can be challenging to detect and terminate. The behavior of device-specific anti-PMT algorithms in such scenarios, as well as the potential utility of DDI mode as an alternative strategy, remain to be fully elucidated.</p><p><strong>Methods: </strong>Five dual-chamber pacemakers from Abbott, BIOTRONIK, Boston Scientific, Medtronic, and MicroPort CRM were tested using an electrophysiological simulator under VAC times of 450 ms and 550 ms. We assessed (1) PMT detection and termination in DDD mode, (2) atrial sensing within the post-ventricular atrial refractory period (PVARP) in DDI mode, and (3) the timing adjustment of atrial pacing after retrograde atrial sensing.</p><p><strong>Results: </strong>At VAC 450 ms, all devices except Medtronic detected PMT. Only Abbott terminated PMT at 550 ms with a shortened AV delay. Four devices detected atrial events within PVARP at 450 ms, whereas only BIOTRONIK did so at 550 ms. Among these, BIOTRONIK, Boston Scientific, and Medtronic adapted atrial pacing timing following atrial sensing within the refractory period, while Abbott did not, resulting in repetitive nonreentrant ventriculoatrial synchrony.</p><p><strong>Conclusions: </strong>Anti-PMT performance varies markedly among manufacturers. Devices featuring a longer PVARP and an atrial pacing delay algorithm provide superior protection against pacemaker-mediated arrhythmias during prolonged VAC. These findings underscore the importance of individualized pacemaker selection and careful programming.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 ","pages":"e70344"},"PeriodicalIF":1.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status of Implantable Cardioverter-Defibrillators (ICDs)/Cardiac Resynchronization Therapy With Defibrillators (CRT-Ds) for Primary Prevention of Sudden Cardiac Death.","authors":"Hisashi Yokoshiki, Masaya Watanabe, Takeshi Mitsuhashi, Akihiko Shimizu","doi":"10.1002/joa3.70349","DOIUrl":"https://doi.org/10.1002/joa3.70349","url":null,"abstract":"<p><p>Among recipients of implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy with defibrillators (CRT-Ds), non-ischemic etiology is predominant, accounting for more than 60% of cases in Japan, which is higher than that in the United States and other European countries. Despite recent concerns about primary prevention ICD/CRT-D implantation for non-ischemic patients with systolic heart failure in advanced guideline-directed medical therapy (GDMT), ICD/CRT-D therapy is likely effective in reducing the slope of the relationship between all-cause death and sudden cardiac death. Two cohort studies in Japan have shown that the cumulative incidence of appropriate ICD/CRT-D therapy is higher among non-ischemic patients than ischemic patients receiving primary prevention ICD/CRT-D implantation. Additionally, recent published cohort studies in the United States, Europe, and Japan reported a significant decrease in the risk of all-cause death in primary prevention ICD/CRT-D recipients compared to those without ICD/CRT-D therapy. Notably, ICD/CRT-D utilization in Japan is the lowest among the Group of Seven (G7) countries. Governmental acknowledgment of the value of primary prevention ICD/CRT-D therapy, as well as educational activities for non-cardiac electrophysiologists, are required to prevent a potential labor shortage and an excess of healthcare costs following out-of-hospital cardiac arrest (OHCA).</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70349"},"PeriodicalIF":1.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Supraventricular Tachycardia Ablation in the Elderly-Characteristics and Outcomes\".","authors":"Umme Roman, Syed Huzaifa Khan","doi":"10.1002/joa3.70346","DOIUrl":"https://doi.org/10.1002/joa3.70346","url":null,"abstract":"<p><p>Catheter ablation for supraventricular tachycardia demonstrates high acute procedural success and acceptable immediate safety in selected elderly patients. However, the absence of long-term follow-up, substrate diversity, and broader patient inclusion limits conclusions regarding durable clinical effectiveness.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70346"},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REgistry Of Catheter AbLation After Congenital Heart Disease Surgery(REAL-CHD Registry).","authors":"Hitoshi Mori, Nobuhiro Nishii, Yoshiaki Kato, Takahiko Kinjo, Tsugutoshi Suzuki, Jun Yoshimoto, Shigeru Tateno, Aya Miyazaki, Hisaaki Aoki, Satoshi Higuchi, Koji Nakagawa, Keiko Toyohara, Daiji Takeuchi, Tetsuri Sakai, Kiyotaka Takefuta, Ryuta Henmi, Masayoshi Mori, Daigo Yagishita, Shun Hasegawa, Yuko Matsui, Shonosuke Watanabe, Kensuke Kikuchi, Kunihiro Kani, Yasunori Hiranuma, Toshiya Matsuyama, Kazuhisa Matsumoto, Masataka Narita, Wataru Sasaki, Taisuke Nabeshima, Kota Nagaoka, Takuro Kojima, Ritsushi Kato, Morio Shoda, Naokata Sumitomo","doi":"10.1002/joa3.70347","DOIUrl":"https://doi.org/10.1002/joa3.70347","url":null,"abstract":"<p><strong>Background: </strong>Advances in surgical management have improved long-term survival in patients with congenital heart disease (CHD), leading to a growing population of adults with postoperative arrhythmias. However, contemporary data on catheter ablation practice and outcomes in patients with CHD remain limited.</p><p><strong>Methods: </strong>This multicenter, retrospective registry study included patients who underwent catheter ablation for postoperative CHD-related arrhythmias between April 2007 and December 2025 at 10 centers. CHD severity was classified as mild, moderate, or severe according to Japanese Circulation Society guidelines. Procedural characteristics, arrhythmia profiles, acute procedural outcomes, and complications were analyzed. Associations between age, disease severity, arrhythmia burden, and procedural success were evaluated using regression analyses.</p><p><strong>Results: </strong>A total of 1 719 patients were included. The number of ablation procedures increased over time across all CHD severity categories. Increasing age was associated with lower disease severity, whereas patients with severe CHD, particularly those after a Fontan repair, underwent ablation at younger ages. Procedural success decreased with increasing CHD severity (complete success: 92.5% in mild, 81.4% in moderate, and 71.4% in severe CHD) and with a greater number of induced arrhythmia types. Overall, procedure-related complications occurred in 2.3% of patients, with worsening heart failure being the most frequent non-vascular adverse event.</p><p><strong>Conclusion: </strong>In a large contemporary Japanese cohort, catheter ablation for postoperative CHD-related arrhythmias was increasingly performed and demonstrated acceptable safety. However, procedural success was lower in patients with more severe CHD and greater arrhythmia complexity, highlighting the need for specialized ablation strategies and careful periprocedural management in this growing population.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70347"},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Dioxide Insufflation for Assessment of Pericardial Adhesions and Informed Decision-Making for Percutaneous Epicardial Access in a Patient With Prior Cardiac Surgery.","authors":"Yuhei Kasai, Takayuki Kitai, Junji Morita, Gentaku Hama, Kennosuke Yamashita","doi":"10.1002/joa3.70348","DOIUrl":"https://doi.org/10.1002/joa3.70348","url":null,"abstract":"<p><p>Carbon dioxide insufflation via intentional coronary sinus perforation allowed real-time assessment of pericardial adhesion distribution before pericardial puncture. Despite localized adhesions, visualization of preserved pericardial space at the intended access site enabled informed procedural planning and safe percutaneous epicardial ablation in a patient with prior cardiac surgery.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70348"},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patchy Earliest Activation on Near-Field Annotation Mapping: A Pitfall in Ablation of Premature Ventricular Contractions Originating From the Right Ventricular Outflow Tract.","authors":"Yusuke Sakamoto, Hiroyuki Osanai, Eiji Yoshida","doi":"10.1002/joa3.70350","DOIUrl":"https://doi.org/10.1002/joa3.70350","url":null,"abstract":"<p><p>Concordance between FD and NF mapping is associated with successful RVOT ablation of PVCs. Discordant or patchy NF activation patterns suggest distant origins and may be linked to ablation failure. Integrating NF activation patterns provides a more comprehensive interpretation beyond ΔFN.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 ","pages":"e70350"},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Outcomes of Pharmacological and Electrical Cardioversion for Atrial Fibrillation and Flutter in an Indian Emergency Department: A Retrospective Study.","authors":"Abid M Sadiq, Bhavana Keerthiparti, Kapil Kumawat, Deepak Padmanabhan","doi":"10.1002/joa3.70342","DOIUrl":"https://doi.org/10.1002/joa3.70342","url":null,"abstract":"<p><strong>Background: </strong>Cardioversion is widely used to restore sinus rhythm in atrial fibrillation (AF) and atrial flutter (AFL), yet real-world outcomes and predictors of success remain underexplored in populations with high rheumatic disease burden. The aim was to evaluate the success rate, in-hospital complications, and predictors of cardioversion among patients presenting with AF or AFL in the emergency department.</p><p><strong>Methods: </strong>We retrospectively analyzed 324 patients who underwent cardioversion between December 2021 and March 2025. Demographic, clinical, and echocardiographic data were extracted. Outcomes assessed included cardioversion success and in-hospital complications. Logistic regression identified independent predictors of success.</p><p><strong>Results: </strong>Of 324 patients (median age 57 years; 61.4% male), 80.9% had AF and 19.1% had AFL; 57.1% had persistent arrhythmia and 31.5% had rheumatic heart disease. Overall, 68.2% achieved successful cardioversion. Success differed by strategy: electrical cardioversion (ECV) 94.3%, pharmacological cardioversion (PCV) 40.9%, and mixed 74.3%. Complications occurred in 4.9%, and in-hospital death occurred in 0.6%. In multivariable analysis, PCV (aOR 9.84; <i>p</i> < 0.001), mixed cardioversion (aOR 4.38; <i>p</i> = 0.006), and pre-procedural class IV anti-arrhythmic drug use (aOR 4.67; <i>p</i> = 0.043) were associated with higher odds of failure, whereas mineralocorticoid receptor antagonist use (aOR 0.50; <i>p</i> = 0.037) and electrophysiologist involvement (aOR 0.43; <i>p</i> = 0.037) were associated with lower odds of failure.</p><p><strong>Conclusion: </strong>In a real world with a high rheumatic disease burden, cardioversion achieved a two-thirds success rate with a modest complication rate. ECV was most effective, and specific clinical predictors, including cardioversion strategy, medication use, and electrophysiologist involvement, were associated with outcomes. These findings provide actionable insights for optimizing acute rhythm-control strategies.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70342"},"PeriodicalIF":1.7,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance of Patient Disease Awareness in Atrial Fibrillation: Risk Profiles and Post-Ablation Outcomes.","authors":"Masanaru Sawada, Naoto Otsuka, Koichi Nagashima, Ryuta Watanabe, Yuji Wakamatsu, Satoshi Hayashida, Shu Hirata, Moyuru Hirata, Sayaka Kurokawa, Yasuo Okumura","doi":"10.1002/joa3.70341","DOIUrl":"https://doi.org/10.1002/joa3.70341","url":null,"abstract":"<p><strong>Background: </strong>The clinical relevance of patient disease awareness on risk factor control and clinical outcomes after atrial fibrillation (AF) ablation remains incompletely understood.</p><p><strong>Methods: </strong>We conducted a prospective cohort study enrolling 133 patients undergoing an initial AF ablation. Disease awareness was assessed using the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) -a 16-item instrument comprising 8 questions on general AF knowledge and 8 questions on oral anticoagulant therapy-administered before and 1 year after ablation. We divided them into the poor disease awareness group and good disease awareness group according to the median value (75%) of the JAKQ score about AF in general and compared the baseline patient characteristics and the 1-year changes in the JAKQ score, blood pressure, laboratory data, echocardiographic parameters, and AF/atrial tachycardia (AT) recurrence rate between the groups.</p><p><strong>Results: </strong>Forty-two (31.6%) patients were classified as having a poor disease awareness (< 75% of the JAKQ score about AF in general), which was associated with hypertension, diabetes, dyslipidemia, and greater left atrial volume (LAV). These trends in the poor disease awareness group remained unchanged 1 year after the ablation. During the 25.3 [15.7-34.9] month follow-up, the AF/AT recurrence rate was significantly higher in the poor disease awareness than good disease awareness group (23.8% vs. 7.7%; <i>p</i> = 0.003 by the log-rank test).</p><p><strong>Conclusions: </strong>Poor disease awareness was linked to lifestyle-related diseases, greater LAV before and even 1 year after the ablation, making it a potential surrogate marker for AF/AT recurrence. These findings highlight the clinical significance of disease awareness for AF.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 ","pages":"e70341"},"PeriodicalIF":1.7,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Bradyarrhythmia Requiring Permanent Pacemaker Implantation and Epicardial Adipose Tissue in Elderly Patients.","authors":"Shunsuke Tomomori, Keita Kimura, Naoya Hironobe, Kiho Itakura, Youji Urabe, Toshiharu Oka, Naoya Mitsuba, Yukihiro Fukuda, Hironori Ueda, Yukiko Nakano","doi":"10.1002/joa3.70340","DOIUrl":"10.1002/joa3.70340","url":null,"abstract":"<p><strong>Background: </strong>Aging is one of the most significant risk factors for sinus node (SN) and atrioventricular node (AVN) dysfunction. Epicardial adipose tissue (EAT) is reported to promote myocardial fibrosis and influence intracardiac conduction through the release of inflammatory cytokines and direct tissue infiltration. The SN and AVN are in contact with EAT, which may affect the SN function and AVN conduction. The purpose of this study was to examine the association between bradyarrhythmia and EAT.</p><p><strong>Methods: </strong>We enrolled 103 patients with bradyarrhythmia requiring permanent pacemaker (PM) implantations and 105 patients who underwent catheter ablation of paroxysmal supraventricular tachycardia in our hospital as a control (all patients were over 65 years old) and analyzed the preoperative echocardiograms retrospectively and measured the EAT thickness. We compared the EAT thickness between the PM group and control.</p><p><strong>Results: </strong>There were 38 (36.9%) PM group patients with sick sinus syndrome and 65 (63.1%) with advanced atrioventricular block. The EAT was significantly thicker in the PM group than control (PM group 4.6 ± 1.2 mm vs. control 3.6 ± 1.3 mm, <i>p</i> < 0.0001). The EAT was also significantly thicker in the PM group than control (PM group 4.5 ± 1.2 mm vs. control 3.6 ± 1.3 mm, <i>p</i> = 0.0017) after propensity score matching (age, gender, hypertension, history of heart failure, left atrial diameter, and estimated glomerular filtration rate).</p><p><strong>Conclusions: </strong>The EAT thickness was associated with bradyarrhythmia requiring permanent PM implantation and may become a risk factor for SN and AVN dysfunction in elderly people.</p>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":"e70340"},"PeriodicalIF":1.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Versus Later Anticoagulation for Acute Ischemic Stroke in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis","authors":"Marwah Nasir Ahmad,&nbsp;Arooj Waheed,&nbsp;Nayan Manish Gandhi,&nbsp;Sushil Rayamajhi,&nbsp;Mariam Amro Alsayed,&nbsp;Sandipta Banerjee,&nbsp;Julie Anne de Lima Loiola,&nbsp;Hamad Mohammed Yousuf,&nbsp;Edikan Bethel Udo,&nbsp;Mamata Bista,&nbsp;Huzaifa Ahmad Cheema,&nbsp;Asma'a Munasar Ali Alsubari,&nbsp;Muhammad Usman Khan,&nbsp;Bilawal Nadeem,&nbsp;Vaibhav Vats","doi":"10.1002/joa3.70328","DOIUrl":"10.1002/joa3.70328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal timing for initiating oral anticoagulation in patients with atrial fibrillation after acute ischemic stroke remains uncertain. This systematic review and meta-analysis aims to compare early versus later initiation of oral anticoagulants in this patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched multiple databases, including MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov, up to January 2026. We included randomized controlled trials (RCTs) comparing early (≤ 4 days, post-stroke) versus later (&gt; 5 days) direct oral anticoagulation (DOAC) initiation in patients with atrial fibrillation and acute ischemic stroke. Our main outcomes were a primary composite outcome of ischemic stroke, sICH, or unclassified stroke and the primary composite outcome, or all-cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four RCTs were included with a total of 6722 patients. Our meta-analysis revealed no significant difference between early and later DOAC initiation for the primary composite outcome (RR: 0.84, 95% CI: 0.64–1.10), primary composite outcome or mortality (RR: 0.99; 95% CI: 0.82–1.19), ischemic stroke (RR: 0.78, 95% CI: 0.54–1.12), symptomatic intracranial hemorrhage (RR: 1.00, 95% CI: 0.48–2.06), all-cause mortality (RR: 0.96, 95% CI: 0.80–1.14), or major bleeding (RR: 0.72, 95% CI: 0.33–1.60).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early initiation of anticoagulants appears to be comparable to later initiation in terms of stroke recurrence, bleeding risks, and mortality in patients with atrial fibrillation. These findings support a more individualized approach to anticoagulation timing, balancing ischemic and hemorrhagic risks based on patient characteristics. Further high-quality trials are needed to refine clinical guidelines and optimize anticoagulation strategies in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>CRD42024629570 [PROSPERO]</p>\u0000 </section>\u0000 </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"42 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}