Journal of the American College of Cardiology最新文献

{"title":"Inappropriate Shocks From Subcutaneous vs Transvenous Implantable Cardioverter-Defibrillators: Individual Participant Data Meta-Analysis of Randomized Trials.","authors":"Alexander P Benz, Louise R A Olde Nordkamp, William F McIntyre, Leonard A Dijkshoorn, Blandine Mondésert, Jamil Bashir, Timothy R Betts, Martin C Burke, Mikhael F El-Chami, Laura Heenan, Andrew D Krahn, Jürgen Kuschyk, Shun Fu Lee, Reinoud E Knops, Jeff S Healey","doi":"10.1016/j.jacc.2025.10.020","DOIUrl":"10.1016/j.jacc.2025.10.020","url":null,"abstract":"<p><strong>Background: </strong>The PRAETORIAN (Prospective Randomized Comparison of Subcutaneous and Transvenous Implantable Cardioverter Defibrillator Therapy) and ATLAS (Avoid Transvenous Leads in Appropriate Subjects) trials demonstrated a reduction in lead-related complications with subcutaneous compared with transvenous implantable cardioverter-defibrillators (ICDs) in patients with standard ICD indications. However, they were not individually powered to assess differences in inappropriate shock.</p><p><strong>Objectives: </strong>The aims of this study were to compare the rates of a first inappropriate shock between subcutaneous and transvenous ICDs and to explore the underlying causes.</p><p><strong>Methods: </strong>An individual participant data meta-analysis of PRAETORIAN and ATLAS was performed, using Cox regression models stratified by trial. The primary endpoint was time to first inappropriate shock.</p><p><strong>Results: </strong>The pooled modified intention-to-treat population included 1,342 patients (median age 58 years, 21.8% women, 77.7% with primary prevention indications) who had been randomized to subcutaneous or transvenous ICDs. A proprietary algorithm aimed at reducing inappropriate shock was activated at baseline or at some point during follow-up in 77.1% of patients with subcutaneous ICDs. During a median follow-up period of 3.5 years, a first inappropriate shock occurred more frequently in patients randomized to subcutaneous compared with transvenous ICDs (2.5 vs 1.5 per 100 patient-years; HR: 1.61; 95% CI: 1.06-2.45; P = 0.03). Patients with subcutaneous ICDs had a higher hazard of first inappropriate shock due to cardiac oversensing (HR: 15.07; 95% CI: 3.60-63.15; P < 0.001) and electromagnetic interference or myopotentials (HR: 8.19; 95% CI: 1.88-35.64; P = 0.005) but a lower hazard of first inappropriate shock due to atrial arrhythmia (HR: 0.37; 95% CI: 0.19-0.71; P = 0.003).</p><p><strong>Conclusions: </strong>Although first inappropriate shocks were infrequent overall, they were more common with subcutaneous ICDs. First inappropriate shocks due to cardiac oversensing and electromagnetic interference were more common with subcutaneous ICDs, while first shocks due to atrial arrhythmia were more common with transvenous ICDs.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1732-1743"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartwatch-Integrated Atrial Fibrillation Detection: What the EQUAL Trial Tells Us About Screening in High-Risk Older Adults.","authors":"Wen-Han Cheng, Tze-Fan Chao","doi":"10.1016/j.jacc.2025.12.013","DOIUrl":"10.1016/j.jacc.2025.12.013","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1729-1731"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Detection and Prompt Diagnosis of Atrial Fibrillation Using Apple Watch: A Randomized Controlled Trial.","authors":"Nicole J van Steijn, Isabel S Blommestijn, Sebastiaan Blok, Shari Pepplinkhuizen, G Aernout Somsen, Reinoud E Knops, Laura Breukel, Jan G P Tijssen, Igor I Tulevski, Philip M Croon, Michiel M Winter","doi":"10.1016/j.jacc.2025.11.032","DOIUrl":"10.1016/j.jacc.2025.11.032","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major cause of stroke and often remains undiagnosed due to its paroxysmal and frequently asymptomatic nature. Wearables provide a scalable, noninvasive screening tool.</p><p><strong>Objectives: </strong>This trial evaluated new onset AF detection in patients at elevated stroke risk using remote smartwatch-based screening.</p><p><strong>Methods: </strong>This prospective multicenter randomized controlled trial included patients ≥65 years with elevated stroke risk (CHA₂DS₂-VASc ≥2 men, ≥3 women) from 2 secondary care centers in the Netherlands. Patients were randomized to 6-month (180-day) monitoring with a smartwatch with photoplethysmography and single-lead electrocardiogram (ECG) functions, or standard care. ECGs were reviewed remotely by an independent eHealth team within 24 hours. The primary outcome was new onset AF, defined as a confirmed episode lasting ≥30 seconds on single-lead ECG or standard ECG methods.</p><p><strong>Results: </strong>Between November 2022 and December 2023, 437 patients were randomized (219 intervention, 218 control); the median age was 75 years, 46.7% were female and the median CHA₂DS₂-VASc score was 3.0. New onset AF occurred in 21 (9.6%) patients of the intervention group and 5 (2.3%) patients of the control group (risk difference: 7.3 percentage points; 95% CI: 2.9-11.7 percentage points; P = 0.001; HR: 4.40; 95% CI: 1.66-11.66). Several asymptomatic AF episodes were detected only in the intervention group, while paroxysmal AF occurred in both groups.</p><p><strong>Conclusions: </strong>This randomized controlled trial provides evidence that 6-month smartwatch-based AF screening enhances the detection rate of new onset AF compared with standard care in patients at elevated stroke risk. (Detection and Quantification of Atrial Fibrillation in High-risk Patients Using a Smartwatch Wearable [Apple Watch] [EQUAL]; NCT05686330).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1714-1728"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconciling Genetic (PRS_AF) and Clinical (CHA₂DS₂-VASc) Risk in AF Screening: The Missing Interaction.","authors":"Guoqiang Ren, Weifeng Xu, Honghua Ye","doi":"10.1016/j.jacc.2025.11.052","DOIUrl":"10.1016/j.jacc.2025.11.052","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"e101"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Led Smartwatch ECG Monitoring After AF Ablation: A Randomized Trial.","authors":"Nikhil Ahluwalia, Hakam Abbass, Ahmed Hussain, Gunkavee Saengkrajang, Rangeena Assadi, Charles Butcher, Edd Maclean, Michele Orini, Malcolm Finlay, Shohreh Honarbakhsh, Ross J Hunter, Richard J Schilling","doi":"10.1016/j.jacc.2025.12.047","DOIUrl":"10.1016/j.jacc.2025.12.047","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":"1817-1819"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-Guided Atrial Fibrillation Screening With Artificial Intelligence-Enabled Electrocardiogram Models: A VITAL-AF Trial Analysis.","authors":"Natasha A Vedage, Sam F Friedman, Yuchiao Chang, Leila H Borowsky, Sachin J Shah, David D McManus, Steven J Atlas, Daniel E Singer, Steven A Lubitz, Mahnaz Maddah, Patrick T Ellinor, Shaan Khurshid","doi":"10.1016/j.jacc.2026.01.087","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.01.087","url":null,"abstract":"<p><strong>Background: </strong>Screening for atrial fibrillation (AF) may lead to earlier detection and initiation of preventive measures. Current AF screening approaches using a guideline age-based threshold of ≥65 years have shown limited yield.</p><p><strong>Objectives: </strong>In an AF screening trial, we assessed whether the screening effect was larger among individuals at elevated AF risk using validated clinical and electrocardiogram (ECG)-based artificial intelligence (AI) risk models.</p><p><strong>Methods: </strong>VITAL-AF was a cluster-randomized trial of patients aged ≥65 years treated at 1 of 16 primary care practices affiliated with Massachusetts General Hospital. Patients randomized to a screening practice were screened using a single-lead ECG. Among VITAL-AF participants without prevalent AF with at least one 12-lead ECG within 3 years before enrollment, we estimated AF risk using 3 validated models derived outside of VITAL-AF: the Cohorts of Heart and Aging Research in Genomic Epidemiology-AF (CHARGE-AF) clinical score, an AI-based model using a 12-lead ECG alone (ECG-AI), and a model combining ECG-AI and CHARGE-AF (CH-AI). Two-year incident AF discrimination was assessed by the time-dependent area under the receiver-operating characteristic curve (AUROC) and average precision. AF screening effect was defined as the difference in 2-year incident AF diagnosis rate (per 100 person-years) in screening vs control across AF risk deciles.</p><p><strong>Results: </strong>Of 30,630 VITAL-AF participants without prevalent AF, 16,937 had pretrial ECG and clinical data. Each score discriminated 2-year AF risk according to AUROC (CHARGE-AF: 0.711 [95% CI: 0.671-0.749]; ECG-AI: 0.784 [95% CI: 0.743-0.819]; CH-AI: 0.788 [95% CI: 0.754-0.824]) and average precision (0.0952 [95% CI: 0.0836-0.112]; 0.132 [95% CI: 0.113-0.157]; 0.133 [95% CI: 0.117-0.159]). An AF screening effect was observed in the top decile of CH-AI (AF diagnosis rate in screening 10.07/100 person-years [95% 8.28-11.87] vs 7.76 [95% 6.30-9.21] in control, P < 0.05), corresponding to a difference in AF diagnosis rate of 2.32/100 person-years (95% CI: 0.01-4.63) and number-needed-to-screen of 43 per year.</p><p><strong>Conclusions: </strong>Use of ECG-based AI and clinical factors identified individuals at particularly high risk for AF who may benefit from screening. Findings suggest a trade-off between increasing AF screening efficiency and decreasing population coverage (ie, restriction of the screening pool). Future studies are needed to determine whether a risk-based approach is optimal or whether consideration of additional clinical- and systems-level factors (eg, access, health care system engagement) can further refine AF screening strategies. (Screening for Atrial Fibrillation Among Older Patients in Primary Care Clinics [VITAL-AF]; NCT03515057).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"87 14","pages":"1798-1813"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opening the Aperture: From Episodic Data Capture to Continuous Understanding.","authors":"Harlan M Krumholz","doi":"10.1016/j.jacc.2026.03.024","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.03.024","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"87 14","pages":"1711-1713"},"PeriodicalIF":22.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body Mass Index, Clinical Outcomes, and Mortality in Heart Failure: A Mendelian Randomization Study.","authors":"Nicholas Sunderland, Geraldine Asselin, Albert Henry, Christopher P Nelson, Louis-Philippe Lemieux Perreault, Folkert W Asselbergs, Eric Boersma, Thomas P Cappola, Olympe Chazara, William Chutkow, Marie-Christyne Cyr, Apostolos Gkatzionis, Hongsheng Gui, Carolina Haefliger, Åsa K Hedman, Hans Hillege, Craig L Hyde, Frederick K Kamanu, Isabella Kardys, Andrea L Koekemoer, William E Kraus, Chim C Lang, Anders Malarstig, Kenneth B Margulies, Nicholas A Marston, Giorgio E M Melloni, Michael P Morley, Michelle L O'Donoghue, Anjali T Owens, Dirk S Paul, Kate Tilling, Pim van der Harst, Jessica van Setten, Marion van Vugt, Niek Verweij, Abirami Veluchamy, Lars Wallentin, Xiaosong Wang, Heming Xing, Yifan Yang, Harvey D White, Faiez Zannad, J Gustav Smith, Hans-Peter Brunner-La Rocca, David E Lanfear, Douglas L Mann, Simon de Denus, Jean-Claude Tardif, Adriaan A Voors, Nilesh J Samani, Patrick T Ellinor, Christian T Ruff, Marc S Sabatine, Naveed Sattar, John J V McMurray, Lavinia Paternoster, Marie-Pierre Dubé, R Thomas Lumbers","doi":"10.1016/j.jacc.2026.02.5093","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.02.5093","url":null,"abstract":"<p><strong>Background: </strong>Excess adiposity, most commonly indexed through body mass index (BMI), is strongly associated with the development of heart failure (HF). Weight loss therapies improve outcomes in patients with obesity and HF with preserved left ventricular ejection fraction (LVEF), but their effects in HF with reduced LVEF remain unclear.</p><p><strong>Objectives: </strong>The aim of this work is to determine whether higher BMI is associated with adverse clinical outcomes in patients with HF and whether there is effect modification by LVEF subgroup.</p><p><strong>Methods: </strong>Two-sample Mendelian randomization (MR) was used, with genome-wide significant loci associated with BMI as instrumental variables and outcome data from a genome-wide association study (GWAS) of time-to-event clinical outcomes in patients with HF. A total of 50,636 individuals of European ancestry with established HF from 22 cohorts were included in the genetic analysis: 12 HF trials, 1 prospective case-cohort study, 9 cohorts nested within non-HF cardiovascular trials, and 1 population-based cohort derived from the UK Biobank. The exposure was genetically predicted BMI and the outcome measures were all-cause mortality and a composite of cardiovascular mortality or HF hospitalization. Genetic associations for the outcomes were derived from our GWAS and MR was used to estimate the unbiased association of genetically predicted BMI with these clinical outcomes.</p><p><strong>Results: </strong>The mean BMI was 29.2 ± 5.8 kg/m². Over a median follow-up of 27.0 months, all-cause mortality occurred in 11,454 patients (23%), and 11,360 participants (22%) experienced the composite endpoint. Genetically predicted BMI was associated with an increased rate of both all-cause mortality (HR per SD [4.8 BMI units] 1.21; 95% CI: 1.13-1.29; P = 9 × 10^-8) and the composite outcome (HR 1.29; 95% CI: 1.20-1.38; P = 8 × 10^-13). Associations were consistent across LVEF ≤40% and >40%: for all-cause mortality, HR: 1.16 (95% CI: 0.99-1.37) and 1.20 (95% CI: 0.94-1.53); and for the composite outcome, HR: 1.30 (95% CI: 1.15-1.48) and 1.57 (95% CI: 1.29-1.91), respectively.</p><p><strong>Conclusions: </strong>Among patients with HF, higher BMI was associated with increased all-cause mortality and cardiovascular death or HF hospitalization, supporting the potential role of weight-management strategies across the ejection fraction spectrum.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midlife Cardiorespiratory Fitness and Healthy Aging: An Observational Cohort Study.","authors":"Clare Meernik, David Leonard, Kerem Shuval, Carolyn E Barlow, Tammy Leonard, Andjelka Pavlovic, I-Min Lee, Nina Radford, Jarett D Berry, Laura F DeFina","doi":"10.1016/j.jacc.2026.02.5122","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.02.5122","url":null,"abstract":"<p><strong>Background: </strong>Higher cardiorespiratory fitness (CRF) is associated with a lower risk for chronic disease and death, but its relation to healthy aging more broadly remains understudied.</p><p><strong>Objectives: </strong>The aim of this study was to examine the associations between midlife CRF and later life health span (years without major chronic disease), disease burden, and lifespan among adults who remained apparently healthy through 65 years of age.</p><p><strong>Methods: </strong>This cohort study included 24,576 participants (25% women) from the CCLS (Cooper Center Longitudinal Study) (1971-2017) linked to Medicare administrative claims (1999-2019). CRF was estimated using a maximal treadmill test at a preventive medicine clinic visit before age 65 years. Eleven major chronic conditions were identified from the Medicare Chronic Conditions Data Warehouse and used to define disease as: 1) any of the 11 conditions (composite); 2) any condition within a clinical group (cardiovascular, cardiovascular-kidney-metabolic, cancer); or 3) an individual condition. Multivariable illness-death models estimated the likelihood of transitioning between health, disease, and death by CRF level (low, moderate, or high). Model parameters were used to calculate adjusted Aalen-Johansen probabilities and expected times in each state of health, disease, and death; these were then used to calculate expected health span, number of diseases, disease-years, and lifespan by CRF.</p><p><strong>Results: </strong>When disease was defined as any of 11 major chronic conditions, high-fit men had a 2% (95% CI: 1%-2%) longer health span, 9% (95% CI: 1%-17%) fewer diseases, and a 3% (95% CI: 2%-4%) longer lifespan compared with low-fit men, with similar patterns among women. When disease was clinically grouped, higher fit men and women generally had a later onset of cardiovascular, cardiovascular-kidney-metabolic, and cancer outcomes and developed fewer conditions within each group. On average, the onset of each of the 11 chronic conditions occurred at least 1.5 years later among high-fit men and women compared with low-fit individuals. Results were consistent across clinical subgroups defined by clinic visit year (before or after 1990), age (younger or older than 45 years), smoking status (current smoking, nonsmoking, or missing smoking), and weight status according to body mass index (healthy weight and overweight or obese).</p><p><strong>Conclusions: </strong>Higher midlife CRF was associated with longer health span, lower multimorbidity, and longer lifespan among men and women.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Clinical Success to Physiologic Understanding: Disentangling Sotatercept's Effects in PAH.","authors":"Thomas M Cascino, Marat Fudim, Vallerie V McLaughlin","doi":"10.1016/j.jacc.2026.03.049","DOIUrl":"https://doi.org/10.1016/j.jacc.2026.03.049","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}