Heart Rhythm O2最新文献

{"title":"Grid annotation vs ablation tags in predicting lesion area coverage for pulmonary vein isolation using a variable-loop circular catheter","authors":"Giampaolo Vetta MD, Charles Audiat MD, Lorenzo Marcon MD, Luigi Pannone MD, PhD, Alvise Del Monte MD, Erwin Stroker MD, PhD, Gezim Bala MD, PhD, Juan Sieira MD, PhD, Domenico Giovanni Della Rocca MD, PhD, Carlo de Asmundis MD, PhD, FHRS, Gian-Battista Chierchia MD, PhD, Alexandre Almorad MD, PhD","doi":"10.1016/j.hroo.2026.06.021","DOIUrl":"10.1016/j.hroo.2026.06.021","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 2048-2051"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219275","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":"Atrial fibrillation detection using an implantable loop recorder after cryptogenic stroke","authors":"Evan C. Adelstein MD, FHRS,&nbsp;Deborah F. Steinberg MD,&nbsp;David A. Steckman MD, FHRS,&nbsp;Alfred M. Loka MD","doi":"10.1016/j.hroo.2026.06.025","DOIUrl":"10.1016/j.hroo.2026.06.025","url":null,"abstract":"<div><h3>Background</h3><div>Implantable loop recorders (ILRs) assist in detecting occult atrial fibrillation (AF) in patients with cryptogenic stroke (CS), yet many patients do not manifest subsequent AF.</div></div><div><h3>Objective</h3><div>To identify factors associated with ILR-detected AF, thereby improving device specificity.</div></div><div><h3>Methods</h3><div>All 744 patients implanted with ILRs at our Stroke Center from 2014 to 2025 after ischemic CS were followed for AF episodes of ≥6 minutes and recurrent stroke.</div></div><div><h3>Results</h3><div>During 657 ± 450 (median 591) days, 138 (18.5%) patients manifested AF lasting ≥6 minutes, with the highest risk within the first 6 months. Older age (hazard ratio [HR], 1.05 per year; 95% confidence interval [CI], 1.03–1.07; <em>P</em> &lt; .001), tricuspid regurgitation (HR, 1.61; 95% CI, 1.10–2.35; <em>P</em> = .015), and middle cerebral artery stroke (HR, 1.79; 95% CI, 1.18–2.71; <em>P</em> = .006) were independently associated with shorter time to initial AF. Multivessel strokes were not associated with AF detection. In the oldest age quartile (≥76), 28% manifested AF. Mitral regurgitation, tricuspid regurgitation, and β-blocker use were associated with shorter time to initial AF. In the middle 2 age quartiles (57–75), 18% had detected AF. Middle cerebral artery stroke was independently associated with AF risk. Only 6% in the youngest age quartile (≤56) manifested AF. Of 44 patients with recurrent stroke, 6 had detected AF. Stroke was temporally related to AF in 2 patients.</div></div><div><h3>Conclusion</h3><div>Older age is highly associated with subsequent AF detection in CS. Mitral and tricuspid regurgitation and middle cerebral artery strokes are associated with AF in older and middle-aged patients, respectively. Recurrent stroke was rarely associated with temporally related AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1912-1922"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219268","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":"Improving obstructive sleep apnea screening in patients with atrial fibrillation (SLEEP-AF project)","authors":"T. Jennifer Walker DNP, MSN, ANP-BC,&nbsp;Tracy Vernon Platt DNP, ANP-BC,&nbsp;Suja Davis PhD, RN,&nbsp;Linda Chappell RN,&nbsp;Anil Gehi MD, FHRS","doi":"10.1016/j.hroo.2026.05.013","DOIUrl":"10.1016/j.hroo.2026.05.013","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) contributes to negative cardiac remodeling and worsened atrial fibrillation (AF) outcomes, yet screening remains suboptimal despite guideline recommendations.</div></div><div><h3>Objective</h3><div>This quality improvement project aimed to improve screening, diagnosis, and treatment of OSA in patients with AF.</div></div><div><h3>Methods</h3><div>A pre- and postintervention design evaluated an OSA screening protocol with home sleep apnea testing (HSAT) and positive airway pressure (PAP) initiation for new patients with AF in the electrophysiology (EP) clinic over 3 months. Patients were screened with an OSA questionnaire; those with elevated scores underwent HSAT coordinated by the EP clinic. Patients with moderate to severe OSA were initiated on PAP therapy.</div></div><div><h3>Results</h3><div>The sample included 141 patients (pre, n = 81; post, n = 60) with no significant baseline differences. The OSA screening rate increased from 49.3% to 96.7% (<em>P</em> &lt; .001), and the sleep study completion rate increased from 2% to 25% over 3 months (<em>P</em> &lt; .001). The mean time to diagnosis decreased from 151.5 to 22 days. 15 patients were diagnosed as having OSA; 3 initiated PAP therapy.</div></div><div><h3>Conclusion</h3><div>This protocol with HSAT and PAP delivered by the EP clinic improved OSA detection and treatment. Further study is needed to understand the impact on patient outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 2014-2019"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219212","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":"Vascular closure strategies in pulmonary vein isolation to reduce vascular complications and facilitate same-day discharge","authors":"Isabelle N. Bax MD,&nbsp;Marisa van der Graaf MD,&nbsp;Nina F.T. Keijzer MD,&nbsp;Marije de Lange MSc,&nbsp;Jippe C. Balt MD, PhD,&nbsp;Wouter R. Berger MD, PhD,&nbsp;Vincent F. van Dijk MD, PhD,&nbsp;Gerjan de Roest MD, PhD,&nbsp;Maurits C.E.F. Wijffels MD, PhD,&nbsp;Max Liebregts MD, PhD,&nbsp;Lucas V.A. Boersma MD, PhD","doi":"10.1016/j.hroo.2026.07.005","DOIUrl":"10.1016/j.hroo.2026.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Minor access-site bleeding is common after pulmonary vein isolation (PVI) for atrial fibrillation. Vascular closure devices (VCDs) may reduce bleeding, facilitating shorter bed rest and same-day discharge (SDD).</div></div><div><h3>Objective</h3><div>This study assessed the impact of closure strategies (Perclose™ ProStyle™ [VCD] and figure-of-8 [FO8]-suture) and mobilization protocols on access-site bleeding complications and length of hospital stay.</div></div><div><h3>Methods</h3><div>This single-center observational study included patients undergoing a primary PVI for atrial fibrillation between January 15 and December 31, 2025, at St. Antonius Hospital, the Netherlands. 4 protocols were evaluated sequentially: cohort 1: FO8-suture + 4 hours bed rest; cohort 2: VCD + 4 hours bed rest; cohort 3: VCD + 2 hours bed rest + 2 hours seated; cohort 4: VCD + FO8-suture + 2 hours bed rest + 1 hour seated. Primary outcome was in-hospital access-site bleeding, categorized by intervention. Secondary outcomes included SDD, time to discharge, unplanned overnight stay, and emergency room visits due to groin complications.</div></div><div><h3>Results</h3><div>A total of 738 patients were included (cohorts 1–4: n = 170, 161, 210, and 197, respectively). Baseline characteristics were comparable. 2 major bleeding complications occurred in cohort 1. Minor bleeding complications decreased across the 4 cohorts from 19.4% to 9.6% (<em>P</em> = .027). Female sex (odds ratio [OR], 1.52), protamine use (OR, 0.50), and cohort 4 protocol (OR, 0.38) predicted bleeding. SDD increased from 56.5% (cohort 1) to 67.0% (cohort 4, <em>P</em> = .168), without more unplanned overnight stays or bleeding-related emergency room visits.</div></div><div><h3>Conclusion</h3><div>The use of a VCD in combination with an FO8 suture and protamine was significantly associated with lower observed access-site bleeding complications and optimized the workflow of PVI.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1856-1865"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219119","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":"Use of multi-modal artificial intelligence model for prediction of atrial fibrillation in hospitalized patients","authors":"Unmesh Khanolkar BS,&nbsp;Ashish Yadav MD,&nbsp;Avdhesh Mann BTech,&nbsp;Laith Alomari MD,&nbsp;Emmanuel Otabor MD,&nbsp;Rukmini Pisipati BS, MS,&nbsp;Abhishek Deshmukh MD,&nbsp;Scott Pappada PhD,&nbsp;Abhishek Maan MD, ScM, MSc","doi":"10.1016/j.hroo.2026.06.017","DOIUrl":"10.1016/j.hroo.2026.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation (AF) tends to be a common cardiac arrhythmia in hospitalized patients with acute illness. Although some general predictors are known, a systematic and integrated prediction schema that incorporates clinical predictors along with machine learning (ML) is lacking. In our study, we aimed to develop a multimodal artificial intelligence–based approach as a potential predictive tool for AF in hospitalized patients.</div></div><div><h3>Objective</h3><div>In our study, we sought to develop 3 different ML models for AF prediction in hospitalized patients.</div></div><div><h3>Methods</h3><div>We used the Symile-MIMIC dataset to develop 3 ML models: (1) clinical only, (2) electrocardiogram (ECG)-based, and (3) a multimodal fusion model.</div></div><div><h3>Results</h3><div>We used a total of 13,817 ECGs from the Symile-MIMIC-IV dataset. These ECGs were then split into a training set (8923 ECGs, 65%), a validation set (675 ECGs, 5%), and an independent testing set that included a total of 4219 ECGs (30%). The clinical-only model had 250 predictor variables, and based on Shapley Additive exPlanations analysis to assess explainability of this model, age was the strongest risk factor for the prediction of AF. Although our ML models based on clinical- and ECG-only achieved a reasonable degree of predictive ability, the multimodal fusion model demonstrated the best predictive value (area under the receiver operating characteristic curve: 0.81) for the diagnosis of AF.</div></div><div><h3>Conclusion</h3><div>In our study, we developed 3 ML models based on clinical factors, 12-lead ECGs, and a multimodal fusion model combining both clinical and ECGs. Based on assessment with various performance metrics and different thresholds, the multimodal fusion model demonstrated the best predictive ability for AF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1900-1911"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219267","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":"Device-dependent activated clotting time measurements during transseptal ablation under continuous anticoagulation: Comparison of mechanical-optical and microfluidic electrochemical systems","authors":"Konstantin Krieger MD,&nbsp;Hendrik Feller MD,&nbsp;Holger Krebbel MD,&nbsp;Jan Stepek MD,&nbsp;Ahmed El Shazly MD,&nbsp;Dimitrios Kolyvakis MD,&nbsp;Yvonne Dell MD,&nbsp;Alexander Wutzler MD, MA","doi":"10.1016/j.hroo.2026.06.024","DOIUrl":"10.1016/j.hroo.2026.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Monitoring activated clotting time (ACT) is essential during transseptal ablation. Despite having distinct analytical principles and potentially non-equivalent values, different point-of-care ACT systems are used interchangeably.</div></div><div><h3>Objective</h3><div>This study aimed to compare ACT values from a mechanical-optical and a microfluidic electrochemical system in patients treated with direct oral anticoagulant (DOAC) undergoing transseptal ablation and to quantify the impact of device-related bias on guideline-recommended ACT targets.</div></div><div><h3>Methods</h3><div>30 consecutive patients undergoing left-sided transseptal catheter ablation under uninterrupted DOAC therapy were studied. After transseptal puncture, unfractionated heparin was administered, and ACT was measured simultaneously with both systems at predefined time points. The primary analysis included 42 paired post-heparin measurements; a complementary analysis included all 55 paired measurements (pre- and post-heparin). Agreement was assessed using paired <em>t</em>-tests, linear regression, and Bland–Altman analysis. Thresholds of ≥250 seconds and ≥300 seconds were evaluated.</div></div><div><h3>Results</h3><div>In the primary post-heparin analysis, mean ACT was 316.3 ± 51.5 seconds with the mechanical-optical system and 259.3 ± 29.8 seconds with the microfluidic system, yielding a mean bias of 57.0 seconds (95% confidence interval, 41.7–72.3; <em>P</em> &lt; .001). Including all 55 measurements, the mean bias remained large at 48.4 seconds with strong per-measurement correlation. Using a threshold of ≥250 seconds, 90.0% vs 46.6% of measurements met the target; at ≥300 seconds, 60.0% vs 10.0%.</div></div><div><h3>Conclusion</h3><div>Mechanical-optical and microfluidic electrochemical ACT systems show a consistent positive offset of roughly 50–60 seconds. Uniform ACT cutoffs across devices may misclassify anticoagulation adequacy, supporting device- and cartridge-specific ACT targets during DOAC-treated transseptal ablation.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1847-1855"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219115","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":"P-wave characteristics in Bayés syndrome predict feasibility of anterior mitral line ablation: The Left Anterior Bayés-Derived Mitral Linear Ablation Outcome and Conduction score","authors":"Suguru Nishiuchi MD, PhD,&nbsp;Hirohiko Kohjitani MD, PhD,&nbsp;Kohki Nakamura MD, PhD,&nbsp;Kojiro Hattori MD,&nbsp;Akiko Kodama MD,&nbsp;Taiki Masuyama MD, PhD,&nbsp;Shingo Yoshimura MD,&nbsp;Takehito Sasaki MD,&nbsp;Kenichi Kaseno MD, PhD,&nbsp;Shigeto Naito MD, PhD,&nbsp;Ren Kawaguchi MD","doi":"10.1016/j.hroo.2026.07.010","DOIUrl":"10.1016/j.hroo.2026.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Bayés syndrome is characterized by a P-wave showing interatrial block (IAB) from impaired Bachmann bundle conduction. In patients without overt IAB, persistent epicardial conduction via the Bachmann bundle can hinder a successful completion of an anterior mitral line (AML) ablation.</div></div><div><h3>Objective</h3><div>This study aimed to determine whether preprocedural P-wave duration and inferior-lead P-wave morphology predict the feasibility of AML and to derive a preprocedural score.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed data of 69 consecutive patients who underwent AML radiofrequency ablation for atrial fibrillation or tachycardia (May 2022–February 2026), of whom 57 met inclusion criteria. Preprocedural electrocardiograms in sinus rhythm were assessed for P wave. AML feasibility was classified as feasible or difficult. Firth penalized logistic regression and a random forest classifier identified predictors. The Left Anterior Bayés-Derived Mitral Linear ablation Outcome and Conduction (LA-BLOC) score was derived in the discovery cohort (n = 35) and evaluated in the temporal validation cohort (n = 22).</div></div><div><h3>Results</h3><div>AML block was feasible in 24 patients and difficult in 11 of the discovery cohort. The feasible AML had longer P-wave duration (169 ± 28 ms vs 139 ± 31 ms; <em>P</em> = .012) and more frequent biphasic P waves in inferior leads. P-wave duration (continuous; area under the curve, 0.80), with a 130 ms receiver operating characteristic-derived cutoff, and P-wave morphology in II (odds ratio, 8.49; <em>P</em> = .008) were key predictors. The LA-BLOC score (P-wave duration, ≥130 ms = 1; biphasic P in II = 2 and in III = 1) with a threshold of ≥3 predicted AML feasibility (area under the curve, 0.94; sensitivity, 0.88; specificity, 1.00).</div></div><div><h3>Conclusion</h3><div>Preprocedural Bayés syndrome P-wave characteristics are associated with successful AML completion. The LA-BLOC score may facilitate preprocedural planning.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1874-1883"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219121","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":"Accelerated pacing rates to improve exercise tolerance, quality of life, and arrhythmia burden in patients with evidence of heart failure with preserved ejection fraction: The PACE-UP rationale and design","authors":"Jackson O. Howie MClinExPhys,&nbsp;Jenelle K. Dziano BClinExPhys (hons),&nbsp;Jonathan P. Ariyaratnam MB BChir, PhD,&nbsp;Mehrdad Emami MD,&nbsp;Shaun Evans MD,&nbsp;Melissa E. Middeldorp PhD, MPH, FHRS,&nbsp;Alexis Puvrez MD, PhD,&nbsp;Genevieve T. Kenny BClinExPhys (hons),&nbsp;Prashanthan Sanders MBBS, PhD, FHRS,&nbsp;Adrian D. Elliott PhD","doi":"10.1016/j.hroo.2026.07.006","DOIUrl":"10.1016/j.hroo.2026.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Patients with permanent pacemakers often present with early or established heart failure with preserved ejection fraction (HFpEF). Increasing the lower pacing rate has demonstrated improvements in quality of life and patient physical activity, while lowering the burden of atrial arrhythmias. However, the impact on objective measures of exercise tolerance and cardiac function is not well established.</div></div><div><h3>Objective</h3><div>This study aims to assess the impact of an accelerated lower rate setting on peak oxygen consumption in patients with stage B/C HFpEF.</div></div><div><h3>Methods</h3><div>The Accelerated Pacing Rates to Improve Exercise Tolerance, Quality of Life, and Arrhythmia Burden in Patients with Evidence of Heart Failure with Preserved Ejection Fraction study is a multicenter, prospective, 2-arm randomized controlled trial recruiting 160 participants. Participants will be randomized to accelerated pacing rate (75 beats per minute) or usual care (60 beats per minute), with follow-up assessments at 4 and 52 weeks after randomization.</div></div><div><h3>Results</h3><div>The primary endpoint is peak oxygen consumption obtained during cardiopulmonary exercise testing at 52 weeks after randomization. Secondary endpoints include change in N-terminal pro-B-type natriuretic peptide, Minnesota Living With Heart Failure Questionnaire, device-detected atrial arrhythmias and physical activity, resting and exercise transthoracic echocardiography, and Montreal Cognitive Assessment.</div></div><div><h3>Conclusion</h3><div>This trial will be the first randomized trial to assess the impact of a high lower rate pacing on objective exercise tolerance and cardiac function in patients with stage B/C HFpEF. We anticipate the findings to improve our knowledge and guide pacemaker programming for patients with HFpEF.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1997-2005"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219210","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":"Left ventricular summit premature ventricular contraction successfully eliminated by ethanol infusion via a hypoplastic great cardiac vein","authors":"Khuong Dang Tran MD, FHRS,&nbsp;Yuen Hoong Phang MD,&nbsp;Duy Thai Vo MD, FHRS,&nbsp;Phuoc Huu Nguyen MBBS,&nbsp;Chin-Yu Lin MD, PhD","doi":"10.1016/j.hroo.2026.06.020","DOIUrl":"10.1016/j.hroo.2026.06.020","url":null,"abstract":"","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 2042-2045"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219219","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":"Circadian patterns of device-detected postoperative atrial fibrillation during 2.5 years of continuous monitoring after cardiac surgery: The RACE V–Tissue Bank Study","authors":"Michal J. Kawczynski MD,&nbsp;Martijn D. Gilbers MD,&nbsp;Joris Winters PhD,&nbsp;Bart Maesen MD, PhD,&nbsp;Aaron Isaacs PhD,&nbsp;Dominik Linz MD, PhD,&nbsp;Michiel Rienstra MD, PhD,&nbsp;Isabelle van Gelder MD, PhD,&nbsp;Jos G. Maessen MD, PhD,&nbsp;Elham Bidar MD, PhD,&nbsp;Ulrich Schotten MD, PhD","doi":"10.1016/j.hroo.2026.06.023","DOIUrl":"10.1016/j.hroo.2026.06.023","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative atrial fibrillation (POAF) is common after cardiac surgery. AF in non-surgical patients exhibits distinct circadian patterns (adrenergic/daytime and vagal/nocturnal), but such patterns for new-onset POAF and recurrent AF remain undefined.</div></div><div><h3>Objective</h3><div>This study aimed to characterize circadian AF patterns and relate chronotypes to clinical, biochemical, histological, and outcome features.</div></div><div><h3>Methods</h3><div>Patients undergoing first cardiac surgery, with and without preoperative AF, were continuously monitored for 2.5 years with an implantable loop recorder. Early AF was defined as AF within 30 days. Patients with sustained AF (≥20 episodes) were chronotyped via circular statistics and local regression of episode duration and ventricular rate (Vrate), and classified as adrenergic, vagal, mixed, or non-rhythmic. Preoperative imaging, electrocardiography, biomarkers, and paired atrial histology were compared across chronotypes.</div></div><div><h3>Results</h3><div>Of the 98 patients (71 without and 27 with preoperative AF), 53 (54.1%) developed POAF (3607 episodes). Patients with prior AF showed a morning onset peak, whereas new-onset POAF showed a uniform 24-hour distribution. Of 26 patients with sustained AF, 20 were rhythmic (9 adrenergic, 7 vagal, 4 mixed), and 6 were non-rhythmic; 27 had incidental AF (&lt;20 episodes). Rhythmic AF correlated with larger atrial volumes, prolonged PR intervals, higher bone morphogenetic protein-10 levels, and greater right-atrial endomysial fibrosis and asymmetry, most pronounced in the mixed chronotype. Adrenergic AF was associated with more arrhythmia-related emergency visits and cardioversions.</div></div><div><h3>Conclusion</h3><div>AF after cardiac surgery comprises distinct circadian subtypes. New-onset POAF and recurrent AF display different circadian patterns, and individual chronotypes are associated with varying degrees of atrial remodeling and clinical outcomes.</div></div>","PeriodicalId":29772,"journal":{"name":"Heart Rhythm O2","volume":"7 10","pages":"Pages 1884-1899"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219122","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}