Persistent left superior vena cava is associated with complex atrial tachyarrhythmias in repaired tetralogy of Fallot: evidence for a right-sided arrhythmogenic substrate.

Atrial fibrillation (AF) is a prevalent comorbidity among patients undergoing transcatheter aortic valve implantation (TAVI); however, its prognostic implications remain uncertain. This study aimed to elucidate the impact of preprocedural AF on clinical outcomes following TAVI in patients with aortic stenosis (AS). We conducted a single-center, retrospective cohort study comprising 297 consecutive AS patients who underwent TAVI (mean age 83 ± 4years; 69% female). Pre-existing AF was identified in 89 (30%) patients. Patients were stratified into two groups based on the presence or absence of AF, and propensity score matching (PSM) was employed, resulting in 68 matched pairs. The study endpoint was the incidence of net adverse clinical events (NACE) and all-cause mortality. NACE was defined as a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, systemic thromboembolism, valve thrombosis, and major bleeding events. These clinical outcomes were analyzed according to the presence and subtype of pre-existing AF and further stratified across body mass index (BMI) categories. To further assess the combined impact of AF and BMI, patients were additionally categorized into four groups according to the presence or absence of AF and low BMI (< 18.5kg/m2), and multivariable Cox regression analysis was performed across these groups. The median duration of follow-up was 2.3 [1.0-3.7] years. While baseline characteristics, including age and gender, were comparable between groups, patients with pre-existing AF exhibited a higher prevalence of prior heart failure hospitalizations and reduced renal function. There were no statistically significant differences in the incidence of NACE and all-cause mortality between the AF and non-AF groups, both before and after PSM. However, among patients with AF, those with a low BMI < 18.5kg/m2 experienced a significantly higher rate of adverse clinical events compared to those with normal or high BMI. This was supported by multivariable analysis. Although preprocedural AF was not independently associated with adverse clinical outcomes following TAVI, the coexistence of AF and low BMI was linked to significantly worse prognosis. These findings suggest a potential synergistic effect warranting further investigation and individualized risk stratification.

Paroxysmal atrial fibrillation (AF) may underlie some embolic strokes of undetermined source (ESUS), but the widespread use of loop recorders (LRs) to detect it may not be cost-effective. This study evaluated whether assessing left atrial (LA) function by speckle tracking echocardiography (STE) could help to identify ESUS patients most likely to benefit from LR monitoring for AF detection. Consecutive ESUS patients diagnosed between 2020 and 2023, who underwent LR implantation and comprehensive echocardiographic evaluation, including STE, were enrolled. Patients were divided into two groups based on AF detection by LR over a median follow-up of 10.0months (IQR 6.0-21.7). A total of 64 patients were included: 27 (42.2%) with AF (AF group) and 37 (57.8%) without AF (No-AF group). Compared to the No-AF group, patients in the AF group showed a significantly larger left atrial volume index (LAVi: 44.7 ± 10.8 vs. 34.4 ± 8.3mL/m2; p < 0.001), a lower LA longitudinal strain of reservoir (LASr: 19.7 ± 8.9% vs. 27.4 ± 9.5%; p = 0.003) and contraction (LASct: 7.4 ± 6.5% vs. 12.4 ± 7.2%; p = 0.008), and an increased LA stiffness index (LASi: 0.6 ± 0.3 vs. 0.3 ± 0.2; p < 0.001). In multivariable Cox regression analysis, only LAVi and LASct remained independent predictors of AF. LAVi and LASct appear useful and reliable predictors of AF occurrence during follow-up in ESUS patients and may aid in selecting those who are most likely to benefit from LR implantation.

Identification of metabolic biomarkers in atrial fibrillation patients via the multi-omics strategy: the critical involvement of pyruvate kinase M2.

Impact of atmospheric pollutant exposure on atrial fibrillation dynamics: Insights from 3D models.

Risk prediction of atrial fibrillation progression in patients with paroxysmal atrial fibrillation: data from the RACE V study.

Ibrutinib, a frontline therapy for chronic lymphocytic leukemia (CLL), has been associated with an approximately 10-fold increased risk of atrial fibrillation (AF) during treatment. Wenxin Granules, as a multi-component and multi-target drug, exert therapeutic effects on AF. We conducted electrophysiological studies in ibrutinib-treated mice models to assess AF inducibility and the therapeutic efficacy of Wenxin Granules. Through network pharmacology screening, we identified potential molecular targets of Wenxin Granules. Subsequent proteomic analysis revealed specific targets through which Wenxin Granules may prevent ibrutinib-associated AF. These targets were further validated in mice model experiments. Our study demonstrates that Wenxin Granules treatment in mice significantly reduces AF inducibility, shortens AF duration, and attenuates pathological cardiac remodeling, including left atrial (LA) enlargement and myocardial fibrosis (p < 0.05). Through comprehensive analysis integrating proteomics with network pharmacology-predicted molecular targets, we systematically screened and identified 25 core therapeutic targets of Wenxin Granules, which are primarily associated with oxidative stress and calcium protein-related signaling pathways. The ibrutinib treatment group demonstrated significantly elevated expression of reactive oxygen species (ROS)-related proteins, including NOX2, NOX4, p22-phox, and XO. Additionally, ibrutinib substantially increased the expression of ox-CaMKII, p-CaMKII (Thr-286), and p-RyR2 (Ser2814), resulting in enhanced abnormal sarcoplasmic reticulum (SR) Ca2+ release, altered mitochondrial structures, and atrial fibrosis. Notably, Wenxin Granules administration reduced the expression of these proteins (p < 0.05). These findings demonstrate that Wenxin Granules can ameliorate the occurrence and progression of AF induced by ibrutinib treatment, thereby laying the groundwork for further research and potential clinical applications in AF therapy.

Background: Critically ill adults are more commonly being admitted to intensive care units (ICU) with a recent history of direct oral anticoagulant (DOAC) use. No consensus guidance exists on optimal anticoagulation strategies in critically ill adults with non-valvular atrial fibrillation (NVAF) on DOAC's prior to ICU admission, and there is considerable variability in clinical practice. Objective: To evaluate rates of major bleeding and thrombosis between 2 anticoagulation strategies for NVAF upon ICU admission: package insert (continuation of oral or parenteral anticoagulation per manufacturer recommendations) vs non-package insert (prophylactic dosing or delayed therapeutic anticoagulation). Study design: This was a retrospective cohort study conducted from January 2019 to August 2023. Patients with NVAF and objective evidence of DOAC exposure within 48 hours of ICU admission were included. Those admitted to the ICU for a bleeding event or who received anticoagulation for indications other than NVAF were excluded. Results: A total of 353 patients met inclusion criteria (122 vs 231 in the package insert and non-package insert groups, respectively). There was no significant difference in the composite incidence of major bleeding and stroke or systemic embolism between groups (4.1% in package insert vs 6.1% in non-package insert; P = 0.437). Conclusion: This study demonstrated no difference in the incidence of major bleeding, in-hospital stroke, or systemic embolism with a package insert vs a non-package insert approach to anticoagulation in critically ill patients receiving DOAC therapy for atrial fibrillation. However, more studies are needed to develop evidence-based guidance on anticoagulation management in this population.

Stroke risk, gray matter network, and cognitive performance in stroke-free individuals with atrial fibrillation.

Atrial fibrillation (AF) may progress from paroxysmal AF (PAF) to more persistent forms, but the underlaying mechanisms are not well understood. The aim of this study was to assess the association between atherosclerosis and AF progression in patients with PAF. In this substudy of RACE V, 612 patients with PAF underwent extensive phenotyping at baseline and continuous rhythm monitoring. The association between atherosclerosis and AF progression was investigated. The median age was 64 (57-70) years, 257 (42%) were women, and the median CHA2DS2-VA score was 2 (1-3). At baseline, 395 (65%) patients had atherosclerosis, defined by carotid/coronary imaging and/or history of vascular disease. Patients with atherosclerosis were older, had higher waist circumference, more hypertension, and lower eGFR than patients with no atherosclerosis. During a median of 3.4 (2.8-3.7) years follow-up, 108 (18%) patients had AF progression. The presence of atherosclerosis was associated with increased progression (21% vs. 12%; p = .004). In univariable analyses, atherosclerosis was a determinant of AF progression (OR: 2.04; 95% CI: 1.28-3.37; p = .004), and the association persisted following adjustment for established risk factors (OR: 2.23; 95% CI: 1.10-4.89; p = .034). In patients with paroxysmal AF, 65% of patients had atherosclerosis. Atherosclerosis was a determinant of AF progression after adjustment for established risk factors and comorbidities, suggesting that vascular disease may contribute directly to atrial remodelling and arrhythmia persistence.

Interactive and joint associations of C-reactive protein-triglyceride glucose index and body roundness index on incident cardiovascular diseases: a nationwide prospective cohort study.

Atrial fibrillation (AF) is a common cardiac dysrhythmia encountered in the Emergency Department (ED) setting. The term, 'recent-onset AF', whilst inconsistently defined across protocols and guidelines, generally refers to the 48-h window for cardioversion when used in the ED setting. A clear terminology and taxonomy of AF is needed to guide ED clinicians, researchers and patients with respect to AF and its acute presentation to the ED. In this article, we discuss the current inconsistencies with terminology pertaining to acute AF and present evidence to support the use of the term 'acute recent-onset AF'. In addition, a three-part taxonomy is suggested to better delineate the various presentations of AF to the ED.

Appropriateness of oral anticoagulant therapy and associated factors among hospitalized atrial fibrillation patients with the CHA2DS2-VASc score of 1 (beyond sex).

Both percutaneous left atrial appendage occlusion (LAAO) and nonvitamin K antagonist oral anticoagulants (NOACs) are noninferior to warfarin for stroke prevention in high-risk patients with atrial fibrillation (AF). However, there is limited data comparing LAAO with NOACs. The CATALYST trial compares a dual-seal LAAO device (Amplatzer™ Amulet™) to NOACs in AF patients indicated for thromboprophylaxis. CATALYST is a prospective, multicenter, randomized controlled, open-label trial with an adaptive statistical design. Up to 2,650 AF patients with CHA2DS2-VASc score ≥2 (men) or ≥3 (women) will be randomly assigned to LAAO or NOAC at 123 global sites. Patients randomized to NOACs take the appropriate labeled dose with compliance monitored at each visit, while LAAO patients receive dual antiplatelet therapy followed by aspirin monotherapy for ≥12 months postimplant. Patients are followed through 5 years, with postimplant cardiac imaging at 3- and 12-months. There are three co-primary endpoints: (1) ischemic stroke, systemic embolism, or cardiovascular death through 2 years, tested for noninferiority; (2) major or clinically relevant nonmajor bleeding through 2 years, tested for superiority; and (3) ischemic stroke or systemic embolism through 3 years, tested for noninferiority. The following secondary endpoints will be tested if the primary endpoints are met: (1) all-bleeding, tested for noninferiority; (2) followed by testing for superiority; (3) disabling or fatal strokes, tested for superiority; all through 2 years. CATALYST is evaluating the safety and effectiveness of a dual seal LAAO device compared to NOACs in patients with AF at increased risk of stroke. URL https://clinicaltrials.gov; Unique Identifier NCT04226547.

The impact of body mass index (BMI) on the outcomes of radiofrequency catheter ablation (RFCA), including atrial fibrillation (AF) recurrence rate, cardiac remodelling, and quality of life (QoL), remains uncertain. We analysed 12 104 first-time RFCA patients from the China-AF registry, stratified by BMI: under/normal weight (< 25 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). The primary outcome was AF recurrence. Exploratory outcomes included 12-month echocardiographic parameters and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores. Multivariable Cox regression, median regression, restricted cubic splines (RCS), and subgroup analyses were performed. In this cohort (median age 61.55 years, 32.6% female), obese patients were significantly younger with higher comorbidities burdens. Over a median follow-up of 47.5 months, 4932 (40.8%) patients experienced AF recurrence. BMI exhibited a linear, dose-dependent association with recurrence risk (fully adjusted HR 1.01, 95% CI, 1.00-1.02; obese HR 1.16, 95% CI: 1.05-1.28), consistent across primary analyses, sensitivity analyses using Chinese BMI classification standards, and subgroups (with stronger associations in males, < 65 years, persistent AF), without significant interactions across these subgroups (all pinteraction > 0.05). Exploratory analyses suggested obesity was linked to nonlinearly higher 12-month left ventricular end-diastolic diameter (LVEDD; 2.17 mm, 95% CI: 0.79-3.55) and left ventricular wall thickness (LVWT; 0.81 mm, 95% CI: 0.45-1.17) versus under/normal-weight, with nonlinear association in primary analysis (both pnonlinear < 0.05). Higher BMI exhibits a linear association with AF recurrence post-RFCA. Obesity is linked to nonlinear adverse remodelling (LVEDD and LVWT).

Atrial fibrillation (AF), the most common clinical arrhythmia, is driven by inflammatory activation and oxidative stress, though precise molecular links remain unclear. This study identifies the P2X7 receptor as a key upstream regulator orchestrating proarrhythmic atrial remodeling through reactive oxygen species (ROS)-mediated mitogen-activatedprotein kinase (MAPK) signaling. Transcriptomic analysis of rapid-paced cardiomyocytes revealed P2X7 upregulation and MAPK pathway enrichment. Functional validation demonstrated that P2X7 activation promotes ROS accumulation, MAPK phosphorylation (p-ERK, p-p38, and p-JNK), and pro-inflammatory cytokine release (IL-6 and IL-1β), culminating in action potential shortening and calcium handling dysfunction. Critically, both P2X7 inhibition (A-438079) and ROS scavenging (NAC) attenuated this signaling axis. In vivo, P2X7 antagonism reduced AF susceptibility, improved conduction heterogeneity, and ameliorated structural and autonomic remodeling. These results establish the P2X7-ROS-MAPK axis as a central mechanism in AF vulnerability and highlight its therapeutic potential.

CYP2C19 genetic polymorphisms impact the antiplatelet effect of clopidogrel and associate with ischemic and bleeding risk in patients undergoing percutaneous coronary intervention (PCI). This study aimed to evaluate the association of CYP2C19 and platelet reactivity (PR) with these risks, in atrial fibrillation (AF) patients undergoing PCI,treated with an oral anticoagulation (OAC) and clopidogrel. This two-center prospective cohort study included patients with AF and OAC undergoing PCI. Carriers of ≥ 1 loss-of-function (LOF) allele were classified as poor/intermediate metabolizers (PM/IM), whereas carriers of ≥ 1 gain-of-function allele without LOF alleles were classified as rapid metabolizers (RM). PR was assessed by thromboelastography (TEG) and/or multiple electrode aggregometry (MEA). The primary outcome included death, MI, or stroke at 6 months ±2 weeks; the secondary outcome consisted of non-major clinically relevant (NMCR) or major bleeding. Among 283 patients (median age 78 years; 72% male), 73 (26%) were PM/IM, 108 (38%) were NM, and 102 (36%) were RM. PM/IM status was not significantly associated with the primary ischemic outcome (PM/IM: 6 [8.2%] vs. NM + RM: 16 [7.6%], p = 0.869), but any bleeding rates were numerically lower. While there was a trend for association of high platelet reactivity (HPR) with the ischemic outcome (OR 2.005 [95% CI 0.820-4.902], p = 0.127), low platelet reactivity (LPR) was associated with major bleeding (OR 2.646 [95% CI 1.075-6.509], p = 0.034). PM/IM status did not detect an increased ischemic risk but might, however, protect from bleeding risk in AF patients undergoing PCI. HPR might indicate a higher ischemic risk, while LPR was associated with major bleeding.

Impact of pulmonary hypertension on atrial fibrillation recurrence after pulmonary vein isolation: A prospective multicenter registry study.

Mitral valve repair (MVr) is effective for mitral regurgitation, but the benefit of prophylactic left atrial appendage occlusion (LAAO) in patients without prior atrial fibrillation (AF) remains unclear. This meta-analysis aimed to assess the long-term safety and efficacy of LAAO in this understudied population. We performed a meta-analysis from four major databases until December 2025. Kaplan-Meier curves data were reconstructed and analyzed using Cox regression models and hazard ratios (HR) for thromboembolic events (mainly stroke). A random-effects meta-analysis was performed with R software to calculate risk ratios (RR), hazard ratios (HR), and mean differences (MD), all with 95% confidence intervals (CIs). Three studies with 5048 patients were included. LAAO was associated with a significant reduction in thromboembolic risk at 5 years (HR 0.60, 95% CI 0.46 to 0.77). LAAO reduced in-hospital stroke (RR 0.43, 95% CI 0.25 to 0.72) but increased postoperative AF (RR 1.17, 95% CI 1.09 to 1.26). No significant differences were observed in 30-day mortality (RR 0.56, 95% CI 0.07 to 4.33) or hospital stay (MD -0.16 days, 95% CI - 0.48 to 0.16). Prophylactic LAAO during MVr in patients without AF may reduce thromboembolic events risk but appears to increase postoperative AF. Further randomized studies are warranted.

Phenotype-stratified treatment response in obese atrial fibrillation: Post-hoc cluster analysis of the PRAGUE-25 randomized trial.