Atrial Fibrillation Research Articles

Physician Preferences in Using Novel Digital Devices for the Management of Atrial Fibrillation-A DAS-CAM III Survey.

A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision-making. Participants of the DAS-CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33-46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG-based (92% vs. 68%, p < 0.001) and PPG-based (60% vs. 34%, p < 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low-risk, symptomatic high-risk, or asymptomatic high-risk patient) was heterogeneous. Electrophysiologists preferred intermittent single-lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non-electrophysiologists would rarely use PPG-based devices to diagnose and screen for AF (8.2%-9.8%). Electrophysiologists and non-electrophysiologists use ECG-based technology to confirm PPG-documented tracings suggestive of AF. While PPG-based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG-based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.

25-year trajectories of physical activity and atrial fibrillation risk: results from the ARIC study

BackgroundThe relationship between serial changes in physical activity and the risk of developing atrial fibrillation (AF) has been rarely studied.ObjectivesTo evaluate the association between changes in physical activity over time and the incidence of AF.MethodsA total of 11,828 participants without AF at baseline (visit 1: 1987–1989) from the ARIC Study were included. Physical activity was measured using the modified Baecke Physical Activity Questionnaire at three different visits between 1987 and 2013. Physical activity trajectories over 25 years were identified using latent class trajectory modeling. The primary outcome was the incidence of AF. Multivariable Cox hazard regression models were used to evaluate the relationship between physical activity trajectories and the incidence of AF.ResultsOver a median follow-up of 24 years, 2,108 AF cases (17.8%) occurred. Four distinct physical activity trajectories were identified: light [n = 5,266 (43.3%)]; reduced moderate [n = 3,583 (29.0%)]; moderate [n = 2,691 (25.0%)]; and vigorous intensity [n = 288 (2.8%)]. Compared to the light group, the hazard ratio (HR) and 95% confidence interval (CI) for AF were 1.18 (1.07–1.30) (p &amp;lt; 0.001) for the reduced moderate group, 0.61 (0.53–0.70) (p &amp;lt; 0.001) for the moderate group, and 0.82 (0.59–1.12) (p = 0.21) for the vigorous group, after multivariate adjustments.ConclusionMaintaining moderate levels of physical activity is associated with a lower risk of AF, while a decrease in activity from moderate to light levels increases the risk. These findings highlight the importance of sustaining adequate physical activity levels for the prevention of AF.

Factors influencing the use of direct oral anticoagulants among patients with chronic chagas cardiomyopathy

Objective. Chronic Chagas cardiomyopathy (CCC) carries a high risk of embolic events due to structural changes in the left ventricle and frequent conduction disorders. However, there is limited data on anticoagulant prescription patterns and factors influencing the use of direct oral anticoagulants (DOACs) in these patients. This study aims to characterize CCC patients based on the anticoagulant therapy received and identify factors associated with DOACs use. Materials and Methods. A cross-sectional study was conducted at a tertiary-level hospital in Colombia between 2019-2022. Multivariate logistic regression models were used to assess factors associated with anticoagulant therapy and DOACs use. Results. Among 224 CCC patients, 65.7% (n=153) were on anticoagulants, with DOACs being the most prescribed (53%). Notably, 35% of patients at high risk of stroke (CHA2DS2-VASc) were not receiving anticoagulants. Atrial fibrillation (OR 256.08; 95% CI 61.94-1058.72), ventricular aneurysms (OR 4.82; 95% CI 1.54-15.09), and reduced interventricular septal thickness (OR 0.75; 95% CI 0.60-0.92) were associated with anticoagulant use. DOACs were mainly prescribed for patients with atrial fibrillation (OR 13.29; 95% CI 2.47-71.56) and high bleeding risk (HAS-BLED ≥3, OR 11.36; 95% CI 1.15-112.11). Conclusions. A significant proportion of CCC patients were not receiving anticoagulants despite their high risk of stroke and embolic events. The use of anticoagulation was significantly associated with atrial fibrillation, the presence of ventricular aneurysms and reduced interventricular septal thickness. It is crucial to raise awareness among healthcare professionals in endemic areas to improve treatment.

Systemic Embolism and Clinically Significant Bleeding Events in Older Adults with Nonvalvular Atrial Fibrillation After Treatment with Direct Oral Anticoagulants and Warfarin: A Retrospective Cohort Study in Japan

Background/Objectives: Anticoagulant therapy, particularly the use of direct oral anticoagulant agents (DOACs), is recommended for patients with nonvalvular atrial fibrillation (NVAF). This multicenter observational retrospective cohort study aimed to assess the efficacy and safety of DOACs compared to warfarin in Japanese patients aged 75 years and older with NVAF. Methods: Data from the Mie-Life Innovation Promotion Center Database were used to collect medical information on the patients. The cumulative incidences of clinically significant bleeding events and systemic embolic events (SEEs) were analyzed. Results: This study included 1787 older adult patients, of whom 1321 received DOACs (edoxaban: 428; apixaban: 586; dabigatran: 105; rivaroxaban: 202) and 466 receiving warfarin. There were no statistically significant differences in the cumulative incidence of bleeding events between the DOAC- and warfarin-treated groups. However, a statistically significant difference was observed for SEEs, with dabigatran showing a significantly lower incidence compared to warfarin. Conclusions: The incidence rates of bleeding events for individual DOACs were comparable to those for warfarin. Additionally, a history of vascular disorders was identified as a risk factor for bleeding events in the DOAC-treated group (hazard ratio (HR): 1.83, 95% confidence interval (CI): 1.16–2.88, p &lt; 0.01) and warfarin-treated group (HR: 1.80, 95% CI: 1.15–2.84, p &lt; 0.01). Based on real-world data, the overall efficacy and safety of DOACs were generally comparable to warfarin.

Everyone over the age of 65years should wear a smartwatch : Pro and contra

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias and has far-reaching consequences not only for patients, but also for our healthcare system. The prevalence of this condition is expected to double in the coming decades. On the one hand, this is due to our aging population, the increasing number of comorbidities, and the improved technical possibilities for detection. A major complication of AF is stroke, whereby at-risk patients can be protected by oral anticoagulation if AF is diagnosed. The extent to which continuous screening for AF in patients with an increased risk of thromboembolic events should be carried out using wearables remains an important point in the current debate.

Using computed tomogram atrial myocardial thickness maps in cryoballoon pulmonary vein isolation: The UTMOST AF II Randomized Clinical Trial.

Whether adjusting the duration of ablation based on left atrial wall thickness (LAWT) provides extra benefits for pulmonary vein (PV) isolation for atrial fibrillation (AF) is uncertain. We studied the safety and efficacy of tailored cryoballoon PV isolation (CB-PVI) based on LAWT for paroxysmal AF. 277 patients with paroxysmal AF refractory to anti-arrhythmic drug were randomized 1:1 to either LAWT-guided CB-PVI (n=135) and empirical CB-PVI (n=142). Empirical CB-PVI was performed using a 28-mm cryoballoon with recommended application for 240 seconds per ablation. Cryoapplication in the LAWT-guided group was titrated (additional application for 120 seconds at PVs, where >25% of the circumference includes segments with LAWT >2.5mm and reduced baseline application to 180 seconds at PVs where >75% of the circumference includes segments with LAWT <1.5mm) according to the computed tomogram-LAWT color map. The primary endpoint was freedom from any documented atrial arrhythmia of more than 30 seconds without antiarrhythmic medication, after a single ablation procedure. During a mean follow-up of 18.7 months, patients in the LAWT-guided CB-PVI group (70.8%) had a higher event-free rate from primary endpoint than those in the empirical CB-PVI group (54.4%; HR 0.64, 95% CI 0.42-0.99; P=0.043). No differences were observed between the groups in complication rates (3.0% in LAWT-guided vs. 4.9% in empirical CB-PVI). The total procedure time was extended in the LAWT group than in the empirical group (mean 70.2 vs. 65.2 minutes, respectively). The LAWT-guided energy titration strategy improved freedom from atrial arrhythmia recurrence, compared with conventional strategy.

Heart failure after left atrial appendage occlusion: Insights from the LAAOS III randomized trial.

The left atrial appendage (LAA) produces natriuretic peptides and its removal or occlusion might increase the risk of heart failure (HF). We aimed to investigate the incidence of HF after LAA occlusion or removal (LAAO) in the Left Atrial Appendage Occlusion Study (LAAOS III). Patients (n = 4811) with atrial fibrillation (AF) and a CHA2DS2-VASc score ≥2, who were having cardiac surgery for another indication, were randomized to undergo surgical LAAO or not. We compared the composite outcome of HF-related hospitalizations and HF death between the two groups. HF assessment required clinical and radiographic evidence of HF. Analyses included a landmark analysis before and after 30 days and subgroups. Mean age was 71.2 years, 67.5% were male and 57.0% had prior HF. Over a mean follow-up of 3.8 years, 396 (8.3%) patients met the composite HF outcome: 209 (8.8%) with LAAO (n = 2379) and 187 (7.8%) without LAAO (n = 2391) (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.92-1.37, p = 0.25). There was no difference between the two groups in the first 30 days (1.6% vs. 1.1%; p = 0.12) and thereafter (7.6% vs. 7.1%; p = 0.57). Subgroups based on age, sex, body mass index, AF type, prior HF, cardiac rhythm or left ventricular ejection fraction showed consistent results. There was no difference in HF outcomes with LAAO between the cut-and-sew (HR 0.93, 95% CI 0.70-1.23, p = 0.62) versus other closure methods (HR 1.05, 95% CI 0.77-1.41, p = 0.77). Left atrial appendage occlusion or removal at the time of cardiac surgery does not appear to alter the risk of HF-related hospitalization or death. ClinicalTrials.gov NCT01561651.

Effect of blood pressure variability on the outcomes of acute ischemic stroke patients undergoing intravenous thrombolysis

BackgroundThere is limited research on the relationship between blood pressure variability (BPV) and outcomes among patients receiving intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). This study aimed to investigate the effect of 24-h BPV on the outcome of patients with AIS treated with IVT. MethodsA retrospective analysis was conducted on clinical data of patients with AIS who had undergone IVT treatment. During the initial 24 h after IVT, various BPV parameters for systolic and diastolic blood pressure were calculated, including the maximum BP, minimum BP, mean BP, standard deviation, coefficient of variation, and average real variability (ARV). Follow-up was conducted at 90 days post-onset, with outcomes classified as “good” or “poor” based on a modified Rankin Scale score of ≤2 or >2, respectively. ResultsA total of 216 patients were included in the study and divided into two groups based on their outcomes: a good-outcome group (n = 151, 69.9 %) and a poor-outcome group (n = 65, 30.1 %). A comparison of the poor-outcome group with the other group revealed significant differences in age, baseline National Institutes of Health Stroke Scale, Trial of Org 10172 in Acute Stroke Treatment classification, diabetes mellitus, and atrial fibrillation (P < 0.05). The maximum systolic blood pressure (163.58 ± 19.76 vs. 173.91 ± 18.51 mmHg) and average rate of ventricular response (10.35 vs. 12.09) in the good-outcome group were lower than those in the poor-outcome group (all P < 0.05). After adjusting for confounding factors in the binary logistic regression analysis, the maximum systolic blood pressure (odds ratio = 1.023, 95 % confidence interval = 1.004–1.043, P = 0.019] and ARV (odds ratio = 1.103, 95 % confidence interval = 1.007–1.208, P = 0.035) were significantly associated with adverse outcomes. ConclusionThe maximum systolic blood pressure and mean true variation rate were negatively correlated with outcomes.

Serum total calcium levels as a non-linear predictor of in-hospital mortality in heart failure patients: insights from a retrospective cohort study

BackgroundCalcium is pivotal in the regulation of bodily homeostasis, with numerous studies highlighting its link to cardiovascular disease in the adult population. However, the relationship between serum calcium levels and the prognosis of heart failure (HF) patients is not clear. This study explored the association between serum total calcium (STC) and in-hospital mortality in patients with HF.MethodsClinical data of 1,176 patients with HF were obtained from the Multiparametric Intelligent Monitoring in Intensive Care III (MIMIC-III) database. The patients were categorized into STC quartiles, and baseline characteristics were comprehensively analyzed. Univariate and multivariate analyses were employed to identify factors associated with in-hospital mortality. To explore the non-linear relationship between STC and mortality, a two-piecewise linear regression model was applied. Subgroup analyses were conducted to identify potential confounding variables.ResultsIn this cohort, 159 (13.53%) patients experienced in-hospital mortality. Significant differences in various parameters were observed among STC quartiles. Univariate analysis identified numerous factors associated with mortality. Multivariate analysis confirmed STC as an independent predictor of in-hospital mortality, with a negative association persisting even after adjusting for confounding factors (odds ratio [OR]: 0.49, 95%CI: 0.32–0.76; P = 0.0016). Non-linear analysis revealed an inflection point at 8.41 mg/dL, below which the risk of in-hospital death significantly increased (OR: 0.26, 95%CI: 0.12–0.55; P = 0.0005). Subgroup analyses indicated a pronounced inverse association in patients without atrial fibrillation or chronic obstructive pulmonary disease, as well as those with a left ventricular ejection fraction ≤ 50%.ConclusionThis study identified STC as an independent predictor of in-hospital mortality in HF patients, with a non-linear relationship.

Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis.

This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger's test. Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40-80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27-0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment. Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.

Dabigatran attenuates the binding of thrombin to platelets - a novel mechanism of action.

Thrombin is a multifunctional regulatory enzyme of the hemostasis and has both pro- and anticoagulant roles. It has, therefore, been a main target for drug discovery over many decades. Thrombin is a serine protease and possesses two positively charged regions called exosites, through which it is known to bind to many substrates. Dabigatran is a thrombin inhibitor and is widely used as an oral anticoagulant for the antithrombotic treatment of atrial fibrillation and venous thromboembolism. The mechanism by which dabigatran inhibits thrombin is the blockage of the active site, however, its effect on thrombin binding to its substrates has not been studied thoroughly and is thus poorly understood. We have discovered that apart from blocking the active site, dabigatran also inhibits thrombin binding to platelets, which is an important step in the hemostasis. This was achieved by evaluating the binding of fluorescently labelled thrombin to platelets by flow cytometry. Further, to confirm the results we utilized modern techniques for biomolecular binding studies, microscale thermophoresis combined with SPR, which validated the results. The inhibition of thrombin binding to its substrates in flow cytometry was dose dependent with IC50 of 118 nM which was slightly lower than for inhibition of platelet activation and is close to the clinically relevant plasma concentration of dabigatran. Since thrombin has numerous functions beyond the cardiovascular system, this finding may have important implications.

Clinical implication of ANTWERP score in patients receiving catheter ablation for atrial fibrillation

Clinical implication of <scp>ANTWERP</scp> score in patients receiving catheter ablation for atrial fibrillation

Connectivity Analysis of Atrial Fibrillation Related Stroke Based on Co-Expression Structure Network

Connectivity Analysis of Atrial Fibrillation Related Stroke Based on Co-Expression Structure Network

Prevention of New-Onset Heart Failure in Atrial Fibrillation: The Role of Pharmacological Management.

Atrial fibrillation (AF) is the most common type of chronic arrythmia, with a lifetime prevalence of one in every three to five individuals above the age of 45 years. The higher heart rate, abnormal rhythm and inflammation caused by AF lead to changes in the function and structure of the heart. This, over time, can culminate in heart failure. In patients with AF, the lifetime prevalence of new-onset heart failure is twice that of stroke. The development of new-onset heart failure in AF is associated with high mortality. Despite the emphasis that AF guidelines put on preventing cardiovascular comorbidities, there is limited evidence regarding pharmacological therapies to prevent incident heart failure in individuals with AF. Specifically, the association between the use of rate control agents and incident heart failure in this population is unknown. Whilst rhythm control may reduce the risk of heart failure, the comparative effect of each pharmacological agent is not clear. In select subgroups of patients with AF, the choice of direct-acting oral anticoagulants and their optimal dosing has been attributed to a lower risk of new-onset heart failure. Future research is needed to identify an evidence-based approach to minimizing the development of heart failure in patients with AF.

Atrial Fibrillation Type Classification by a Convolutional Neural Network Using Contrast-Enhanced Computed Tomography Images

Catheter ablation therapy, which is a treatment for atrial fibrillation (AF), has a higher recurrence rate as AF duration increases. Compared to paroxysmal AF (PAF), sustained AF is known to cause progressive anatomic remodeling of the left atrium, resulting in enlargement and shape changes. In this study, we used contrast-enhanced computed tomography (CT) to classify atrial fibrillation (AF) into paroxysmal atrial fibrillation (PAF) and long-term persistent atrial fibrillation (LSAF), which have particularly different recurrence rates after catheter ablation. Contrast-enhanced CT images of 30 patients with PAF and 30 patients with LSAF were input into six pretrained convolutional neural networks (CNNs) for the binary classification of PAF and LSAF. In this study, we propose a method that can recognize information regarding the body axis direction of the left atrium by inputting five slices near the left atrium. The classification was visualized by obtaining a saliency map based on score-class activation mapping (CAM). Furthermore, we surveyed cardiologists regarding the classification of AF types, and the results of the CNN classification were compared with the results of physicians’ clinical judgment. The proposed method achieved the highest correct classification rate (81.7%). In particular, models with shallow layers, such as VGGNet and ResNet, are able to capture the overall characteristics of the image and therefore are likely to be suitable for focusing on the left atrium. In many cases, patients with an enlarged left atrium tended to have long-lasting AF, confirming the validity of the proposed method. The results of the saliency map and survey of physicians’ basis for judgment showed that many patients tended to focus on the shape of the left atrium in both classifications, suggesting that this method can classify atrial fibrillation more accurately than physicians, similar to the judgment criteria of physicians.

The predictive value of pan-immune inflammatory index for early recurrence of atrial fibrillation after cryoablation

ObjectiveThe pan-immune inflammatory (PIV) index holds prognostic value for cardiovascular diseases. This study aimed to investigate the predictive value of the PIV index regarding recurrence of atrial fibrillation (AF) after cryoballoon ablation (CBA).MethodsThe study included 307 patients with AF. Four inflammatory markers, namely, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation (SII) index, and PIV index, were used as indicators. COX regression analysis was conducted to evaluate the predictive value of AF recurrence after CBA. A receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the discriminative power of the indicators.ResultThe PIV index [94.9 (168.9,504.9) vs. 143.2 (98.2,210.6), P < 0.01] and SII index [366.3 (256.6,491.9) vs. 569.9 (658.1,438.4), P < 0.01] were significantly higher in the recurrence group. Univariable COX regression analysis showed that these four indices, persistent AF, and left atrial diameter (LAD) were all associated with AF recurrence. In multivariable regression analysis, the PIV index, persistent AF, and LAD (all P < 0.05) were independent predictors of postoperative AF recurrence. The ROC curve analysis showed that the PIV index had a higher predictive value for AF recurrence (AUC = 0.768, P < 0.01, 95% CI: 0.696–0.840) than the SII index and NLR. Kaplan–Meier analysis showed that patients with a PIV index > 260.7 had a higher recurrence rate at 1-year follow-up (P < 0.01). Subgroup analysis indicated that PIV had a predictive value in patients with different types of AF.ConclusionPIV index may be a potential biomarker for predicting relapse in patients with AF after CBA.

The Relationship Between Left Atrial Appendage Morphology and Thrombus presence in Patients with Atrial Fibrillation, Evaluated by Transesophageal Echocardiography

The Relationship Between Left Atrial Appendage Morphology and Thrombus presence in Patients with Atrial Fibrillation, Evaluated by Transesophageal Echocardiography

Impact of Age Differences in Chronic Limb Threatening Ischaemia Outcomes in Octogenarians

IntroductionThe aging population is a growing challenge for healthcare services and as such multi-morbidity and associated aging are the focus of research programs. Chronic limb threatening ischaemia (CLTI) in the older patient is perceived to be associated with high morbidity and mortality but a potentially contentious area with limited evidence. MethodsRetrospective review of all consecutive CLTI admissions to a UK tertiary vascular during 2020. Analysis included descriptive statistics and comparisons by age. The primary outcome was survival (by Kaplan-Meier with secondary outcomes being major adverse limb (MALE) and cardiovascular events (MACE). Results183 patients, with a median age of 72 of which 55(30%) were octogenarians.Fewer octogenarians were diabetic (38.2% vs 58.6% , p=0.015), but comorbidities such as previous stroke (25.5% vs 10.9% , p=0.015) and atrial fibrillation (36.4% vs 16.4%, p=0.004) were increasingly common. 87.3% of octogenarians had moderate or severe frailty compared to 57.8% in those <80 (p=0.001)(by electronic frailty index). Median survival time was 30 months with no significant difference between groups (p=0.406).MACE (10.9% vs 7.81%, p=0.504) and MALE (34.5% vs 24.2% p=0.261) were comparable between groups. Octogenarians were less likely to have open surgery (10.9% vs 25.8%, p=0.024). ConclusionsOctogenarians have similar cardiovascular, limb and survival outcomes following intervention despite being increasingly frail and comorbid. Holistic assessment, perioperative optimisation and risk stratification are important in this group.

Dysregulated RBM24 phosphorylation impairs APOE translation underlying psychological stress-induced cardiovascular disease

Psychological stress contributes to cardiovascular disease (CVD) and sudden cardiac death, yet its molecular basis remains obscure. RNA binding protein RBM24 plays a critical role in cardiac development, rhythm regulation, and cellular stress. Here, we show that psychological stress activates RBM24 S181 phosphorylation through eIF4E2-GSK3β signaling, which causally links psychological stress to CVD by promoting APOE translation (apolipoprotein E). Using an Rbm24 S181A KI mouse model, we show that impaired S181 phosphorylation leads to cardiac contractile dysfunction, atrial fibrillation, dyslipidemia, reduced muscle strength, behavioral abnormalities, and sudden death under acute and chronic psychological stressors. The impaired S181 phosphorylation of RBM24 inhibits cardiac translation, including APOE translation. Notably, cardiomyocyte-specific expression of APOE rescues cardiac electrophysiological abnormalities and contractile dysfunction, through preventing ROS stress and mitochondrial dysfunction. Moreover, RBM24-S181 phosphorylation acts as a serum marker for chronic stress in human. These results provide a functional link between RBM24 phosphorylation, eIF4E-regulated APOE translation, and psychological-stress-induced CVD.

Multielectrode Catheter-Based Pulsed Electric Field Versus Cryoballoon For Atrial Fibrillation Ablation: A Systematic Review And Meta-Analysis.

Pulsed field ablation (PFA) is an innovative technology recently adopted for the treatment of atrial fibrillation (AF). Preclinical and clinical studies have reported a remarkable safety profile, as a result of its tissue specific effect targeting cardiomyocytes and sparing adjacent tissues. Single-shot pentaspline system was the first PFA device to receive regulatory approval. We performed a meta-analysis to compare the efficacy and safety of PFA with the single-shot pentaspline system versus currently available 2nd/3rd/4th generation Cryoballoon technologies (CRYO). We systematically searched electronic databases for studies focusing on AF ablation employing the PFA single-shot pentaspline system or 2nd/3rd/4th generation CRYO technologies. The primary endpoints were acute procedural success assessed on a vein and patient basis. Safety endpoints included overall periprocedural complications and major periprocedural complications. We also compared procedural, fluoroscopy times, and freedom from atrial tachyarrhythmias (ATs) at follow-up (secondary endpoints). Twenty and 70 studies were included for PFA and CRYO, respectively. PFA demonstrated greater acute procedural success on a vein basis (99.9% vs 99.1%; p<0.001), as well as per patient (99.5% vs 98.4%; p<0.001). PFA yielded lower overall periprocedural complications (3.1% vs 5.6%; p<0.001), shorter procedural time (75.9 min vs 105.6 min; p<0.001) and fluoroscopy time (14.2 min vs 18.9 min; p<0.001) compared to CRYO. No differences were found for major periprocedural complications (1.2% vs 1.0%; p=0.46) and freedom from ATs at 1 year (82.3% vs 80.3%; Log-rank p= 0.61). PFA contributed to higher acute procedural success, and safety compared to CRYO. No statistically significant differences in AT recurrence at 1-year follow-up were observed.