BACKGROUND:The optimal long-term antithrombotic strategy in patients with atrial fibrillation (AF) and coronary artery disease (CAD) after successful catheter ablation (CA) remains uncertain. OBJECTIVE:This study aimed to compare the effectiveness and safety of single antiplatelet therapy (SAPT) vs oral anticoagulation (OAC) monotherapy in this population. METHODS:This cohort study used a target trial emulation framework based on data from the China Atrial Fibrillation Registry. Patients with nonvalvular AF and CAD who underwent index CA were screened. Those free from AF recurrence, thromboembolism, or bleeding 12 months after ablation were included and categorized according to antithrombotic regimen at the 12-month landmark. The primary effectiveness outcome was thromboembolism (ischemic stroke or systemic embolism), and the primary safety outcome was bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding). Secondary outcomes included all-cause mortality and net clinical benefit. Inverse probability of treatment weighting was used for confounding adjustment. RESULTS:Among 998 patients (mean age 66.8 years; 26.5% women), 706 received SAPT and 292 OAC monotherapy. Over a mean follow-up of 3.0 years, 19 thromboembolic and 29 bleeding events occurred. After weighting, no statistically significant difference in thromboembolism was observed (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.18-1.61), whereas SAPT was associated with lower bleeding risk (HR, 0.40; 95% CI, 0.18-0.91). No significant differences were observed in mortality (HR, 0.77; 95% CI, 0.35-1.72) or net clinical benefit (HR, 0.66; 95% CI, 0.36-1.20). CONCLUSION:In this stable postablation population with AF and CAD, SAPT was associated with lower bleeding risk vs OAC monotherapy, whereas no statistically significant difference in thromboembolism was observed.

Identifying the underlying cause of cardiac dysfunction is essential for determining the appropriate treatment and prognosis. The current management paradigm for heart failure (HF) and cardiomyopathies predominantly emphasizes structural and ischemic etiologies, often overlooking the substantial role of electrical dyssynchrony in cardiac dysfunction and remodeling. This work introduces a novel conceptual framework that integrates existing evidence illustrating how electrical dyssynchrony induces mechanical dyssynchrony, culminating in regional cardiac impairment and structural remodeling. The myocardial area that activated early lacks proper afterload, impairing its ability to perform work effectively. Consequently, disuse atrophy gradually manifests in the early activation area over time. We propose the concept of early-excitation segment atrophy (EESA) syndrome to address the HF caused by asynchronous conduction. For the left ventricle, whichever part contracts first will become disused and may contribute to or exacerbate HF. The conduction abnormalities known to induce EESA include left bundle branch block (LBBB), right ventricular pacing (RVP), bilateral bundle branch block (BBBB), Wolff-Parkinson-White (WPW) syndrome, and premature ventricular contractions (PVCs). Appropriate diagnosis and treatment will lead to improved left ventricular ejection fraction and reduced mortality. By integrating EESA into clinical practice, we aim to improve the recognition and management of dyssynchrony-induced cardiomyopathies, ultimately enhancing patient outcomes. This review presents an update of the mechanisms, prevalence, incidence, and risk factors, as well as their diagnosis and management, while highlighting current gaps of knowledge.

QuestionIs discontinuation of guideline-directed medical therapy (GDMT) after catheter ablation feasible and safe in patients with atrial fibrillation (AF) with improved cardiac function?FindingsIn this randomized clinical trial of 50 patients with AF and heart failure (HF) with improved ejection fraction (suspected with AF-mediated cardiomyopathy), phased GDMT withdrawal in those with normalized left ventricular ejection fraction and sinus rhythm resulted in HF deterioration in 3 of 23 patients (13%) compared with none in the continuation group. This was not a statistically significant difference.MeaningAlthough this study did not find significantly more HF deterioration in patients who discontinued GDMT vs those who continued, further studies are needed to determine whether GDMT can be safely discontinued in this population. This pilot randomized clinical trial assesses whether phased withdrawal of heart failure medication in patients who have undergone catheter ablation for atrial fibrillation (AF) and experienced improvements in cardiac function is feasible and safe. ImportanceWithdrawal of guideline-directed medical therapy (GDMT) for heart failure (HF) is common after atrial fibrillation (AF) catheter ablation and recovery of cardiac function, but safety remains uncertain.ObjectiveTo assess the feasibility and safety of phased GDMT withdrawal in patients with AF with highly suspected AF-mediated cardiomyopathy after catheter ablation.Design, Setting, and ParticipantsThis open-label pilot randomized clinical trial included adult patients who were enrolled and randomized from April 13, 2023, to September 19, 2024, at Beijing Anzhen Hospital, China, with a 6-month follow-up. Eligible patients were those with suspected AF-mediated cardiomyopathy at 3 months after ablation, defined by sinus rhythm at 3 months after ablation, absence of other suspected cardiomyopathies, improvement of left ventricular ejection fraction (LVEF) from 45% or less to 55% or more, normalized LV end-diastolic diameter (LVEDD), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels less than 250 ng/L, and no HF symptoms or signs.InterventionsPatients were randomly assigned in a 1:1 ratio to phased GDMT withdrawal or GDMT continuation.Main Outcomes and MeasuresThe primary end point was HF deterioration, defined as LVEF decline more than 10% to less than 55%, LVEDD increase more than 10% and beyond normal, NT-proBNP levels doubling to more than 400 ng/L, or worsening HF signs or symptoms. Secondary outcomes included cardiovascular events, changes in echocardiographic and cardiac magnetic resonance (CMR) parameters, NT-proBNP levels, Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) scores, atrial arrhythmia recurrence, and adverse drug events.ResultsAmong 50 patients enrolled and randomized, 47 completed follow-up (median [IQR] age, 56.0 [48.0-60.5] years; 37 males [78.7%]), including 23 (48.9%) in the GDMT withdrawal group and 24 (51.1%) in the continuation group. HF deterioration occurred in 3 patients with GDMT withdrawal (13.0%) and 0 with GDMT continuation (0%) (P = .11). Early GDMT reinitiation in 3 patients with HF deterioration showed recovery of LVEF or NT-proBNP. No cardiovascular events occurred. Median (IQR) echocardiographic (LVEF: 0% [-3.0% to 3.5%] vs 1.5% [-5.0% to 5.0%]), CMR (LVEF: -2.1% [-7.2% to 4.6%] vs 2.9% [-2.6% to 7.4%]), and KCCQ-12 score (0 [0 to 0.5] vs 0) changes were similar between groups. Median (IQR) NT-proBNP levels declined more in the GDMT continuation group than the withdrawal group (-25.7 [-33.6 to -6.7] pg/mL vs 2.7 [-21.4 to 24.2] pg/mL; P = .03). Adverse drug events were more frequent in the GDMT continuation group than the withdrawal group (5 [20.8%] vs 0 [0%]; P = .050). Arrhythmia recurrence rates were comparable (GDMT withdrawal: 3 [13.0%] vs continuation: 3 [12.5%]).Conclusions and RelevanceIn this pilot randomized clinical trial of carefully selected patients with AF with normalized cardiac function and sinus rhythm after catheter ablation, 13% of patients with GDMT withdrawal experienced HF deterioration, whereas drug-related complications were more common in the continuation group, suggesting that further studies are needed to determine whether GDMT can be safely discontinued in this population.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2300077439

PurposeTo explore the impact of epidemic diseases outbreak on the psychological status of medical workers.MethodsA total of 266 online questionnaires were distributed to medical staff in several mobile cabin hospitals in Beijing. The questionnaires were divided into a General Demographic Characteristics Questionnaire and the 12-item General Health Questionnaire (GHQ-12), and a total score of ≥4 in the GHQ-12 was considered to be a decline in mental health.ResultsA total of 266 members of medical staff participated in this study, and 30.1% experienced a decline in mental health recently. The highest prevalence of emotional distress was found among those who were female, married without children, working as doctors and other occupations, aged 30–39 years, working in the confirmation department, supporting the mobile cabin hospitals three times or more, the duration of this support for 1 month or longer, and having a previous state of anxiety and depression. In addition, females experienced higher rates of insomnia due to worry compared to males, as did medical staff in the confirmation department compared to the administration and logistics departments. In the same stressful environment, men and doctors had a greater rate of perceived loss of self-worth than women and nurses.ConclusionThe outbreak of epidemic makes medical workers face the risk of emotional distress. To achieve the purpose of preventing and treating emotional distress of medical workers, we need to carry out continuous and strict research and evaluation on the mental health planning of medical workers, formulate relevant policies and carry out professional psychological intervention.

Objectives: Real-world data on oral anticoagulant (OAC) use patterns and dosing appropriateness in patients with nonvalvular atrial fibrillation (AF) remain limited in China. This study aims to characterize trends in OAC prescribing and assess the dosing appropriateness of direct oral anticoagulants (DOAC) in nonvalvular AF. Methods: This is a retrospective secondary analysis of the prospective China-AF Registry (ChiCTR-OCH-13003729, registered on October 22, 2013), using data from patients with nonvalvular AF who were discharged on OAC between 2011 and 2022. Real-world trends in warfarin versus DOAC use and dosing appropriateness were evaluated. Predictors of inappropriate DOAC dosing were identified. Results: Among the included patients, 10,205 received warfarin and 15,084 received DOAC. The proportion of DOAC prescriptions increased from 0% in 2011 to 98% after 2020, whereas warfarin use declined from 99.74% to 1.99%. The shift accelerated after 2017, coinciding with the inclusion of dabigatran and rivaroxaban into the National Reimbursement Drug List. DOAC were less frequently prescribed to high-risk patients, including those with higher CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age [≥75 years earns 2 points, 65–74 years earns 1 point], diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism [2 points], vascular disease [e.g., prior myocardial infarction, peripheral artery disease], and female sex category) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65 years), drugs/alcohol use (HAS-BLED) scores, older age, and lower creatinine clearance (all P for trend < 0.05). Inappropriate dosing was more prevalent in these higher-risk groups ( P for trend < 0.001). Older age was independently associated with inappropriate dosing (per 10 years, odds ratio [OR] = 1.39; 95% confidence interval [CI], 1.29–1.51; P < 0.001). In contrast, male (OR = 0.77; 95% CI, 0.65–0.91; P = 0.002), prescriptions post-2017 (OR = 0.12; 95% CI, 0.07–0.20; P < 0.001), persistent AF (OR = 0.78; 95% CI, 0.67–0.92; P = 0.002), and dabigatran use (OR = 0.020; 95% CI, 0.020–0.028; P < 0.001) were associated with lower odds of inappropriate dosing. Conclusions: From 2011 to 2022, OAC prescribing in China shifted dramatically from warfarin to DOAC, with more rapid DOAC adoption after the 2017 National Reimbursement Drug List update. Although DOAC dosing appropriateness improved over time, inappropriate dosing remained common in higher-risk patients, particularly older adults.

Abstract Background and aims CRAFT was an investigator-conducted, international, multicenter, open-label, blinded outcome assessed, randomized controlled trial to determine the effectiveness of intensive long-term blood pressure (BP) control on the prevention of major adverse cardiovascular events in patients with AF (ClinicalTrials.gov NCT04347330). Methods Eligible adults were ‘high-risk’ AF, with another CV risk factor (age ≥65 years, history of ischemic stroke/TIA, systemic embolism, diabetes, or coronary, peripheral artery, or chronic kidney disease) and a resting office SBP 140-179mmHg (or home 125-154mmHg) on ≤3 antihypertensive drugs. Participants who successfully completed a 2-week run-in phase were randomized to intensive (home SBP <120mmHg) or standard BP (home SBP <135mmHg) BP control according to standardized protocols. The primary outcome was a hierarchical time/event composite of centrally adjudicated CV death, stroke, myocardial infarction, and heart failure hospitalization, compared using the win-ratio approach, where 1600 patients with a mean 3-years follow-up was estimated to provide 80% power to detect an effect size of 1.5. Results Of 2109 patients who entered the run-in phase, 1676 (mean age 69 yr; male 60%) were randomized at 145 sites in China and 12 sites in Japan during 2020-2024. During a mean follow-up of 2.7 person-years, the mean between-group DSBP was 8mmHg (121mmHg intensive vs. 129mmHg control). The main results are to be presented. Conclusions CRAFT will provide evidence as to whether more-intensive long-term BP control, as compared to contemporaneous recommended BP management (SBP <130mmHg) in AF, provides greater benefits for secondary prevention in this high-risk patient group. Conflict of interest

Background Serum magnesium (Mg) plays an important role in cardiac electrophysiology, but its association with atrial arrhythmia recurrence after catheter ablation remains unclear. Objective To investigate the association between preprocedural serum Mg levels and atrial arrhythmia recurrence after AF ablation. Methods We included 5,789 patients undergoing AF ablation from the prospective China-AF registry. Patients were categorized into tertiles according to baseline serum Mg levels: low (<0.84 mmol/L), intermediate (0.84–0.90 mmol/L), and high (>0.90 mmol/L). The primary outcome was atrial arrhythmia recurrence. Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between serum Mg levels and recurrence risk. Results During a median follow-up of 372 days, recurrence occurred in 40.5%, 36.5%, and 41.1% of patients in the low, intermediate, and high Mg groups, respectively. Compared with the intermediate group, both low and high Mg levels were associated with increased recurrence risk (low versus intermediate: hazard ratio [HR], 1.09 [95% CI, 1.01–1.21]; high versus intermediate: HR, 1.12 [95% CI, 1.01–1.25]). Restricted cubic spline analysis demonstrated a significant nonlinear association between serum Mg levels and recurrence risk (P for nonlinearity = 0.003), with the lowest estimated risk observed within the intermediate range of serum Mg values. Findings were consistent across subgroup, sensitivity, and competing-risk analyses. Conclusions Preprocedural serum Mg levels were nonlinearly associated with atrial arrhythmia recurrence after AF ablation. Serum Mg may serve as a readily available marker of recurrence risk and warrant further investigation into the mechanisms linking Mg homeostasis and post-ablation outcomes.

BACKGROUND: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. METHODS: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. RESULTS: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). CONCLUSION:Higher BMI exhibits a linear association with AF recurrence post-RFCA. Obesity is linked to nonlinear adverse remodelling (LVEDD and LVWT).

Background: Rising evidence indicates that several autoimmune rheumatic diseases (ARDs) are associated with higher risk of heart failure (HF), however large-scale comparative studies across multiple ARDs are scarce. Methods: In this cohort study, participants from the UK Biobank without prevalent HF were included. The relation between ARDs and the incidence of HF and mortality were analyzed using Cox proportional hazards models. Results: Of 499,525 participants included in this study ( n = 10,198 with ARDs, n = 489,327 without ARDs), 18,686 HF cases occurred over a median follow-up of 13.8 years. Significantly elevated risks for HF were observed among all patients with ARDs ( P < 0.05), with the highest relative risk of HF in patients with systemic sclerosis (HR: 4.38; 95% CI: 2.98–6.43; P < 0.001). Of patients who developed HF, those with ARDs exhibited a higher prevalence of rheumatic valvular disease (16.6% vs. 14.0%), non-rheumatic aortic valve disease (12.6% vs. 9.6%), and pulmonary heart disease (7.0% vs. 4.6%) prior to the diagnosis of HF ( P < 0.05), while the prevalence of coronary artery disease, atrial fibrillation/atrial flutter, and hypertensive heart disease were similar. A history of ARDs was associated with increased all-cause mortality after diagnosis of HF (HR: 1.32; 95% CI: 1.23–1.42; p < 0.001), especially for non-cardiovascular mortality (HR: 1.42; 95% CI: 1.30–1.56; p < 0.001). Conclusions: Various ARDs were associated with a higher risk of HF. Patients with HF and ARDs had a higher prevalence of valvular disease and pulmonary heart disease before HF diagnosis compared to other patients with HF. A history of ARDs was associated with higher mortality after diagnosis of HF.

Aim: Constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM) require distinct treatments but share overlapping clinical and imaging features, making them difficult to distinguish using single conventional imaging. This study evaluated whether machine learning models integrating multimodal imaging data could improve the differential diagnosis. Methods: CP and RCM patients were included between January 2014 and September 2024 at two hospitals. Demographic, laboratory, echocardiography, computed tomography, magnetic resonance imaging, and cardiac catheterization data were collected. Seven machine learning models were trained and validated using five-fold cross-validation. Model performance was assessed by the area under the receiver-operating characteristic curve (AUC), accuracy, sensitivity, specificity and 95% confidence interval (CI). Results: A total of 156 CP and 91 RCM patients were analyzed. Compared with RCM, CP patients showed a higher ejection fraction (62.9 ± 7.5% vs. 51.9 ± 15.2%, P < 0.001) and more frequent pericardial thickening over 4 mm (66.1% vs. 0%, P < 0.001). The Gaussian SVM of multimodal-imaging achieved the highest AUC of 0.97 (95%CI: 0.93–0.99), accuracy of 85%, sensitivity of 89%, and specificity of 90%, outperforming other SVM models, decision tree, logistic regression and k-nearest-neighbor models. ML based on multimodal imaging data achieved higher diagnostic performance than those based on any single-modality imaging features. Conclusions: A Gaussian SVM integrating multimodal imaging data markedly improves the differential diagnosis between CP and RCM. This model may help reduce misclassification and improve timely interventions for the two diseases.

BACKGROUND:Despite the growing use of catheter ablation for atrial fibrillation, large-scale studies assessing the efficacy and safety of oral anticoagulation (OAC) after ablation, particularly in patients with high stroke risk, remain limited. METHODS:This prospective study enrolled consecutive patients from the China-AF (China Atrial Fibrillation) registry between August 2011 and June 2022. Stroke risk was stratified by CHA2DS2-VA score as low (0-1), intermediate (2), or high (≥3). The study end points were thromboembolism (ischemic stroke or systemic embolism), and bleeding (International Society on Thrombosis and Hemostasis major bleeding and clinically relevant non-major bleeding). A 6-month landmark analysis was applied to evaluate the association of OAC with end points using incidence rates and Cox models. RESULTS:Among 13 669 patients (median follow-up, 4.0 years), 2637 continued and 11 032 discontinued OAC at the 6-month landmark. OAC was not associated with reduced thromboembolism risk across low- (adjusted hazard ratio [aHR], 1.11 [95% CI, 0.70-1.77]; P=0.649), intermediate- (aHR, 0.64 [95% CI, 0.36-1.16]; P=0.141) or high-stroke risk patients (aHR, 1.05 [95% CI, 0.74-1.48]; P=0.801). In contrast, continued OAC was associated with higher bleeding risk, including clinically relevant non-major bleeding across stroke risk strata, and International Society on Thrombosis and Hemostasis major bleeding among high-risk patients (aHR, 2.32 [95% CI, 1.19-4.50]; P=0.013). These results were consistent across subgroups and sensitivity analyses. CONCLUSIONS:In this large, real-world cohort of patients with atrial fibrillation undergoing catheter ablation, continued OAC was not associated with lower thromboembolic risk, but with higher major bleeding risk among patients with CHA2DS2-VA scores ≥3. These findings support individualized post-ablation anticoagulation strategies and warrant future investigation. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06987825.

AIMS:Optimal management of oral anticoagulation (OAC) after atrial fibrillation (AF) ablation remains uncertain. We evaluated thromboembolic and bleeding outcomes associated with OAC discontinuation vs. continuation at a clinically relevant 6-month post-ablation landmark. METHODS AND RESULTS:This target trial emulation used data from a multicentre prospective registry in China. Patients with CHA2DS2-VA scores ≥2, no prior thromboembolism, and no atrial arrhythmia recurrence within 6 months after ablation were classified according to OAC discontinuation or continuation at the 6-month landmark. The primary outcome was the composite of stroke, systemic embolism, and major bleeding. Inverse probability weighting was applied, with intention-to-treat as the primary analysis. Among 8339 patients (mean age 68 years; 40.5% women), 4406 discontinued and 3933 continued OAC. The risk of the primary outcome did not differ significantly between groups [weighted hazard ratio (HR) 0.93; 95% CI 0.67-1.29]. Thromboembolic risk was similarly comparable (HR 0.96; 95% CI 0.69-1.35). Clinically relevant non-major bleeding occurred less frequently after OAC discontinuation (HR 0.68; 95% CI 0.47-0.97). Findings were consistent in sensitivity analyses. Annualized thromboembolic rates after discontinuation were <1% in patients with CHA2DS2-VA scores 2-3 but 1.52% in those with scores ≥4. CONCLUSION:Among patients without prior thromboembolism who remained arrhythmia-free at 6 months after AF ablation, OAC discontinuation was not associated with a difference in the composite outcome of stroke, systemic embolism and major bleeding compared with OAC continuation. Residual risk remained low in patients with CHA2DS2-VA scores 2-3 but exceeded conventional thresholds in those with scores ≥4.

BACKGROUND:The clinical significance of isolated systolic hypertension (ISH) among young-to-middle-aged adults remains controversial. This study aimed to investigate the association between ISH and cardiovascular disease (CVD) risk in individuals aged 18-49 years. METHODS:Our study included 73,552 Kailuan cohort participants aged 18-49 years without a history of CVD and who were not taking antihypertensive medications between 2006 and 2013. The primary outcome was the occurrence of composite CVD events, including stroke, heart failure (HF), and myocardial infarction (MI). The participants were categorized into five groups by baseline blood pressure (BP): normal, high-normal, ISH, isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). RESULTS:Of the 73,552 participants, 1775 (2.4%) had ISH. Over a median follow-up of 12.1 years, 102 composite CVD events were documented in patients with ISH. Individuals with ISH exhibited a significantly higher risk of CVD than those in the normal group (Hazard eratio [HR], 2.10, 95% confidence interval [CI], 1.67-2.65). The CVD risk remained lower in the high-normal and IDH groups than in the ISH group, whereas SDH conferred a greater risk. Compared to the normal group, the risk of stroke (HR, 2.41, [95% CI, 1.92-3.20]) and HF (HR, 1.89, [95% CI, 1.16-3.08]) were significantly increased in the ISH group, whereas the risk of MI was not (HR, 1.17, [95% CI, 0.63-2.17]). CONCLUSIONS:In Chinese young-to-middle-aged adults, ISH was associated with a significantly higher risk of CVD events than those with normal BP. CLINICAL TRIAL REGISTRATION:ChiCTR-TNRC-11001489 (Chinese Clinical Trial Registry).

Atrial fibrillation (AF) increases the risk of stroke and heart failure, yet accurate quantification of AF burden in daily life remains difficult. Although smartwatch photoplethysmography (PPG) supports continuous monitoring, complex rhythms and signal noise can impair burden estimation. We developed an AI-enhanced dual-modal framework that combines continuous watch-based PPG (W-PPG) with intermittent single-lead watch-based ECG (W-ECG). A hybrid convolutional neural network-long short-term memory model uses high-fidelity W-ECG segments as dynamic anchors to correct long-term W-PPG classifications. In this prospective validation study, 1,054 patients with AF undergoing catheter ablation (mean age, 62.1 years) were evaluated against patch-based ECG as the reference standard. After ECG-based correction, the system achieved 98.60% sensitivity and 99.27% specificity. The mean absolute percentage error of AF burden decreased by 23.4%, from 1.11% to 0.85%, while the Pearson correlation remained 0.9988. This dual-modal approach offers a scalable and clinically practical solution for long-term AF monitoring, improving burden estimation beyond PPG-only devices without requiring continuous multi-lead ECG. It may support personalized AF management and large-scale cardiovascular screening in real-world settings. (NCT06552468)

Current evidence is limited concerning the temporal impact of atrial fibrillation (AF) ablation timings on post-ablation outcomes. Patients who experienced ablation in the CABANA trial were enrolled in our analysis. Diagnosis to ablation time (DAT) was calculated from the date when the initial AF episode was documented. The primary endpoint was a composite of death, disabling stroke, serious bleeding or cardiac arrest. Secondary end points included AF recurrence, all-cause mortality, and all-cause mortality or cardiovascular hospitalisation. Associations between DAT and post-ablation outcomes were evaluated by restricted cubic spline (RCS) curves based on Cox models. Out of 1145 patients (median age 67.0 years, interquartile range (IQR) 61.0–72.0; 36.7

Background:The contribution of coagulation parameters to pregnancy loss, especially the TEG, independent of embryonic chromosomal anomalies, is not well defined. This study investigated the association of coagulation profiles with Missed Abortion and Recurrent Spontaneous Abortion (RSA), accounting for chromosomal status. Methods:In this cross-sectional study, 648 participants were enrolled (398 missed abortion cases, 250 controls). From the 398 cases, 94 patients with recurrent spontaneous abortion (RSA) were selected and compared with healthy controls who had a normal current pregnancy and no history of adverse pregnancy outcomes (n = 233). Preoperative assessments included conventional coagulation tests, thromboelastography (TEG), and relevant clinical covariates (e.g., gravidity, parity, and history of adverse pregnancies). Postoperative embryonic chromosomal status was determined by CNV-seq. Multivariable logistic regression models adjusting for potential confounders were used to evaluate the associations. Results:Prolonged APTT and R-time were significantly associated with increased risks of missed abortion (APTT: OR = 1.14, 95% CI: 1.08-1.21; R-time: OR = 1.85, 95% CI: 1.38-2.49) and RSA (APTT: OR = 1.20, 95% CI: 1.09-1.33; R-time: OR = 1.81, 95% CI: 1.37-2.38). These associations persisted after stratifying by chromosomal normality in missed abortion. While, APTT and R-time values did not differ significantly in missed abortion between CNV-seq Negative and Positive groups. Conclusion:Prolonged APTT and R-time are independently associated with missed abortion and RSA, suggesting a role for impaired coagulation initiation in pregnancy loss etiology. These parameters may serve as useful clinical biomarkers for prognostic evaluation of pregnancy loss.

Background Takotsubo syndrome (TTS) is frequently misdiagnosed as acute coronary syndrome (ACS), yet a substantial proportion of patients present without typical ACS features—often leading to delayed recognition and suboptimal management. The prognostic implications of the non-ACS phenotype remain poorly characterized, particularly in Asian populations. Objectives This study aimed to investigate the treatment patterns and outcomes of non-ACS TTS. Methods Using data from the multicenter TAKOC (Takotsubo syndrome of Chinese patients) Registry (18 tertiary hospitals in China), we compared 421 TTS patients stratified by initial presentation: ACS-like (typical chest pain, ischemic electrocardiogram changes, and peak troponin >10-fold the upper limit of normal) versus non-ACS. Inverse probability of treatment weighting was applied to account for baseline imbalances. Results Non-ACS TTS (n = 257, 61.0%) was associated with male sex, physical triggers, dyspnea as primary symptom, lower left ventricular ejection fraction, and higher incidence of cardiogenic shock. Paradoxically, despite significantly lower troponin levels, these patients experienced markedly higher 30-day all-cause mortality (adjusted HR: 2.28; 95% CI: 1.18-4.41; P = 0.017) and long-term mortality (adjusted HR: 2.44; 95% CI: 1.32-4.51; P = 0.043). Patients in the non-ACS group required more intensive in-hospital support—including diuretics, vasoactive drugs, and mechanical circulatory support; however, they received fewer cardiovascular medications (antiplatelets, beta-blockers, and renin-angiotensin-aldosterone system inhibitors) that were independently associated with lower 30-day mortality. Conclusions Non-ACS presentation defines a high-risk TTS subtype characterized by atypical symptoms and disproportionately poor outcomes—despite less pronounced biomarker elevation. These findings underscore the critical need for heightened clinical suspicion and exploring effective treatment strategies for patients with TTS. (Registration number: ChiCTR2300075095).

BACKGROUND:Current hypertension prevention strategies predominantly focus on identifying and treating individuals with established hypertension. Whether a coordinated community- and family-based intervention can shift the population distribution of systolic blood pressure (SBP) remains uncertain. OBJECTIVES:The purpose of this study was to evaluate whether a coordinated, community- and family-centered intervention could shift the distribution of SBP at the population level in rural China. METHODS:In this cluster-randomized trial conducted in rural China, village clusters comprising adults aged 40 to 80 years, irrespective of blood pressure (BP) level or hypertension status, were randomly assigned (1:1) to a multifaceted intervention or usual care. The intervention included community instructor support, potassium-enriched low-sodium salt substitute, home BP and weight monitoring, physical activity promotion, and facilitation of antihypertensive treatment during an initial 6-month active intervention phase, followed by continued digital BP monitoring support through 12 months. Office BP was measured at baseline and at 6 and 12 months by trained staff independent of the intervention team. The primary outcome was the between-group difference in change in SBP from baseline to 6 months. Analyses followed the intention-to-treat principle using linear mixed-effects regression models. RESULTS:A total of 80 village clusters, comprising 8,001 participants, underwent randomization. Baseline mean SBP was 133.1 mm Hg in the intervention group and 131.4 mm Hg in the control group. At 6 months, mean SBP fell by 6.0 mm Hg in the intervention group and increased by 5.1 mm Hg in the control group, resulting in an adjusted between-group difference of -10.7 mm Hg (95% CI: -11.8 to -9.6 mm Hg). BP <130/80 mm Hg was achieved in 46.2% of participants in the intervention group vs 23.6% in the control group (adjusted OR: 5.3; 95% CI: 4.3-6.6). At 12 months, the adjusted between-group difference in SBP was -3.7 mm Hg (95% CI: -4.9 to -2.6 mm Hg). Serious adverse events occurred in 2.8% of participants in the intervention group and 2.3% in the control group. CONCLUSIONS:In rural China, a coordinated community- and family-based intervention significantly shifted the population distribution of SBP toward lower levels over 6 months. Attenuation of the treatment effect over time suggests that sustained population BP reduction may require ongoing implementation infrastructure and continued community support. (Effect of Healthy Family Program on Population Blood Pressure; NCT06427096).

BACKGROUND:Nonvalvular atrial fibrillation (NVAF) patients with low CHA2DS2-VASc scores still have a risk of atrial thrombus formation. This study aims to identify these patients' risk factors for intracardiac thrombus or sludge. METHODS:We conducted a retrospective study of 919 consecutive hospitalized NVAF or atrial flutter patients with a CHA2DS2-Vas score ≤ 1 (male) and ≤ 2 (female) who underwent transesophageal echocardiogram (TEE) before catheter ablation at Beijing An Zhen Hospital from November 2016 to December 2017. We collected the clinical and echocardiographic characteristics of the patients. RESULTS:Excluding seven patients with hypertrophic cardiomyopathy, 919 patients, including 17 identified left atrial appendage (LAA) thrombus/sludge and 902 without LAA thrombus/sludge, were included. Among 17 patients with LAA thrombus/sludge, 16 (94.1%) had non-paroxysmal AF. A subgroup analysis was conducted in 403 non-paroxysmal atrial fibrillation (AF) patients. 87.8% had spontaneous echo contrast (SEC), 59.3% had severe or more severe SEC, and 4.0% had thrombus/sludge. In the multivariable model, female (odds ratio [OR] 4.612, 95% [CI] 1.454-14.627, p = 0.009) and LA diameter ≥ 45 mm (OR 13.340, [CI] 3.601, 49.415, p < 0.001) remained significantly independently associated with LAA thrombus/sludge. CONCLUSION:Among patients with NVAF and CHA2DS2-VASc scores ≤ 1 (male) and ≤ 2 (female), those non-paroxysmal AF patients who were female and had an LA ≥ 45 mm still had a risk of LAA thrombus/sludge formation.