BACKGROUND:The prognostic significance of blanking period arrhythmic events following extensive substrate modification ablation, such as the STABLE-SR procedure, remains inadequately defined. METHODS:In this single-center retrospective study, we analyzed data from 411 consecutive patients with non-paroxysmal atrial fibrillation (AF) undergoing first-time catheter ablation using the STABLE-SR technique. The incidence and characteristics of blanking period events (within 3 months post-ablation) were assessed. All patients were followed for 1 year to determine AF recurrence. Univariable and multivariable Logistic regression analyses were performed to identify predictors of recurrence. RESULTS:Among the 373 patients who completed follow-up, blanking period events occurred in 106 patients (28.4%). The 1-year recurrence rate was significantly higher in patients with blanking period events compared to those without (46.2% vs. 16.9%, p < 0.001). Multivariable analysis identified the presence of any blanking period event (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.22-6.11, p = 0.014), adjunctive cavotricuspid isthmus ablation (OR 1.91, 95% CI 1.01-3.36, p = 0.047), and the need for end-procedural electrical cardioversion (OR 3.10, 95% CI 1.01-9.48, p = 0.047) as independent predictors of long-term recurrence. CONCLUSIONS:In patients undergoing STABLE-SR ablation for non-paroxysmal AF, arrhythmias during the blanking period are common and constitute the strongest independent predictor of 1-year recurrence. Specific procedural characteristics further stratify recurrence risk.

BACKGROUND:Previous studies have demonstrated electrical connections between ipsilateral pulmonary veins (PVs). This study aimed to characterize the electrophysiological features of right middle pulmonary vein (RMPV) originating from right superior pulmonary vein (RSPV). METHODS:We prospectively enrolled patients with atrial fibrillation (AF) with an identifiable RMPV on pre-procedural cardiac computed tomography angiography (CTA) and in whom a multipolar mapping catheter could be advanced into the RMPV. Cardiac CTA was used to assess left atrial and PV anatomy, including ostial diameter, area and ovality index. The RMPV was defined as an inferiorly directed branch arising from the ostium-proximal segment of the RSPV, within 1 cm from the ostium RESULTS: A total of 118 patients were included (mean age 63.9 years, 63.6% male). The mean RMPV ostial area was 0.69 ± 0.41 cm2, with maximum and minimum diameters of 0.83 ± 0.21 cm and 0.63 ± 0.17 cm, respectively. The mean ovality index was 1.35 ± 0.27 for RMPV. AF triggers originating from the RMPV were identified in 3 patients (2.5%). During circumferential pulmonary vein isolation (CPVI), RMPV potentials were eliminated in 99 patients (83.9%), concurrently with disappearance of RSPV potentials. In the remaining 19 patients, RMPV potentials persisted after CPVI and required additional carina ablation to achieve isolation. After a mean follow-up of 41 months, 96 patients remained free from atrial tachyarrhythmia recurrence after the index procedure. CONCLUSIONS:RMPV potentials predominantly originate from the RSPV and can usually be eliminated during CPVI. However, additional carina ablation is required in a subset of patients to achieve RMPV isolation.

BACKGROUND:Bundle branch reentry ventricular tachycardia (BBRT) in patients without structural heart disease (SHD) has been well-documented. However, the occurrence of concomitant atrial tachycardia (AT) in this cohort remain poorly characterized. The study aimed to investigate the prevalence, clinical characteristics, and electrophysiological properties of concomitant AT in patients with BBRT. METHODS:Eighteen patients without SHD were enrolled. Detailed electrophysiological studies were performed to identify and characterize concomitant ATs. Catheter ablation was performed for both BBRT and atrial ATs. RESULTS:Among 18 patients with BBRT, 6 patients (33.3%; mean age 26.3 years) presented with a total of 7 ATs. Three patients had a history of AT ablation, two exhibited BBRT concomitant with AT during the index procedure, and two developed AT following BBRT ablation. All ATs originated from the right atrium, with the following distribution: coronary sinus ostium (CSO) (n = 4), typical atrial flutter (AFL) (n = 2) and mid-crista terminalis (MCT) (n = 1). The mean tachycardia cycle length (TCL) was 337±61 ms. Acute procedural success was achieved in all cases. During a mean follow-up of 54.1±26.0 months, all patients remained free from AT and BBRT recurrence. However, progressive deterioration of left ventricular function requiring cardiac resynchronization therapy occurred in one patient, and two patients developed ventricular enlargement. CONCLUSIONS:Concomitant AT was observed in one-third of patients with BBRT without SHD. Catheter ablation proved effective in treating both arrhythmias. Intensive long-term monitoring of cardiac function is recommended in this population.

INTRODUCTION:Prolonged sinus pause (PSP) after atrial fibrillation (AF) termination shortly after catheter ablation seems to be a reversible phenomenon without further need for pacemaker implantation (PMI). However, no mature management strategy has been established. METHODS:In this prospective observational study, we included consecutive patients who developed PSP ≥ 3 s upon AF termination during hospitalization following AF ablation at our center between October 2020 and October 2022. Regular follow-up was conducted. RESULTS:Twelve patients (mean age 66.3 ± 8.5 years; 7 females) were included. PSP ≥ 3 s upon AF termination initiated at a median of 2.0 days (IQR: 1.3-3.8) post-ablation and resolved by 5.0 days (IQR: 3.5-7.5). Three patients received temporary PMI, all of which were removed before discharge without further pacing. One patient underwent permanent PMI during hospitalization due to Adams-Stokes syndrome. After discharge, one patient received permanent pacing for symptomatic sinus arrest at 3 months, and another underwent atrioventricular node ablation followed by permanent pacing due to recurrent arrhythmia. The remaining patients had no related symptoms or need for pacing during follow-up. CONCLUSION:PSP ≥ 3 s upon AF termination shortly after catheter ablation appears to be reversible. A watch-and-wait strategy was practical. Management may involve discontinuation of antiarrhythmic drugs or temporary pacing support. A small proportion of patients may ultimately require permanent PMI.

BACKGROUND:Atrial substrate progression is common among patients with atrial fibrillation (AF). Unipolar voltage mapping more comprehensively characterizes the atrial substrate compared with bipolar mapping. OBJECTIVE:This study aimed to characterize atrial substrate progression in patients with recurrent AF using unipolar mapping after pulmonary vein isolation. METHODS:In this single-center retrospective study, consecutive AF patients undergoing index and redo ablations were enrolled. Electroanatomic maps from both ablations were compared and assessed by unipolar and bipolar voltage. Low-voltage zone (LVZ) was defined as bipolar voltage <0.5 mV or unipolar voltage <1.6 mV. Patients were categorized into progression (n = 35) and nonprogression (n = 15) groups. RESULTS:A total of 50 patients (mean age 59.5 ± 12.6 years; 40 males) were enrolled. Compared with index ablation, redo ablation demonstrated significantly larger bipolar LVZ (Bi-LVZ) total area (21.25 vs. 15.86 cm2, p = 0.007) and LVZ burden (0.20 vs. 0.14, p = 0.002). The progression group showed a higher LVZ burden (unipolar: 0.27 vs. 0.12, p = 0.007; bipolar: 0.16 vs. 0.09, p = 0.019) and a greater ratio of total unipolar to bipolar LVZ area (Uni/Bi) (1.75 vs. 1.34, p = 0.042) during index ablation compared with the nonprogression group. Linear regression revealed a positive correlation between index-ablation Uni/Bi ratio and the degree of Bi-LVZ area expansion at redo ablation (β = 7.20, p < 0.001). CONCLUSION:Uni-LVZ characterizes the atrial substrate progression, with the higher Uni/Bi ratio during index ablation indicates greater Bi-LVZ expansion at redo ablation.

BACKGROUND:Transition zone (TZ) may serve as a potential substrate for atrial fibrillation (AF). This study aims to investigate the relationship of TZ burden with left atrial conduction velocity (LACV) and recurrence after circumferential pulmonary vein isolation (CPVI) in elderly patients with paroxysmal AF without low-voltage areas (LVA). METHODS:Patients with paroxysmal AF without LVA were categorized into three groups based on the TZ burden (< 5%, 5%-15% and > 15%). TZs were defined as regions with bipolar voltage between 0.5 and 1 mV in more than 3 adjacent points. TZ burden was calculated as the proportion of TZ on the entire left atrium surface. LACV were calculated as conduction distance divided by conduction time. Recurrence was defined as any episode of atrial tachyarrhythmia (ATA) lasting ≥ 30 s after a 3-month blanking period. RESULTS:Among the 158 enrolled patients (mean age 69.7 ± 3.8 years), 48 (30.4%) had a TZ < 5%, 66 (41.8%) had a TZ of 5%-15%, and 44 (27.8%) had a TZ > 15%. Patients with higher TZ burden exhibited significantly decreased anterior LACV (1.52 ± 0.36 vs. 1.21 ± 0.27 vs. 1.02 ± 0.25 m/s, p < 0.0001). After a mean follow-up of 24.9 months, 40 (25.3%) patients experienced recurrence. Patients with recurrence had higher TZ burden (15.4 [7.2-22.4] vs. 8.2 [3.5-14.3], p < 0.0001). TZ burden remained significantly associated with recurrence in a multivariable Cox regression model (adjusted HR 1.065 [95% CI 1.034-1.098], p < 0.0001). CONCLUSIONS:TZ burden is correlated with slow LACV and independently predicts ATA recurrence following CPVI.

BACKGROUND:Cryoballoon ablation (CBA) has been shown as an effective alternative strategy to radiofrequency ablation (RFA) for the treatment of paroxysmal atrial fibrillation (PAF), with comparable efficacy and safety. However, the electrophysiological properties in pulmonary veins (PVs) after CBA and RFA are not well understood. This study compares these characteristics in PAF patients. METHODS:Consecutive patients with PAF undergoing initial catheter ablation were prospectively randomized to CBA (N = 50) or RFA (N = 50) for PV isolation (PVI). Each PV's automaticity and excitability were assessed. Follow-up for atrial tachyarrhythmia recurrence at 3, 6, and 12 months was monitored via electrocardiogram/Holter. RESULTS:A total of 100 patients were randomized (mean age of 62 ± 10 years). After initial PVI, 33 (66%) patients in the RFA group retained PV automaticity, compared to 17 (34%) patients in the CBA group (p = 0.027). The number of PVs exhibiting stable automaticity was significantly higher in the RFA group compared with the CBA group (51/198 vs. 19/197, p < 0.0001). Ipsilateral PV crosstalk was more common in the RFA group (7/17 vs. 0/2, p = 0.5088). Moreover, low-frequency pacing revealed local capture in 46% of the RFA group versus 2% of the CBA group (p < 0.0001). Fluoroscopy time was shorter with RFA (p = 0.0003), but ablation time was longer (p < 0.0001). Over an average of 13-month follow-up, atrial tachyarrhythmia recurrence rates were similar between groups. CONCLUSIONS:Automaticity and excitability within PVs were more prevalent in the RFA group than the CBA group after AF ablation.

BACKGROUND AND AIMS:The optimal long-term antithrombotic strategy after left atrial appendage occlusion (LAAO) remains undetermined. The present study aimed to investigate whether half-dose rivaroxaban (10 mg daily) could better reduce silent cerebral embolic lesions (SCEs) and preserve cognitive function compared to antiplatelet therapy after successful LAAO. METHODS:In this investigator-initiated, prospective, multicenter, randomized controlled trial, patients with successful LAAO confirmed 45 days post-procedure were assigned 1:1 to half-dose rivaroxaban or antiplatelet therapy group. Diffusion-weighted magnetic resonance imaging and cognitive assessments were repeated at 90, 180 and 365 days after LAAO. The primary outcome was the patient-level incidence of any newly detected SCE during follow-up. Secondary outcomes included cognitive trajectories, SCE burden, and a composite of all-cause mortality, clinical thromboembolic events and major bleeding. RESULTS:Between December 2022 and February 2025, 164 patients were randomized. The patient-level incidence of new SCEs was significantly lower in the half-dose rivaroxaban group than in the antiplatelet therapy group (10/82 [12.2%] vs. 26/82 [31.7%]; P = 0.005). At 365 days, model-derived between-group differences favored the half-dose rivaroxaban group for both Mini-Mental State Examination (2.56; 95% confidence interval [CI] 1.11-4.01; P < 0.001) and Montreal Cognitive Assessment (2.67; 95% CI 1.07-4.26; P = 0.001) scores. The composite clinical outcome occurred in 2.4% of the half-dose rivaroxaban group vs. 11.0% of the antiplatelet therapy group (P = 0.057). CONCLUSIONS:In patients eligible for oral anticoagulation after successful LAAO, rivaroxaban 10 mg daily significantly reduced SCEs and better maintained cognitive function compared with antiplatelet therapy, with numerically fewer composite clinical events.

BACKGROUND:Pulsed-field ablation (PFA) emerges as an innovative nonthermal energy modality for catheter ablation of atrial fibrillation (AF). This study aimed to assess the safety and effectiveness of a novel PFA system that uses a multichannel, circular ablation catheter with adjustable diameters in treating paroxysmal AF. METHODS:This clinical trial (PF-Beat-AF) was a prospective, multicenter, single-arm study. Patients with paroxysmal AF underwent pulmonary vein isolation (PVI) using the PFA system, and were followed at discharge, 7-day, 1-, 3-, 6- and 12-month post-procedure. Primary safety endpoint was the incidence of primary adverse events (PAEs). While primary effectiveness endpoint was freedom from documented atrial arrhythmia recurrence lasting >30 s during the 3-12 months evaluation period. RESULTS:A total of 161 patients were enrolled and 159 patients were treated in eight centers. Conscious sedation was used in 68.6 % of cases, and 40.9 % of procedures were completed without fluoroscopy. The mean total procedure time was 132.3 ± 40.4 min, and fluoroscopy time averaged 6.4 ± 6.8 min. Acute PVI was achieved in 100 % of patients. One PAE (0.6 %) occurred (pericardial tamponade, resolved). At 12 months, 87.7 % (95 % CI: 82.5 %-92.9 %) of patients remained free from atrial arrhythmia after the blanking period. No significant differences in effectiveness were observed between conscious sedation and general anesthesia/deep sedation, or fluoroscopy and zero-fluoroscopy cases. CONCLUSION:The results of clinical trial demonstrated the safety and effectiveness of the PFA system in treating paroxysmal AF, including successful use with conscious sedation and zero-fluoroscopy.

Background Left atrial appendage occlusion (LAAO) was associated with a high incidence of procedure‐related silent cerebral embolism (SCE). There are limited data regarding the long‐term cognitive trajectory of patients undergoing LAAO. The aim of our study was to comprehensively assess the acute and long‐term impact of SCE during and after LAAO. Methods Consecutive patients with atrial fibrillation referred for LAAO from the First Affiliated Hospital with Nanjing Medical University between February 2021 and February 2023 were included. All patients underwent magnetic resonance imaging and cognitive assessments before and within 48 hours after the procedure. These evaluations were also repeated at 45‐day, 3‐month, 6‐month, and 1‐year follow up. Results Out of 75 patients included in the final analysis, 29 (38.7%) patients suffered from new SCE during LAAO. Patients with SCE exhibited a significant decline in cognitive function (Mini‐Mental State Examination) immediately after the procedure (P<0.001), which was not reversible during 1‐year follow‐up (P<0.001). Additionally, with time going on, the gap in cognitive function between patients with and without SCE became wider (SCE × 1 year: B=−4.81 [95% CI, −5.58 to −4.05]; P<0.001). New‐onset SCE was detected in 11 (14.7%) patients during the follow‐up magnetic resonance imaging, which also showed a decline in cognitive function (P=0.004). The results in Montreal Cognitive Assessment scores were consistent with Mini‐Mental State Examination. Conclusions LAAO‐related SCE is associated with a marked impairment in cognitive function immediately after the procedure and is irreversible over a 1‐year follow‐up. New magnetic resonance‐detected SCE during follow‐up after LAAO would also be associated with a decline in cognitive function.

BACKGROUND:Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) may impair gastric motility through collateral thermal injury. Pulsed field ablation (PFA), a nonthermal modality, is expected to preferentially affect the cardiomyocytes and spare gastric motility. OBJECTIVE:This study aimed to compare the effects of PFA and RFA for PVI on gastric motility in patients with atrial fibrillation (AF). METHODS:In this prospective matched study, patients undergoing PFA-PVI were compared with age- and sex-matched RFA-PVI parallel controls. Gastric motility, including gastric emptying and related symptoms, was assessed before and subsequently at 48 hours after the ablation. Gastric emptying was evaluated with the emptying rate of nondigestible radiopaque markers 5 hours after ingestion, and symptoms were assessed with standardized questionnaires. RESULTS:28 patients with paroxysmal AF were enrolled, with 14 in each group. Acute PVI was achieved without major complications in both groups. The gastric emptying rate (GER) remained unchanged after PFA (77.9% ± 32.9% vs 78.6% ± 29.0%, P = .98) but decreased after RFA (78.6% ± 24.2% vs 66.1% ± 30.2%, P < .05). The change in GER was significantly greater after RFA than PFA (12.5% ± 24.1% vs -0.7% ± 27.1%, P < .05). New-onset delayed gastric emptying occurred in 1 (7.1%) and 3 (21.4%) patients in the PFA-PVI and RFA-PVI groups, respectively. Post-procedural gastrointestinal symptom scores worsened significantly only in the RFA group. CONCLUSION:PFA causes significantly less damage to gastric motility than RFA during PVI, which translates into an improved quality of life for patients.

Autoantibodies against the M2-muscarinic acetylcholine receptor (anti-M2-R) have been implicated in atrial remodeling and atrial fibrillation (AF) pathogenesis. However, their relationship with atrial fibrosis severity, as assessed by low-voltage areas (LVAs), remains unclear. This prospective study included 164 patients (89 with paroxysmal AF [PAF], 75 with non-paroxysmal AF [NPAF]) undergoing first-time catheter ablation. Preprocedural plasma anti-M2-R levels were measured using ELISA. Left atrial LVAs were assessed via electroanatomic voltage mapping and categorized into four stages. Patients were grouped as having mild (≤ 20

Patients with atrial fibrillation (AF) are at risk for cardioembolic stroke. The recent studies suggest that reduced two-dimensional left atrial (LA) deformation, such as longitudinal strain, may be a potential indicator of stroke risk. We aim to evaluate three-dimensional (3-D) LA global and local strain derived from four-dimensional computed tomography angiography in patients with persistent atrial fibrillation, and compare those with and without cardioembolic stroke history.22 patients with persistent atrial fibrillation (11 with documented cardioembolic stroke) were included in this study. The LA strain was calculated by our novel mesh-regularised sub-volume tracking method. LA morphology, CHADS-VASC2, and 3-D global and local strain in 8 LA regions (anterior, lateral, appendage, roof, posterior, mitral isthmus, floor, and septum) were analysed. To explore the potential performance of the collected parameters for stroke risk evaluation, we used logistic regression to assess the outcomes of using these parameters to identify patients with cardioembolic stroke.Compared to those without previous stroke events, the patients with cardioembolic stroke presented lower global strain (0.090 vs 0.101; p = 0.006). Patients with cardioembolic stroke also had lower strain values in the roof (0.087 vs 0.106, p = 0.030), posterior (0.055 vs 0.072, p < 0.001) and floor (0.083 vs 0.097, p = 0.022). Results from logistic regression indicated that the accuracy of LA posterior strain as the indicator for previous stroke events was 0.8958.Therefore, 3-D LA global and local strain (especially in the posterior wall) could be useful in identifying patients with persistent AF and at high risk for a cardioembolic stroke.

BACKGROUND:The circuit of scar-related upper loop macroreentry atrial flutter (AFL) surrounding the superior vena cava (SVC) has been described by prior case reports. However, the correlation between the circuit and arrhythmogenic substrates and the corresponding optimized ablation strategy need to be further investigated. OBJECTIVE:We aimed to identify the electrophysiologic substrate and corresponding ablation strategies of SVC-AFL using high-resolution mapping. METHODS:From June 1, 2017, to May 1, 2023, consecutive patients with macroreentrant atrial tachycardias (ATs) from 7 institutions were retrospectively evaluated. Patients with SVC-AFL were enrolled and analyzed. RESULTS:Of 1282 patients with macroreentrant ATs, 16 patients (1.2%; median age, 60.9 years; 8 male) had SVC-AFL (mean cycle length, 281.0 ± 55.1 ms), all identified during high-resolution activation mapping. All patients had prior cardiac surgery (14 [87.5%]) or catheter ablation (8 [50.0%]). A longitudinal surgical incision/scar extending from the SVC to the right atrium was observed in all patients, enabling macroreentry. SVC-AFLs with shorter circuits (<180 mm) had more slow conduction areas than those with longer circuits (>180 mm; 3.0 [2.0-4.0] vs 1.0 [1.0-1.5]; P = .023]. All ATs were terminated by ablating the channel between the surgical incision/scar and anatomic barriers. Cavotricuspid isthmus block was achieved in all patients. During a 21-month follow-up, all patients were free of atrial arrhythmias except for 4 patients experiencing short-lived paroxysmal ATs that did not require further ablation. CONCLUSION:A surgical incision/scar extending from the SVC to right atrium promotes the development of SVC-AFL. Substrate-based linear lesions along with prophylactic cavotricuspid isthmus ablation afford favorable clinical outcomes.

MicroRNAs have been implicated in regulating diverse cellular pathways. Emerging evidence indicates that miR-143 plays causal roles in cancer tumorigenesis as a tumor suppress gene; however, its role in prostate cancer tumorigenesis remains largely unknown. The aims of this study were to verify the effect of miR-143 on proliferation and migration abilities of prostate cancer cells. The expression level of miR-143 and its target gene KRAS were measured by realtime PCR and western blotting, respectively. Effects of miR-143 in cell proliferation, migration and chemosensitivity were evaluated by MTT assay, FACS cell cycle analysis, colony formation assay, and transwell migratory assay. Our results revealed an inverse correlation of expression between miR-143 and KRAS protein in prostate cancer samples (Pearson’s correlation scatter plots: R = −0.707, P < 0.05). Moreover, over-expression of miR-143 in prostate cancer cells suppressed their proliferation and migration and increased their sensitivity to docetaxel by targeting EGFR/RAS/MAPK pathway. These findings suggest that miR-143 plays an important role in prostate cancer proliferation, migration and chemosensitivity by suppressing KRAS and subsequent inactivation of MAPK pathway, which provides a potential development of a new approach for the treatment of prostate cancer.

To date, data about pulsed field ablation (PFA) for ventricular arrhythmias are limited, and cardiac magnetic resonance (CMR) characteristics of acute and chronic PFA lesions in the ventricles have not been described. This study sought to examine feasibility and efficacy of premature ventricular complex (PVC) ablation using focal PFA, as well as assess acute and chronic lesion characteristics using CMR. This was a prospective, single-arm study performed at two centers in China. Consecutive patients with frequent, symptomatic PVCs were consented and recruited. All procedures were performed using a comprehensive cardiac PFA system. PVC burden evaluation and CMR were performed before the procedure, within 3 days, and at approximately 6 months post-procedure. Twelve patients (mean age 54 ± 14 years, 41.7

BACKGROUND:Unipolar voltage mapping has shown value in delineating comprehensive atrial substrates. However, the clinical application of unipolar low-voltage areas (Uni-LVAs) in atrial fibrillation (AF) ablation is limited, largely because of the absence of a well established voltage threshold. In this study we aimed to: (1) define the threshold for Uni-LVA in the left atrium (LA); and (2) investigate the association between Uni-LVA burden and ablation outcomes in a prospective AF cohort. METHODS:The Uni-LVA threshold was defined as the average of the 6 cutoff values, representing the voltage at 95% of all electrograms from a reference cohort who underwent left-sided accessory pathway ablation and concomitant LA mapping. In a single-centre, prospective AF ablation cohort, LA mapping was conducted and the Uni-LVA burden was automatically calculated. RESULTS:Uni-LVA was defined as an area with an amplitude of < 1.6 mV. In 145 patients, the Uni-LVA burden was automatically obtained using customized software. During a follow-up period of 16 ± 4 months, 44 patients experienced recurrence. Uni-LVA burden was significantly associated with recurrence rates. Compared with group 1 (< 1%), the recurrence rates for group 2 (1%-10%) and group 3 (> 10%) were significantly higher (hazard ratio, 5.08 [P<0.001] and hazard ratio, 24.07 [P < 0.001]). Receiver operator curve analysis showed significantly higher predictive efficiency for Uni-LVA burden (area under the curve, 0.880 vs 0.762; P < 0.001) compared with the bipolar low voltage burden. CONCLUSIONS:Using a unipolar voltage threshold of < 1.6 mV, Uni-LVA burden was independently associated with long-term AF recurrence after ablation and outperformed bipolar assessment. This finding suggests Uni-LVA could serve as a valuable tool for prognostic evaluation.

BACKGROUND:Atrial fibrosis has a significant impact on the success rate of catheter ablation (CA) treatment of atrial fibrillation (AF). The fibrotic tissues could be reflected by the amplitude of the fibrillatory wave (F-wave). METHODS AND RESULTS:704 patients with persistent AF and at least 1-year follow-up after CA were included as the internal group. 101 patients from another hospital were used as the external validation cohort. A 12‑lead ECG was performed before CA and the maximum FWA in three ECG leads (aVL, aVF, V1) were measured. The FWA score (0 to 6 points according to the amplitude range of the three leads) of each patients was calculated. Five models including clinical features, FWA score, CHA2DS2-VASc score, APPLE score and the fusion of clinical features and FWA score were built. The FWA score was superior to the model constructed by clinical variables, CHA2DS2-VASc score and APPLE score. It not only had good predictive performance for AF recurrence, with an AUC value of 0.812 (95% CI 0.724-0.900), but also showed a significant predictive value for the recurrence rate according to F-wave amplitude. In the external validation cohort, the FWA score showed similar results (AUC 0.768, 95% CI 0.672-0.865). CONCLUSIONS:The present study reveals the significant predictive value of the FWA score for persistent AF ablation recurrence.

BACKGROUND:Cardioembolic strokes are commonly occurred in non-valvular atrial fibrillation (AF) patients, with over 90% of cases originating from clot in left atrial appendage (LAA), which is believed to be greatly related with hemodynamic characters. Numerical simulation is widely accepted in the hemodynamic analysis, and patient-specific boundaries are required for realistic numerical simulations. METHOD:This paper firstly proposed a method that maps personalized pulmonary venous flow (PVF) by utilizing the volume changes of the left atrium (LA) over the cardiac cycle. Then we used data from patients with AF to investigate the correlation between PVF patterns and hemodynamics within the LAA. Meanwhile, we conducted a fluid-structure interaction analysis to assess the impact of velocity- and time-related PVF parameters on LAA hemodynamic characters. RESULTS:The analysis reveal that the ratio of systolic to diastolic peak velocity (VS/VD), and systolic velocity-time integral (VTI) showed a significant influence on LAA velocity in patients with atrial fibrillation, and the increases of velocity- and time-related parameters were found to be positively correlated with the blood update in the LAA. CONCLUSIONS:This study established a method for mapping patient-specific PVF based on LA volume change, and evaluated the relationship between PVF parameters and thrombosis risk. The present work provides an insight from PVF characters to evaluate the risk of thrombus formation within LAA in patients with AF.

Background: Ibrutinib could increase the risk of atrial fibrillation (AF) in chronic lymphocytic leukemia (CLL) patients. However, the precise mechanism underlying ibrutinib-induced AF remains incompletely elucidated. Methods: We investigated the proportion of ibrutinib-treated CLL patients with new-onset AF. Optical mapping was conducted to reveal the proarrhythmic effect of ibrutinib on HL-1 cells. Fluorescence staining and western blot were used to compare connexins 43 and 40 expression in ibrutinib-treated and control groups. To identify autophagy phenotypes, we used western blot to detect autophagy-related proteins, transmission electron microscopy to picture autophagosomes, and transfected mCherry-GFP-LC3 virus to label autophagosomes and lysosomes. Hydroxychloroquine as an autophagy inhibitor was administered to rescue ibrutinib-induced Cx43 and Cx40 degradation. Results: About 2.67% of patients developed atrial arrhythmias after ibrutinib administration. HL-1 cells treated with ibrutinib exhibited diminished conduction velocity and a higher incidence of reentry-like arrhythmias compared to controls. Cx43 and Cx40 expression reduced along with autophagy markers increased in HL-1 cells treated with ibrutinib. Inhibiting autophagy upregulated Cx43 and Cx40. Conclusions: The off-target effect of ibrutinib on the PI3K-AKT-mTOR signaling pathway caused connexin degradation and atrial arrhythmia via promoting autophagy. Clinical Trial Registration: ChiCTR2100046062, https://clin.larvol.com/trial-detail/ChiCTR2100046062.