BACKGROUND:Effective monitoring of atrial fibrillation (AF) recurrence following catheter ablation is crucial for optimizing patient outcomes. Various monitoring strategies exist, but effectiveness comparisons remain underexplored. OBJECTIVE:This study compares the recurrence of atrial arrhythmias detected by continuous versus patch ECG monitoring methods following radiofrequency ablation (RFA) for AF. METHODS:Real-world data from the REAL-AF Registry (NCT04088071) were analyzed. REAL-AF is a prospective, observational, multicenter registry and this analysis included patients with available 12-month follow-up post-RFA. We compared the detected recurrence rates of all-atrial arrhythmias from continuous monitoring insertable cardiac monitors (ICMs), dual-chamber pacemakers, and implantable cardioverter defibrillator (ICDs) or from patch ECG monitoring for 7-14-days. RESULTS:Out of 2263 patients, 688 (30.4%) were monitored continuously, and 1575 (69.6%) were monitored with patch ECGs. The detected recurrence rate of all atrial arrhythmias was significantly higher in the continuous monitoring group compared to the patch monitoring group at 12 months (28.1% and 13.5%, p < 0.001, respectively). This difference remained significant after adjusting for confounding factors such as age, type of AF, CHA2DS2-VASc score, and left ventricular ejection fraction (HR = 0.44, 95% CI [0.35, 0.56], p < 0.001). CONCLUSION:Continuous monitoring is associated with a higher detection rate of atrial arrhythmia recurrences following AF catheter ablation. These findings suggest that continuous monitoring should be considered the standard of care, especially in evaluating new ablation strategies and technologies.

Background: Inflammation plays a key role in atrial fibrillation (AF) pathogenesis. The empirical dietary inflammatory potential (EDIP) score predicts circulating inflammatory biomarkers and adverse cardiac outcomes, but its association with incident AF is unclear. This study aimed to examine the relationship between EDIP score and AF risk. Methods: Participants from the Atherosclerosis Risk in Communities (ARIC) free of baseline AF who completed a validated food frequency questionnaire were included. Correlation of EDIP with inflammatory biomarkers (factor VIII, fibrinogen, von Willebrand factor, and C-reactive protein) was examined at baseline. Incident AF was ascertained using electrocardiograms, hospital records, and death certificates. Cox proportional hazards models estimated hazard ratios of AF across EDIP quantiles and per SD increase, adjusting for sociodemographic and cardiovascular risk factors. Results: Among 8,277 participants (54.1 years old, 51.3% women, 80% white), higher EDIP score correlated with circulating inflammatory biomarkers at baseline. Over a median 24.2 years of follow-up, 1,453 had incident AF (incident rate 8.6 per 1,000 person-years). Compared with the most anti-inflammatory diet (EDIP Q1), the most pro-inflammatory diet (EDIP Q5) was associated with increased AF risk (HR 1.21; 95% CI 1.03?1.43). Sex-stratified analyses showed a stronger association in men (HR 1.43; 95% CI 1.14?1.79), while no significant association was observed in women. Conclusions: Pro-inflammatory dietary patterns are independently associated with higher AF risk in a middle-aged cohort. These findings would support incorporating dietary inflammatory load into AF risk stratification. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement this research did not receive any external funds. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I). The authors thank the staff and participants of the ARIC study for their important contributions. This manuscript was prepared using a limited access dataset obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) and does not necessarily reflect the opinions or views of the ARIC study investigators or the NHLBI. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: this manuscript used public access dataset. No further IRB approval needed as data was daintified as the time of usage. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data used in this study were obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC). The datasets used for this analysis are available under the ARIC BioLINCC accession number HLB00020025a. Researchers may request access to these data directly through the BioLINCC website.

Importance:Diagnosis-to-ablation time (DAT) has emerged as a potential predictor of ablation outcomes in atrial fibrillation (AF). Limited evidence is available on the association of prolonged DAT, and existing studies are constrained by small sample sizes and methodological heterogeneity. Objective:To evaluate whether DAT is associated with atrial arrhythmia recurrence following radiofrequency ablation (RFA) for AF. Design, Setting, and Participants:In this cohort study, patients with AF undergoing de novo RFA from January 2018 to June 2023 in a large, multicenter, clinical practice registry were included. Data were analyzed in August 2024. Exposure:Available DAT and 1-year postablation follow-up. Main Outcomes and Measures:Multivariable Cox regression was used to assess the association between DAT and recurrent atrial arrhythmia (post-blanking period). Results:A total of 3724 patients were included (1492 [40.1%] female; mean [SD] age, 67.0 [10.0] years; mean [SD] BMI, 31.0 [6.8]; and mean [SD] CHA2DS2-VASc score, 2.8 [1.5]). The median (IQR) DAT was 1 (0-4) year, and 2412 (64.8%) underwent RFA for paroxysmal AF. Compared with patients with DAT of less than 1 year, after adjusting for baseline characteristics and comorbidities, patients with DAT of 1 to 4 years had a 48% higher risk of all atrial arrhythmia recurrence (hazard ratio [HR], 1.48; 95% CI, 1.08-2.01; P = .01), and those with DAT greater than 5 years had a 110% increased risk (HR, 2.10; 95% CI, 1.46-3.02; P < .001). Conclusions and Relevance:In this cohort study of patients undergoing de novo RFA, longer DAT was associated with an increased risk of atrial arrhythmia recurrence at 1 year. These results suggest that delayed referral for ablation may be an important prognostic marker in contemporary clinical practice.

Surgical left atrial appendage (LAA) closure is an increasingly utilized approach to mitigate the risk of cardioembolic stroke in patients with atrial fibrillation (AF). Consensus is lacking regarding optimal stroke prevention management after surgical LAA management. To elucidate real world clinical management of anticoagulation in patients undergoing surgical LAA management. Over a 7-year period at a single center, 458 participants carried a diagnosis of AF and underwent surgical exclusion of their LAA during concomitant cardiac surgery. Follow-up was catalogued via retrospective chart review; median follow-up was 2 years. Successful LAA ligation was defined as maximal stump depth < 1.0 cm by transesophageal echocardiography (TEE) without distal leak. Among 458 patients, 299 were discharged on OAC (142 DOAC and 157 warfarin). Of these, 31

Background:Mounting evidence suggests surgical left atrial appendage (LAA) exclusion reduces stroke risk in patients with atrial fibrillation. Prior older research suggests that LAA exclusion is often incomplete, but few transesophageal echocardiogram (TEE) data exist evaluating LAA remnants. Methods:We analyzed 121 patients with an available postoperative TEE who underwent LAA exclusion by surgical excision (SE), AtriClip occlusion (AO), or Tiger Paw occlusion (TO). TEE images were assessed for LAA remnant depths, presence of flow into remnant, and visible suture, thrombus, or pectinate. Successful LAA exclusion was defined as a remnant with depth past LAA ostium <1 cm in all available imaging angles. Results:Left atrial appendage exclusion was successful in 99/121 (82%) patients. Success varied numerically but not statistically by technique; 73/85 (86%), 22/29 (76%), 4/7 (57%) in the SE, AO, and TO groups, respectively. SE group had similar mean and max (cm) remnant depths (0.56 ± 0.32 and 0.65 ± 0.38) compared to the AO group (0.68 ± 0.38 and 0.81 ± 0.49) and TO group (0.69 ± 0.30 and 0.83 ± 0.40). Flow into LAA remnant was seen in 4.4% (SE), 15.0% (AO), and 20.0% (TO). Residual pectinate was seen in 18.8% (SE), 13.8% (AO), and 14.3% (TO); 8% in SE group had visible suture. Thrombus was seen in 2 cases within the SE group. In multivariable models, diabetes and heart failure predicted max LAA depth. Conclusions:Postoperative TEE examination of LAA remnants revealed a relatively high failure rate by current standards. More data are needed to evaluate the clinical relevance of LAA remnant characteristics.

BACKGROUND:Pulsed field ablation (PFA) is emerging as the preferred energy source for atrial fibrillation ablation, largely because of its promising safety profile, including lower risks of esophageal injury, pulmonary vein stenosis, and phrenic nerve injury. However, rare complications may only emerge after treating many thousands of patients. OBJECTIVES:This study sought to determine the real-world utilization and safety profile of the pentaspline PFA catheter in the United States. METHODS:In this retrospective analysis, invitations were sent to U.S. centers performing PFA with the pentaspline catheter. Centers submitted data on patient demographics, procedural details, and adverse events (AEs). The main outcomes included the incidence of major and minor procedure-related AEs. RESULTS:Of the 435 centers contacted, 102 participated, averaging 5.1 operators per center (range 1-16 operators per center). Each center treated a median of 412 patients (range 26-1,961 patients), totaling 41,968 patients between February 2024 and July 2025. The median patient age was 68 years (range 17-99 years), and 56% were male. Most patients underwent first-time ablation (73%), primarily for paroxysmal (54%) or persistent atrial fibrillation (37%). Pulmonary vein isolation was performed in 93% of patients, with extravenous lesions on the posterior wall (57%), cavotricuspid isthmus (31%), or mitral isthmus (14%). Major AEs occurred in only 0.63% of patients, including cardiac tamponade (0.16%), vascular injury requiring intervention (0.18%), and stroke (0.10%). Importantly, no cases of esophageal fistula, persistent phrenic nerve paralysis, or pulmonary vein stenosis occurred. Mortality at 30 days was rare (0.04%), but there was a potential signal for rare (0.019%) unexplained sudden death/cardiac arrest. Rare AEs included coronary spasm (0.10%) and acute renal failure requiring dialysis (0.02%). Minor complications were reported in 2.05%, mainly vascular issues (0.96%), pericarditis (0.52%), and self-limited esophageal dysmotility (0.04%). CONCLUSIONS:In a real-world setting of unselected U.S. patients, PFA demonstrated a safety profile consistent with preferentiality to functional myocardial tissue ablation, without evidence of esophageal fistula or pulmonary vein stenosis. The major complication rate was ∼0.6%-mostly vascular AEs and pericardial tamponade. Stroke (∼1 in 1,000) and death (∼1 in 2,000) were rare. These data indicate that the initial implementation of pentaspline PFA has been overall safe.

Background/Objectives : Hypertension is linked to slower walking pace and cognitive decline, but the ability of slow gait to predict dementia in older adults with hypertension is unclear. This study examined whether slow baseline gait predicts future cognitive impairment in older adults with hypertension enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (MIND) study. Methods : SPRINTMIND randomized adults ≥50 years of age with hypertension to intensive (target systolic blood pressure <120 mmHg) or standard (<140 mmHg) blood pressure control. Baseline gait speed was measured in participants ≥75 years of age. We defined slow gait as speed ≤0.8 m/s. Outcomes were probable dementia (pD), mild cognitive impairment (MCI), and composite pD or MCI. Results : Among 2,351 participants, 33.3% had slow baseline gait. Over median 4-year follow-up, the slow gait group had higher rates of incident pD (13.5% vs 6.4%), MCI (19.4% vs 11.9%), and pD or MCI (29.2% vs 16.3%) compared with normal gait. Adjusted Cox regression models revealed that slow gait was associated with a 1.85-fold higher risk of pD (95% confidence interval [1.37, 2.50], p < .001), 1.52-fold higher risk of MCI (95% confidence interval [1.20, 1.93], p = .001), and 1.61-fold higher risk of pD or MCI (95% confidence interval [1.32, 1.97], p < .001). Intensive blood pressure control did not significantly affect cognitive outcomes in either gait group. Conclusion : Slow gait speed predicts increased cognitive decline risk among older adults with hypertension. Significance/Implications : Gait speed assessment can identify older adults with hypertension at higher risk of cognitive decline, allowing earlier intervention to potentially delay progression.

BACKGROUND:High-frequency low-tidal-volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal and persistent atrial fibrillation (AF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined. OBJECTIVE:To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of paroxysmal AF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone. METHODS:Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of paroxysmal AF using either HFLTV + RAP (500-600 msec) or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-month follow-up. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and procedure-related complications. RESULTS:A total of 545 patients were included in the analysis (HFLTV + RAP = 327 vs. HFLTV = 218). There were no significant differences in baseline characteristics between the groups. No differences were observed in procedural (HFLTV + RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p = 0.617) and RF (HFLTV + RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p = 0.620) times. Both groups showed a similar freedom from all-atrial arrhythmias at 12-month follow-up (HFLTV + RAP 82.68% vs. HFLTV 86.52%, HR = 1.43, 95% CI [0.94-2.16], p = 0.093). There were no significant differences in freedom from AF-related symptoms (HFLTV + RAP 91.4% vs. HFLTV 93.1%, p = 0.476) or AF-related hospitalizations (HFLTV + RAP 98.5% vs. HFLTV 97.2%, p = 0.320). Procedure-related complications were low in both groups (HFLTV + RAP 0.6% vs. HFLTV 0%, p = 0.247). CONCLUSION:In patients undergoing RFCA for paroxysmal AF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.

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Background: The relationship between self-rated health (SRH) and cardiovascular events in individuals with hypertension, but without diabetes mellitus, is understudied. Methods: We performed a post hoc analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). SRH was categorized into excellent, very good, good and fair/poor. Using multivariable Cox regression, we estimated hazard ratios and 95% confidence intervals (CIs) for the association of SRH with both all-cause mortality and a composite of cardiovascular events (the primary outcome), which was defined to include myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure, and cardiovascular death. Results: We included 9319 SPRINT participants (aged 67.9 ± 9 years, 35.6% women) with a median follow-up of 3.8 years. Compared with SRH of excellent, the risk [hazard ratio (95% CI)] of the primary outcome associated with very good, good, and fair/poor SRH was 1.11(0.78–1.56), 1.45 (1.03–2.05), and 1.87(1.28–2.75), respectively. Similarly, compared with SRH of excellent, the risk of all-cause mortality [hazard ratio (95% CI)] associated with very good, good, and fair/poor SRH was 1.13 (0.73–1.76), 1.72 (1.12–2.64), and 2.11 (1.32–3.38), respectively. Less favorable SRH (LF-SRH) was also associated with a higher risk of each component of the primary outcome and serious adverse events (SAE). Conclusion: Among individuals with hypertension, SRH is independently associated with the risk of incident cardiovascular events, all-cause mortality, and SAE. Our study suggest that guidelines should consider the potential significance of including SRH in the clinical history of patients with hypertension.