INTRODUCTION:Atrioventricular node (AVN) ablation after pacemaker implantation is a rate control option for patients with symptomatic atrial fibrillation (AF) when rhythm control with anti-arrhythmic drug therapy and/or ablation with pulmonary vein isolation fails. This study investigated the long-term risk of hospitalization and mortality after AVN ablation using nationwide and population-based registries. METHODS:All AVN ablations between 2015 and 2021 were identified in the National Danish Ablation Database, and hospitalizations were found in the Danish National Patient Registry. Hospitalizations were compared before and after AVN ablation. RESULTS:We studied 571 patients who underwent AVN ablation. The mean age was 74.5 ± 8.8 years, and 53% were male. The success rate of the ablations was 98.4% without any major procedure-related complications. Median follow-up time was 2.7 years (IQR: 1.2; 4.6). The annual cardiac hospitalizations decreased from incidence rate (IR) of 2.3 per person-year (95% CI: 2.2; 2.6) before ablation to IR of 0.5 per person-year (95% CI: 0.4; 0.6) after ablation. The IR ratio was 0.38 (95% CI: 0.35; 0.41) and more significant for AF admissions. The overall clinical outcomes were independent for implanted pacing system and clinical patient characteristics. After 2 years of follow-up, mortality was 14.2%, but was associated with high patient age, advanced pacing systems, and substantial cardiac and non-cardiac comorbidities. CONCLUSION:AVN ablation is associated with an over four-fold reduction of cardiac hospitalization. This procedure has a high success rate and very low risk of complications.

Background Pulsed field ablation (PFA) is increasingly used for pulmonary vein (PV) isolation in atrial fibrillation (AF), but data on PV durability remain limited. Objective We evaluated PV reconduction during repeat ablation and factors associated with reconduction in a nationwide cohort. Methods We retrospectively included consecutive Danish patients undergoing first-time PVI using a pentaspline PFA catheter between July 2021 and January 2024. All PVs were successfully isolated during the index procedure. Patients were followed for ≥12 months. Arrhythmia recurrence was identified from ECGs, ambulatory monitoring, or wearable devices. PV reconduction was assessed during clinically indicated repeat ablation. Results Among 1,269 patients (median age 64 [56–70] years; 65% male; 48% persistent AF), 419 (33%) experienced recurrent atrial tachyarrhythmia during follow-up of 21 [17–26] months. Repeat ablation was performed in 188 patients, including PV remapping in 185. At repeat ablation, 131 patients (71%) demonstrated reconduction in ≥1 PV, whereas 54 (29%) had durable PVI. Reconduction most frequently involved the right-sided PVs. In multivariable analyses, male sex was independently associated with PV reconduction, whereas preprocedural CT was associated with lower odds of reconduction. AF recurrence predominated in patients with PV reconduction, whereas atrial flutter and atrial tachycardias were more common in patients with durable PVI. Conclusion In this nationwide real-world cohort, PV reconduction after first-time pentaspline PFA was common and predominantly involved right-sided PVs. Recurrence phenotype differed according to PV durability. The observed associations between male sex, preprocedural CT imaging, and PV reconduction are hypothesis-generating and require prospective validation.

Physical activity and sleep behaviors are prognostic for ventricular arrhythmias in ICD patients. However, short-term patterns in these behaviors in the days before ICD therapy remain underexplored. By analyzing accelerometer data in the month before a ventricular arrhythmia, we aim to find actionable predictors of arrhythmias and clinical deterioration in ICD carriers. This study aims to investigate behavioural patterns immediately preceding malignant ventricular arrhythmias in patients with an ICD by analysing day-to-day behavioural data. This is a sub-analysis from a multicenter, prospective study, conducted at two European centres. Patients with an ICD were enrolled between May 2021 and September 2022 and wore wrist-based activity monitors for 12 months. Thirteen metrics of daily activity and sleep were derived from tri-axial accelerometer data. Baseline averages were calculated from the first 30 days of monitoring; deviations from these baselines were analyzed over the last 30 days before the outcome of appropriate ICD therapy (shock or anti-tachycardia pacing). A Cox Proportional Hazards model with time-varying variables averaged over each 30-day period was used to identify risk of outcome based on activity and sleep patterns over time. Patients not wearing the wristband 30 days pre-therapy were excluded. The model was adjusted for age, secondary or primary prevention, ischaemic or nonischaemic cardiomyopathy, device type (ICD or CRT-D), and heart failure diagnosis (reduced or preserved ejection fraction). A total of 277 patients (mean age 63 ± 10 years, 81% male) were included, with 51 (18%) experiencing appropriate ICD therapy during follow-up. Long-term analysis revealed no significant differences in average one-year behavior metrics between patients with and without the outcome. In time-varying analysis, two patterns appeared: higher intensity during the most active six minutes each day (M6) was associated with a lower risk of imminent ICD therapy (HR 0.47, 95% CI 0.24–0.94), while longer exercise duration was linked to higher risk (HR 2.16, 95% CI 1.03–4.59). This inverse association suggests that longer but less intense activity durations can be a sign of disease deterioration. Figure 2 shows four examples of baseline deviations, with no significant differences between baseline and 30 days before ICD therapy. This sub-analysis of a prospective study demonstrated changes in intensity and duration of activity to be associated with imminent ventricular arrhythmia. The findings suggest that both the intensity and duration of daily activity impact arrhythmia risk differently, confirming the role of physical activity in arrhythmia risk and generating further hypotheses for understanding individualized risk assessment and personalized treatment.Forest plot of the hazard ratios Four examples of SDs from baseline

BACKGROUND:Cholecystokinin (CCK) is secreted from the intestines in response to food intake. We previously reported that the CCK gene is also expressed in the mammalian heart, and it has been hypothesized that proCCK could be a novel cardiac biomarker. However, it is not known whether cardiac gene expression leads to secretion in humans. PURPOSE:To investigate myocardial secretion of proCCK in patients with heart failure with reduced ejection fraction (HFrEF) or arrythmias. METHODS:A total of 115 patients undergoing invasive cardiac procedures were included: 55 with HFrEF (67 years [interquartile range (IQR) 60-76], 72.7 % male, LVEF 30 % [IQR 20-35]), and 60 without HFrEF (26 with Wolff-Parkinson-White syndrome (WPW) (30 years [IQR 26-39], 61.5 % male), and 34 with atrial fibrillation (AFIB) (66 years [IQR 60-71], 61.8 % male)). Blood was collected from the coronary sinus (CS) as well as the left atrium or femoral artery (A) to determine the transcardiac concentration gradient (TCproCCK) (CS proCCK concentration - A proCCK concentration). Radioimmunoassays were used for measurements of plasma hormones. RESULTS:TCproCCK across failing hearts was 0.05 pmol/l (IQR: -1.49-2.67) (p = 0.365). In non-failing hearts, TCproCCK was 0.35 pmol/l (IQR: -1.57-1.29) (p = 0.778) for WPW and 0.68 pmol/l (IQR: -1.58-3.28) (p = 0.133) for AFIB. Transcardiac gradients for N-terminal pro B-type natriuretic peptide (NT-proBNP) were observed in all groups. CONCLUSIONS:No evidence of net myocardial secretion of proCCK was found in either failing or structurally normal hearts, questioning its proposed role as a cardiac biomarker.

Robotic magnetic navigation (RMN) has demonstrated clinical utility in treating arrhythmia patients by providing direct distal-tip control of an ablation catheter, enhancing catheter precision, safety, and stability with an atraumatic catheter design. We aimed to assess the first in-human efficacy and safety of the new RMN-guided MAGiCTM radiofrequency ablation catheter. This prospective, multicenter single-arm, unblinded study enrolled 67 patients with arrhythmias that met EHRA guidelines for catheter ablation. All patients were treated for their index arrhythmia with the MAGiC RMN catheter. All other devices used in the procedures were approved for treatment including a RMN System (Genesis/Niobe®) used to navigate the MAGiC catheter. Acute procedural success and adverse events were assessed for all patients through discharge from the hospital in the days following the procedure. Sixty-seven patients were treated as follows: 25 cases of atrioventricular nodal reentrant tachycardia, 19 of premature ventricular contractions, 8 of Wolf-Parkinson-White (WPW) syndrome, 8 of atrial fibrillation, 3 of atrial flutter, and 4 of ventricular tachycardia. Acute procedural success was 94

Advances in medical treatment and outcomes in implantable cardioverter-defibrillator (ICD) recipients incentivize a need for improved candidate selection and identification of risk factors for ICD therapy. We examined contemporary rates of and risk factors for ICD therapy. Patients with ICD for primary (PP) or secondary prevention (SP), implanted between January 2010 and December 2020, were followed for appropriate and inappropriate incident and recurrent shock. Overall, 2998 patients (mean age 61.8 ± 12.7 years, 20

Aims Wearable health technologies are increasingly popular. Yet, wearable monitoring only works when devices are worn as intended, and adherence reporting lacks standardization. In this study, we aimed to explore the long-term adherence to a wrist-worn activity tracker in the prospective SafeHeart study and identify patient characteristics associated with adherence.Methods and results This study enrolled 303 participants, instructed to wear a wrist-worn accelerometer day and night for 6 months. Long-term adherence was defined as valid days (>= 22 h of wear time) divided by expected days, and daily adherence as mean hours of wear time per 24 h period. Optimal, moderate, and low long-term and daily adherence groups were defined as long-term adherence above or below 95 and 75% and daily adherence above or below 90 and 75%. Regression models were used to identify patient characteristics associated with long-term adherence. In total, 296 participants [median age 64 years; interquartile range (IQR) 57-72; 19% female] were found eligible, yielding 44 003 days for analysis. The median long-term adherence was 88.2% (IQR 74.6-96.5%). A total of 83 (28%), 127 (42.9%), and 86 (29.1%) participants had optimal, moderate, and low long-term adherence, and 163 (55.1%), 87 (29.4%), and 46 (15.5%) had optimal, moderate, and low daily adherence, respectively. Age and smoking habits differed significantly between adherence levels, and increasing changeover intervals improved the degree of long-term adherence.Conclusion Long-term adherence to a wearable activity tracker was 88.2% over a 6-month period. Older age and longer changeover interval were positively associated with long-term adherence. This serves as a benchmark for future studies that rely on wearable devices.Trial registration number The National Trial Registration number: NL9218 (https://onderzoekmetmensen.nl/). This study explored whether patients with an increased risk of cardiac arrest were willing and able to use an advanced wristband accelerometer for continuous day-to-day collection of physical activity and behavior data to potentially predict worsening health. Graphical Abstract

We aimed to identify and characterise behavioural profiles in patients at high risk of SCD, by using deep representation learning of day-to-day behavioural recordings. We present a pipeline that employed unsupervised clustering on low-dimensional representations of behavioural time-series data learned by a convolutional residual variational neural network (ResNet-VAE). Data from the prospective, observational SafeHeart study conducted at two large tertiary university centers in the Netherlands and Denmark were used. Patients received an implantable cardioverter-defibrillator (ICD) between May 2021 and September 2022 and wore wearable devices using accelerometer technology during 180 consecutive days. A total of 272 patients (mean age of 63.1 +/- 10.2 years, 81% male) were eligible with a total sampling of 37,478 days of behavioural data (138 +/- 47 days per patient). Deep representation learning identified five distinct behavioural profiles: Cluster A (n = 46) had very low physical activity levels and a disturbed sleep pattern. Cluster B (n = 70) had high activity levels, mainly at light-to-moderate intensity. Cluster C (n = 63) exhibited a high-intensity activity profile. Cluster D (n = 51) showed above-average sleep efficiency. Cluster E (n = 42) had frequent waking episodes and poor sleep. Annual risks of malignant ventricular arrhythmias ranged from 30.4% in Cluster A to 9.8% and 9.5% for Clusters D-E, respectively. Compared to low-risk profiles (D-E), Cluster A demonstrated a three-to-four fold increased risk of malignant ventricular arrhythmias adjusted for clinical covariates (adjusted HR 3.63, 95% CI 1.54-8.53, p < 0.001). These behavioural profiles may guide more personalised approaches to ventricular arrhythmia and SCD prevention.

Aims Physical activity has shown association with ventricular arrhythmia, however, the role of specific behavioral patterns over a 24 h cycle remains unknown. Therefore, we aimed to explore associations between physical behavior and appropriate implantable cardioverter defibrillator (ICD) therapy.Methods and results We included patients with an ICD at two European sites, who wore wrist-based accelerometers capturing 24 h movement and sleep behaviours for 28 days. Behavioural measures included activity volume, duration and intensity, sleep duration, and efficiency. Participants were followed for 12 months for the outcome of appropriate ICD therapy. Cox proportional hazard models with restricted cubic splines were used for the analysis. Lastly, the predictive capacity was tested. A total of 253 ICD patients were included (mean age 63.5 (+/- 10.2), 48 (19.0%) female). During follow-up, 40 participants (15.8%) received appropriate ICD therapy; 32 anti-tachycardia pacing (ATP) only (12.6%), 5 shock only (2.0%), and 3 combined ATP and shock (1.2%). In the adjusted model, high inactive duration (HR 1.40 (95% 1.10-1.78)), peak walking cadence (HR 1.07 (95% 1.03-1.12)), and total sleep duration (HR 1.50 (1.02-2.22)) were associated with the outcome. The dose-response relationship was U-shaped for inactive duration with a cut-off at 16 h, and linear for peak cadence and sleep. The prediction model reached an area under the receiver operating characteristic curve of 0.70 +/- 0.03, with highest accuracy in the first months.Conclusion Wearable-derived 24 h movement and sleep behaviours collected over 28 days were associated with later appropriate ICD therapy risk. Testing of the predictive value of digital biomarkers for enhanced risk stratification of ventricular arrhythmia warrants larger prospective studies.Clinical Trial Registration National Trial Registration (NL9218, http://onderzoekmetmensen.nl/). Graphical Abstract

Aims:Patterns in physical behaviour may be associated with an increased risk of ventricular arrhythmia. We examined associations between temporal dynamics in physical behaviour measured through wearable technology and the risk of ventricular arrhythmia. Methods and results:The multicentre, prospective SAFEHEART study recruited 303 patients with an implantable cardioverter-defibrillator (ICD) from May 2021 to September 2022. Continuous physical behaviour data were collected over 365 consecutive days and nights using wearable accelerometers. We characterized each 28-day behavioural time series using statistical summary indices and deep representations learned by neural networks. Logistic regression analyses were used to estimate the associations between physical behaviour and the subsequent risk of ventricular arrhythmia as detected by ICD and treated appropriately. Predictive performance was assessed using k-fold cross-validation and quantified by the area under the receiver operating characteristic curve (AUROC). From the SAFEHEART cohort, 277 patients and 56 ventricular arrhythmia were analysed, contributing to a total of 64 995 days of behavioural data. Reduced numbers of daily physical activity bouts and low day-to-day variation in sleep characteristics were associated with an increased risk of an arrhythmic event. Deep representations improved the predictive performance, with an AUROC of 0.74 ± 0.05, compared with statistical summary indices with an AUROC 0.67 ± 0.14 (P = 0.05 for comparison). Conclusion:Our findings suggest that behavioural patterns captured through wearable technology are independently associated with ventricular arrhythmia, particularly when these are characterised by deep representations.

Background: This post-hoc study investigated whether biomarkers reflecting extracellular matrix (ECM) turnover predicted cardiovascular disease (CVD), mortality, and progression of diabetic kidney disease (DKD) in individuals with type 2 diabetes (T2D) and microalbuminuria. Methods: Serum levels of specific ECM turnover biomarkers were assessed in 192 participants with T2D and microalbuminuria from an observational study conducted at Steno Diabetes Center Copenhagen from 2007 to 2008. Endpoints included CVD events, mortality, and DKD progression, defined as decline in estimated glomerular filtration rate (eGFR) of >30 %. Results: Participants had a mean age of 59 years, with 75 % males. Over a median follow-up of 4.9 to 6.3 years, the study recorded 38 CVD events, 24 deaths, and 40 DKD events. Elevated levels of a degradation fragment of collagen type I (C1M) were associated with an increased risk of >30 % eGFR decline, although this association was not independent of other risk factors. No significant associations were found between other ECM turnover biomarkers and DKD progression, mortality, or CVD risk. Conclusion: Elevated C1M levels were linked to DKD progression in individuals with T2D and microalbuminuria, but not independently of other risk factors. None of the ECM turnover biomarkers were associated with CVD or mortality.

Pulsed field ablation (PFA) is an emerging technology for the treatment of atrial fibrillation (AF), for which pre-clinical and early-stage clinical data are suggestive of some degree of preferentiality to myocardial tissue ablation without damage to adjacent structures. Here in the MANIFEST-17K study we assessed the safety of PFA by studying the post-approval use of this treatment modality. Of the 116 centers performing post-approval PFA with a pentaspline catheter, data were received from 106 centers (91.4% participation) regarding 17,642 patients undergoing PFA (mean age 64, 34.7% female, 57.8% paroxysmal AF and 35.2% persistent AF). No esophageal complications, pulmonary vein stenosis or persistent phrenic palsy was reported (transient palsy was reported in 0.06% of patients; 11 of 17,642). Major complications, reported for similar to 1% of patients (173 of 17,642), were pericardial tamponade (0.36%; 63 of 17,642) and vascular events (0.30%; 53 of 17,642). Stroke was rare (0.12%; 22 of 17,642) and death was even rarer (0.03%; 5 of 17,642). Unexpected complications of PFA were coronary arterial spasm in 0.14% of patients (25 of 17,642) and hemolysis-related acute renal failure necessitating hemodialysis in 0.03% of patients (5 of 17,642). Taken together, these data indicate that PFA demonstrates a favorable safety profile by avoiding much of the collateral damage seen with conventional thermal ablation. PFA has the potential to be transformative for the management of patients with AF.

ObjectivesCardiac arrhythmias predict poor outcome after myocardial infarction (MI). We studied if arrhythmia monitoring with an insertable cardiac monitor (ICM) can improve treatment and outcome.DesignBIO|GUARD-MI was a randomized, international open-label study with blinded outcome assessment.SettingTertiary care facilities monitored the arrhythmias, while the follow-up remained with primary care physicians.ParticipantsPatients after ST-elevation (STEMI) or non-ST-elevation MI with an ejection fraction >35% and a CHA2DS2-VASc score ≥4 (men) or ≥5 (women).InterventionsPatients were randomly assigned to receive or not receive an ICM in addition to standard post-MI treatment. Device-detected arrhythmias triggered immediate guideline recommended therapy changes via remote monitoring.Main outcome measuresMACE, defined as a composite of cardiovascular death or acute unscheduled hospitalization for cardiovascular causes.Results790 patients (mean age 71 years, 72% male, 51% non-STEMI) of planned 1,400 pts were enrolled and followed for a median of 31.6 months. At 2 years, 39.4% of the device group and 6.7% of the control group had their therapy adapted for an arrhythmia [hazard ratio (HR) = 5.9, P < 0.0001]. Most frequent arrhythmias were atrial fibrillation, pauses and bradycardia. The use of an ICM did not improve outcome in the entire cohort (HR = 0.84, 95%-CI: 0.65–1.10; P = 0.21). In secondary analysis, a statistically significant interaction of the type of infarction suggests a benefit in the pre-specified non-STEMI subgroup. Risk factor analysis indicates that this may be connected to the higher incidence of MACE in patients with non-STEMI.ConclusionsThe burden of asymptomatic but actionable arrhythmias is large in post-infarction patients. However, arrhythmia monitoring with an ICM did not improve outcome in the entire cohort. Post-hoc analysis suggests that it may be beneficial in non-STEMI patients or other high-risk subgroups. Clinical Trial Registration[https://www.clinicaltrials.gov/ct2/show/NCT02341534], NCT02341534.

Aims Patient-reported outcome measures (PROMs) serve multiple purposes, including shared decision-making and patient communication, treatment monitoring, and health technology assessment. Patient monitoring using PROMs is constrained by recall and non-response bias, respondent burden, and missing data. We evaluated the potential of behavioural digital biomarkers obtained from a wearable accelerometer to achieve personalized predictions of PROMs.Methods and results Data from the multicentre, prospective SafeHeart study conducted at Amsterdam University Medical Center in the Netherlands and Copenhagen University Hospital, Rigshospitalet in Copenhagen, Denmark, were used. The study enrolled patients with an implantable cardioverter defibrillator between May 2021 and September 2022 who then wore wearable devices with raw acceleration output to capture digital biomarkers reflecting physical behaviour. To collect PROMs, patients received the Kansas City Cardiomyopathy Questionnaire (KCCQ) and EuroQoL 5-Dimensions 5-Level (EQ5D-5L) questionnaire at two instances: baseline and after six months. Multivariable Tobit regression models were used to explore associations between digital biomarkers and PROMs, specifically whether digital biomarkers could enable PROM prediction. The study population consisted of 303 patients (mean age 62.9 +/- 10.9 years, 81.2% male). Digital biomarkers showed significant correlations to patient-reported physical and social limitations, severity and frequency of symptoms, and quality of life. Prospective validation of the Tobit models indicated moderate correlations between the observed and predicted scores for KCCQ [concordance correlation coefficient (CCC) = 0.49, mean difference: 1.07 points] and EQ5D-5L (CCC = 0.38, mean difference: 0.02 points).Conclusion Wearable digital biomarkers correlate with PROMs, and may be leveraged for real-time prediction. These findings hold promise for monitoring of PROMs through wearable accelerometers. Graphical Abstract

Paediatric patients with ventricular pre-excitation/asymptomatic WPW syndrome have a higher risk of atrial fibrillation degenerating into ventricular fibrillation and sudden cardiac death (SCD). In more than half of these patients this can be the first symptom presenting. Hence, it is important to conduct a risk stratification for SCD in asymptomatic patients with pre-excitation/delta wave in the ECGs. In this review, invasive risk stratification by electrophysiologic testing and ablation is recommended when possible. Catheter ablation is reported to have a high rate of success and low risk of complications.

Abstract Aims Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality. Methods and results All Danish patients diagnosed with BrS (2006–2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6% male, median age at diagnosis 46 years, 45.3% symptomatic). Of these, 15.7% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8%) and 14/122 (11.5%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46–8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42–13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8%); however, 3/4 developed depression or anxiety before death. Conclusion Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.

Introduction: Diabetic retinopathy (DR) and obstructive coronary artery disease (OCAD) are the main microvascular and macrovascular complications of diabetes mellitus (DM), respectively. The assessment of DR by means of spectral domain optical coherence tomography (SD-OCT) and angiography (OCTA) conferred a remarkable progress. Objective: investigate if SD-OCT and OCTA can detect DR that is associated with OCAD, determined by coronary angiotomography (CCTA) Hypothesis: DR, assessed by OCTA and OCT-SD, is associated with OCAD, assessed by CCTA Methods: In this single-center, cross-sectional, single-blind study, patients with DM who had undergone CCTA in the previous 3 years (independent indication) were eligible. They were divided according to the presence of OCAD in two groups and underwent SD-OCT and OCTA. The association between OCAD and DR was evaluated through uni and multivariate analysis and another analysis was performed to identify variables independently associated with the presence of DR. Results: We included 171 patients, 87 OCAD and 84 without OCAD. Age (66 vs 64 y,p=0.28), DM duration (12 vs 13 y, p=0.5) and HbA1c (7.5% vs 6,9%,p=0.08) did not differ. Patients with OCAD were more frequently men (74% vs 38%, P<0.01), had a higher prevalence of insulin use (52% vs 38%, p<0.01) and 64% had already undergone some type of revascularization. SD-OCT and OCTA revealed a higher prevalence of DR (48% vs 22%,p=0.01). The main findings were: microaneurysms (25% vs 13%,p=0.04), intraretinal cysts (22% vs 8%, p=0.01) and areas of reduced capillary density in the superficial retinal plexus (46% vs 20%,p<0.01).We also found lower mean vascular density (MVD) (15.7 vs 16.5, p=0.049) and lower circularity of the foveal avascular zone(FAZ) (0.64±0.1 vs 0.69±0.1, p= 0.04).There were significant and negative correlations between Duke coronary score and MVD (r=-0.189; p=0.03) and circularity of the FAZ (r=-0,206; p= 0.02). In an adjusted model, presence of OCAD increased the chance of DR (OR 4.05 [1.4 -11.6], p<0.01). OCAD, DM duration and insulin use were independently associated to DR. Conclusions: OCAD was associated with a greater chance of presenting DR. OCAD, longer DM duration and insulin use were independently associated to the presence of DR.

Objective: Diabetes is a risk factor for atrial fibrillation (AF), and increases the risk of thromboembolic events in persons with AF. However, the link between the two conditions is not fully elucidated. Few studies have investigated the association of dysglycemia and incident AF. We investigated the risk of incident AF and prognosis according to diabetes status. Research design and methods: The Copenhagen Primary Care Laboratory Database was merged with data on medical prescriptions, in-and outpatient contacts and vital status. The risk of AF according to diabetes status was investigated by use of Cox regression models. Results: Of 354.807 individuals with a hemoglobin A1c (HbA(1c)) measurement, 28.541 (8 %) had known diabetes, 13.038 (4 %) had new onset diabetes and 27.754 (8 %) had prediabetes (HbA(1c )42-47 mmol/mol). Persons with dysglycemia (HbA(1c) > 42 mmol/mol) and diabetes were older, more were men, they had lower level of education and were more likely to be living alone. We observed a gradual increase in risk of developing AF from HbA(1c) levels of 40 to 60 mmol/mol. In adjusted analyses we found a stepwise increase in hazard of AF from normoglycemia over prediabetes to persons with diabetes (no diabetes: 1.00 [ref.]; prediabetes: 1.12 [1.08-1.16]; new-onset diabetes: 1.16 [1.10-1.22]; known diabetes: 1.15 [1.11-1.20]). Persons with known diabetes had a significant higher hazard of stroke, cardiovascular and all-cause mortality. Conclusion: Increasing levels of HbA(1c) were associated with an increased hazard of developing AF. Persons with new onset of diabetes and those with known diabetes had similar hazard of developing AF, however persons with known diabetes had a significant higher hazard of stroke, cardiovascular-and all-cause mortality.