The role of prophylactic cavotricuspid isthmus (CTI) ablation remains controversial in atrial fibrillation (AF) patients without atrial flutter (AFL). Given the strong association between AF, AFL, and age, this study aimed to evaluate the impact of additional CTI ablation on recurrence-free survival, with a focus on age-stratified outcomes. Between June 2020 and June 2022, 1226 paroxysmal AF patients without AFL who underwent first AF catheter ablation at Beijing Anzhen Hospital were enrolled. 899 patients underwent pulmonary vein isolation (PVI) alone (PVI group) and remaining 327 patients underwent additional CTI ablation (PVI + CTI group). Both groups were stratified into four age quartiles to assess age-related recurrence risk. Over a median 36.6-month follow-up, prophylactic CTI ablation did not have a better outcome in overall population. In the PVI + CTI group, the oldest age quartile (> 70 years) was independently associated with a lower risk of recurrence compared with the youngest quartile (≤ 56 years; adjusted HR 0.41, 95

Atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) remains a significant clinical challenge. We aimed to evaluate whether combined markers capturing both local substrate derangement and systemic endothelial stress can outperform conventional predictors for AF recurrence. This study retrospectively enrolled 765 patients with atrial fibrillation (paroxysmal and persistent) who underwent radiofrequency ablation at the First Affiliated Hospital of Anhui Medical University from October 2022 to August 2024. Epicardial adipose tissue index (EAT Index = EAT volume/body surface area) was derived from cardiac CT, and the endothelial activation and stress index (EASIX = LDH × creatinine/platelets) was calculated from routine blood tests. Restricted cubic splines revealed an approximately linear dose–response relationship between EAT Index and recurrence risk (Poverall < 0.001; Pnonlinearity = 0.952, indicating no evidence of nonlinearity). In fully adjusted Cox models, each 10 mL/m2 increase in EAT Index carried a hazard ratio (HR) of 1.92 (95

Aim: To evaluate the long-term impact of obstructive sleep apnea (OSA) risk profile on atrial fibrillation (AF) recurrence after catheter ablation in patients with paroxysmal AF. Methods: This prospective study enrolled 161 patients with paroxysmal AF undergoing initial ablation. Patients were stratified by the Berlin Questionnaire (BQ) into high-risk (n = 94) and low-risk (n = 67) OSA groups. Atrial tachyarrhythmias occurring within the initial three months were defined as early recurrence, whereas recurrence beyond three months was defined as late recurrence. A subgroup of 71 patients with recurrence underwent a redo ablation. Results: After 16.1 ± 0.4 years, multivariable models revealed that a BQ-defined high OSA risk was independently associated with early recurrence (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.02-3.86, P = 0.043), whereas it was not independently associated with late recurrence after the initial procedure (hazard ratio [HR] 1.05, 95%CI: 0.70-1.57, P = 0.810). Cox regression identified early recurrence (HR 2.95, 95%CI: 1.99-4.39, P < 0.001) and baseline high-sensitivity C-reactive protein (hs-CRP; HR 1.02, 95%CI: 1.00-1.03, P = 0.022) as independent predictors of late recurrence after the initial procedure. Following redo ablation, early recurrence remained a strong independent predictor (HR 5.93, 95%CI: 2.13-16.50, P < 0.001). Conclusions: The BQ-defined high OSA risk was an independent predictor of early recurrence; however, it was not significantly associated with late recurrence after AF ablation. Early recurrence was the strongest predictor of long-term outcome, highlighting the importance of management during the post-procedural blanking period.

AIMS:The aim of this study was to systematically quantify the global, regional, and national burden of heart failure (HF) attributable to atrial fibrillation/flutter (AF/AFL) from 1990 to 2021, and project trends to 2040. METHODS AND RESULTS:Using Global Burden of Disease (GBD) 2021 data, we analysed AF/AFL-attributed HF prevalence and years lived with disability (YLDs) across 204 countries, stratified by age, sex, and socio-demographic index (SDI). Joinpoint regression identified temporal inflection points; decomposition analysis quantified contributions from population growth, ageing, and epidemiological change; Bayesian age-period-cohort (BAPC) models forecasted burden to 2040. Globally, AF-attributed HF cases increased 3.4-fold, from 162 561 (95% UI: 120 008-213 951) in 1990 to 714 137 (95% UI: 520 543-940 901) in 2021, with age-standardized prevalence rates (ASPRs) rising from 5.36 to 8.85 per 100 000 (EAPC: 1.76%, 95% UI: 1.66-1.85%). YLDs increased more than four-fold, from 14 615 (95% UI: 8848-23 114) to 63 943 (95% UI: 39 058-96 196; EAPC: 1.76%, 95% CI: 1.67-1.85%). High-SDI regions exhibited the highest burden (ASPR: 13.97 (95% UI: 10.31 to 18.36) per 100 000), with epidemiological changes contributing 44% of the absolute increase in high-SDI regions to case growth. Women outnumbered men beyond age 65 (female-to-male ratio: 1.1 at age 65-69, widening to 2.4 at ≥95 years), yet age-standardized rates showed no significant sex difference (female ASPR: 8.91 vs. male ASPR: 8.78 per 100 000). Joinpoint analysis revealed accelerated growth during 1990-2007 (APC: 2.12%, P < .05), which decelerated during 2007-2018 (APC: 1.41%, P < .05) and plateaued during 2018-2021 (APC: -0.36%, P > .05). Projections indicate a near-doubling of global cases to 1 307 469 (95% UI: 661 547-1 953 391) by 2040, corresponding to an ASPR of 8.45 per 100 000 (95% UI: 4.28-12.63). CONCLUSION:AF/AFL is a major and growing driver of global HF burden, projected to affect 1.3 million individuals by 2040, with disproportionate impact in older adults (≥65 years) and high-SDI regions. Integrating standardized AF management-including systematic screening, anticoagulation, and early rhythm control-into HF prevention pathways represents a critical strategy to mitigate projected increases.

BACKGROUND:Population-based evidence on the predictive role of left ventricular ejection fraction (LVEF) in incident Cardiac Conduction Dysfunction (CCD) and the mediating effects of electrophysiological parameters remains understudied. This study aimed to characterize the relationship between LVEF and incident CCD and explore the potential mediating effects of electrophysiological parameters. METHODS:This prospective cohort study included 32,398 participants (96.6% White ethnicity) from the UK Biobank with analyzable LVEF and electrocardiogram data. Incident CCD was defined as the first occurrence of atrioventricular block, left bundle branch block, or other conduction disorders. Stepwise backward Cox regression and sensitivity analyses evaluated the association between LVEF and CCD. Additionally, mediation analysis was performed to examine QRS duration, PQ interval, and corrected QT interval as potential mediators. RESULTS:During a mean follow-up of 6.96 ± 1.63 years, 484 incident CCD cases were identified. LVEF was an independent predictor of incident CCD, with each 1-standard deviation increase in LVEF associated with a 17% reduction in risk (adjusted hazard ratio, 0.83; 95% confidence interval, 0.77-0.89; p < 0.001). Sensitivity analyses across LVEF thresholds, competing risks, and exclusion of early events confirmed the robustness of these findings. Mediation analysis showed that PQ interval mediated 6% (p < 0.001), QRS duration mediated 17% (p < 0.001), and corrected QT interval mediated -3% (p = 0.002) of the total effect. CONCLUSION:LVEF is independently associated with incident CCD, with electrophysiological parameters potentially explaining part of this association. These findings underscore the clinical relevance of myocardial mechano-electrical coupling in large-scale population settings.

BACKGROUND:Ethanol infusion of the vein of Marshall (EIVOM) improves outcomes in atrial fibrillation (AF) ablation. However, its association with delayed pericardial effusion (PE)-specifically its incidence, clinical features, and mechanism-remains poorly defined. OBJECTIVES:This study sought to investigate the risk of delayed PE associated with EIVOM and characterize its clinical profile, management, and outcomes. METHODS:This study analyzed 15,101 patients with persistent AF from the China-AF Registry, stratified into an EIVOM group (n = 8,151) and a non-EIVOM group (n = 6,950). The primary endpoint was delayed PE, defined as newly detected PE >10 mm occurring ≥7 days after ablation and resulting in rehospitalization. Propensity score overlap weighting was applied to balance baseline covariates between groups. RESULTS:Delayed PE occurred in 0.17% of the total cohort, with a higher incidence in the EIVOM group compared with the non-EIVOM group (0.25% vs 0.07%). EIVOM was an independent risk factor for delayed PE (overlap-weighted HR: 3.18; 95% CI: 1.15-8.74; P = 0.025). Delayed PE in the EIVOM group tended to manifest late (median 38 days vs 14 days), with large effusion size and severe systemic inflammation. Management in the EIVOM group frequently required invasive intervention (17 of 20 [85%]). Notably, 20% (4 of 20) of patients with EIVOM-related delayed PE experienced recurrence post-discharge, requiring prolonged management. CONCLUSIONS:EIVOM is associated with an increased risk of delayed PE, characterized by late onset, systemic inflammation, frequent need for invasive management, and high recurrence risk. These findings support the need for extended echocardiographic monitoring beyond the standard postprocedural period.

BackgroundMajor adverse cardiovascular events (MACE) exhibit sex-specific disparities, but comprehensive analyses of combined genetic and clinical risk factor profiles across sexes remain limited.MethodsThis prospective cohort study included 397,806 UK Biobank participants (55.1% female) without baseline MACE. Five weighted risk scores [social-demographic, lifestyle, metabolic, clinical comorbidity, polygenic risk score (PRS)] were evaluated for associations with incident MACE via sex-stratified Cox proportional hazards regression, interaction analyses, and population-attributable risk (PAR) assessments.ResultsOver a median follow-up of 15.6 years, 32,019 participants (8.0%) developed MACE (11.1% males vs. 5.5% females). Social-demographic (Interaction effect: HR 0.91, 95% CI 0.89–0.93), lifestyle (Interaction effect: HR 0.94, 95% CI 0.91–0.97), and clinical comorbidity (Interaction effect: HR 0.85, 95% CI 0.82–0.87) scores exhibited stronger MACE associations in females than males, while males had higher PRS-related risk (Interaction effect: HR 1.07, 95% CI 1.03–1.11, P for interaction < 0.001). Pairwise interaction patterns differed by sex. PRS integration improved MACE prediction in males (ΔC-statistic = 0.010, P < 0.001) but not in females (ΔC-statistic = 0.005, P = 0.299). PAR ranking differed: while social-demographic and clinical comorbidity scores remained the top two contributors across sexes, polygenic risk emerged as the third largest contributor in males (15.9%), and unhealthy lifestyle was the third largest in females (15.6%).ConclusionsSex-specific differences in the effects and contributions of risk factor profiles highlight the need for tailored MACE prevention strategies. Polygenic risk provided modest additional discrimination in males, supporting further evaluation of precise cardiovascular risk assessment.

Background and Objective:A potential association between sleep disturbances and adverse cardiovascular prognoses has been proposed in patients with chronic obstructive pulmonary disease (COPD), although high-quality confirmatory evidence remains limited. Sleep disturbances may contribute to increased cardiovascular risk through multiple biological pathways, including chronic intermittent hypoxia, systemic inflammation, and metabolic dysregulation. This study aimed to examine the association between sleep disturbances and adverse cardiovascular events in patients with COPD. Materials and Methods:A prospective cohort study of 21423 UK Biobank participants with COPD. We set the research subjects as non-sleep disorder group and sleep disorder group. Outcomes included stroke, heart failure (HF), atrial fibrillation (AF), angina pectoris, and myocardial infarction (MI). Cox proportional hazards models were applied with adjustment for sociodemographic and lifestyle factors to evaluate the association between sleep disorders and subsequent cardiovascular outcomes. Results:In this manuscript, compared with COPD patients in the non-sleep disorder group, sleep disorder group had a 79% higher risk of HF (HR = 1.79, 95% CI: 1.57-2.03). Moreover, sleep disorder had a 49% higher HR for AF (HR = 1.49, 95% CI: 1.32-1.68) and a 44% higher HR for angina development (HR = 1.44, 95% CI: 1.23-1.68). The risk of MI was also increased by 0.24-fold in the sleep disorder group (HR = 1.24, 95% CI: 1.01-1.54). Furthermore, male sex, older age, previous cardiovascular medication use, smoking, and obesity were significantly associated with elevated cardiovascular risk among COPD patients with sleep disorders. Conclusion:Sleep disorders are associated with an increased risk of adverse cardiovascular outcomes in COPD patients. These findings suggest that identification and appropriate management of sleep disorders could potentially contribute to improved cardiovascular risk profiles in this population.

BACKGROUND:Although sex disparities in atrial fibrillation (AF) epidemiology and outcomes are well documented, the role of sex in modulating genetic susceptibility to incident AF remains poorly characterized. In this study we assessed sex-specific effects of polygenic risk score (PRS) on AF incidence and the sex-specific PRS effects, stratified by the Cohorts for Heart and Aging Research in Genomic Epidemiology for Atrial Fibrillation (CHARGE-AF) clinical risk score. METHODS:This prospective cohort study included 444,463 AF-free UK Biobank participants (54.67% women; mean age 56.46 ± 8.09 years). Participants were stratified by sex, AF-PRS (cutoff ≥ 0.295), and CHARGE-AF clinical risk score (cutoff ≥ 12.048). Incident AF was ascertained via ICD-10 codes. Cox hazards regression (adjusting for clinical, metabolic, lifestyle, and socioeconomic covariables) was used to evaluate the multiplicative interactions among AF-PRS, sex, and CHARGE-AF. RESULTS:Over 14.67 ± 3.01 years, 31,070 participants experienced incident AF. A significant interaction between male sex and higher AF-PRS emerged (hazard ratio [HR] 0.95, 95% confidence interval [CI] 0.91-1.00; P = 0.031). Women were more genetically susceptible to AF at higher CHARGE-AF (HR 1.99 vs 1.83 in men) and men at lower CHARGE-AF (HR 2.33 vs 2.11 in women). In addition, the tripartite interaction (AF-PRS × sex × CHARGE-AF, HR 0.84; P < 0.001) further validated the sex-specific results stratified by CHARGE-AF. CONCLUSIONS:The association between AF-PRS and incident AF is modified by sex, with clinical risk burden modifying sex-related PRS effects. Women presented with higher genetic susceptibility at higher CHARGE-AF, and men at lower CHARGE-AF. Rethinking AF genetic susceptibility in a sex- and context-dependent manner may enhance precise prevention.

Catheter ablation is an established therapy for atrial fibrillation, yet its application in patients with complex congenital cardiovascular anomalies remains challenging. Dextrocardia (1–2/20,000 incidence) and interruption of the inferior vena cava are rare structural abnormalities that complicate vascular access and catheter navigation during catheter ablation. We report the case of a 39-year-old Chinese woman with persistent atrial fibrillation, dextrocardia, interruption of the inferior vena cava (with azygos continuation to the superior vena cava), severe mitral regurgitation, and pulmonary hypertension who underwent catheter ablation in the fluoroless catheterization laboratory. After thorough preoperative imaging assessment, we decided to perform the procedure through the right femoral vein and the left internal jugular vein approaches. Intracardiac echocardiography combined with the three-dimensional electroanatomic mapping method facilitated real-time visualization of the fossa ovalis and transseptal needle positioning without fluoroscopy. We safely completed the transseptal puncture by using this method. Pulmonary vein isolation and posterior wall box isolation were performed using a SmartTouch Surround Flow catheter, despite limited catheter maneuverability due to anatomical constraints. Successful sinus rhythm restoration was achieved without complications. At 3-month follow-up, the patient remained asymptomatic with a reduced left atrial diameter (57.7 mm to 51.2 mm) and stable sinus rhythm on electrocardiography. Integration of intracardiac echocardiography, three-dimensional electroanatomic mapping, and multidisciplinary planning enabled precise catheter ablation in the patient with complex anatomy. The results support fluoroless techniques as a viable option for atrial fibrillation ablation in challenging congenital anomalies, minimizing radiation exposure while maintaining procedural success.

Introduction: The safety and effectiveness of catheter ablation in patients with atrial fibrillation (AF) who underwent mechanical mitral valve replacement (MVR) have been reported. However, the impacts of different types of mitral valves on the safety and effectiveness of catheter ablation in patients with AF who underwent MVR have not been elucidated. Methods and results: From 2015 to 2021, 17,496 patients underwent catheter ablation of AF for the first time in Beijing Anzhen Hospital were screened. The inclusion criteria were (1) aged 18 years or older; (2) diagnosed with AF; (3) history of mitral valve replacement. The exclusion criteria were a history of catheter ablation, surgical maze procedure, left atrial appendage closure or resection. A total of 68 patients were enrolled in the study. The patients were divided into two groups: the bioprosthetic MVR group (n=12) and the mechanical MVR group(n=58). The size of the left atrial was larger (49.5mm vs. 46.0mm, p<0.05), the thickness of the left interventricular septum was larger (11.0mm vs. 10.0mm, p<0.05), and the mitral ring area was smaller (2.3mm2 vs. 2.6mm2, p<0.05) for the bioprosthetic MVR group than the mechanical MVR group. During 23.4 (6.1, 36.5) months of follow-up, the incidence of the endpoint events was not significantly different between the two groups (33.3% vs. 30.4%, log-rank p=0.48). There were 2 cases (3.4%) of pseudoaneurysm and 1 case of acute cerebral infarction in the mechanical MVR group. No complication was observed in the bioprosthetic MVR group. No significant clinical bleeding events were observed in the bioprosthetic group while eight patients in the mechanical MVR groups had bleeding events (p=0.368) during the follow-up. Conclusion: The safety and effectiveness of catheter ablation of AF were comparable between the patients with mechanical MVR and bioprosthetic MVR.

AIMS:Steam pops present a significant concern during radiofrequency (RF) ablation of atrial fibrillation (AF). It is crucial to analyse the incidence and ablation characteristics associated with steam pops. This study aims to investigate the occurrence and potential predictors of steam pops. METHODS AND RESULTS:This study included 3263 patients with AF who underwent RF ablation. Patients with paroxysmal AF received bilateral circumferential pulmonary vein (PV) ablation, while those with persistent AF underwent additional linear ablation. The ablation parameters at the sites of steam pops were compared to those at adjacent anatomical locations. A total of 81 steam pops (2.5%) with one pericardial tamponade were recorded. Steam pops were observed at liner ablation sites: 6 (0.4%) at the mitral isthmus, 16 (0.9%) at the tricuspid isthmus (CTI), and 7 (0.5%) along the roofline. The most common sites of steam pops were the anterior edge of the left superior PV and the inferior vena cava side of the CTI. The impedance drop was significantly higher (18.2 ± 9.5 Ω vs. 13.5 ± 4.8 Ω, P < 0.001) at steam pop sites. The optimal cut-off points of impedance drop for predicting steam pops were > 9.5 Ω within the first 3 s, > 10.5 Ω within the first 5 s, > 13.5 Ω within the first 10 s, and > 18.5 Ω in the whole ablation, respectively. CONCLUSION:The incidence of steam pops during ablation of AF is infrequent. Impedance drop is the only ablation parameter that could predict the occurrence of steam pops.

BACKGROUND:The effectiveness of continuous anti-arrhythmic drugs (AAD) therapy during the 3-month blanking period following repeat catheter ablation to prevent atrial fibrillation (AF) recurrence remains unclear. To evaluate the impact of continuous AAD therapy during the blanking period on AF recurrence in patients with paroxysmal atrial fibrillation (PAF) undergoing repeat ablation. METHODS:Patients with PAF who underwent repeat ablation from the China-AF Registry (2011-2022) were included in this study and categorized into two groups based on AAD use during the 3-month blanking period. The AF recurrence was defined as recurrent atrial tachyarrhythmias lasting for >30 s following the blanking period. Cox proportional hazard models were performed to assess the association between AAD status in the blanking period and AF recurrence at 12 months. RESULTS:The study included 740 PAF patients (mean age 59.4 ± 10.6 years, 36.1% female) who underwent repeat ablation, with 289 patients in the on-AAD group and 451 in the off-AAD group. At 12 months post-ablation, 258 patients (34.9%) experienced AF recurrence. After adjusting for confounders, AAD use during the blanking period did not significantly associate with AF recurrence within 12 months after this period (HR = 1.07; 95% CI: 0.83-1.37; p = 0.599). Consistent results were found in different age, sex, body mass index, left atrial diameter, and CHA2DS2-VASc score subgroups. CONCLUSIONS:There was no significant relationship between AAD therapy during the blanking period after repeat ablation and AF recurrence at 12 months in patients with PAF.

Background Attempted catheter manipulation through the retrograde aortic approach carries a risk of aortic dissection (AD) during catheter ablation. Objective This study aimed to determine the incidence, management, and outcomes of iatrogenic AD associated with ablation of ventricular arrhythmia (VA). Methods All patients who sustained iatrogenic AD during retrograde aortic VA ablation at 6 centers between January 1, 2011, and September 30, 2023, were prospectively identified. Results Of 5925 patients who underwent ablation procedures during the study period, iatrogenic AD developed in 18 (0.3%; 8 type A AD, 10 type B AD) during the procedure. The mean age was 65.4 ± 5.3 years, and 5 patients (27.8%) were female. Considerable catheter resistance was reported in all cases. Presenting symptoms included sudden-onset severe chest pain (n = 13 [72.2%]), back pain (n = 9 [50%]), abdominal pain (n = 3 [16.7%]), and syncope (n = 3 [16.7%]). Of the type A AD patients, 3 (37.5%) with antegrade dissection underwent surgical repair, and 2 (25%) with retrograde dissection were successfully managed conservatively. Three (30%) of the type B AD patients underwent endovascular intervention and 7 (70%) were managed medically. Three patients (16.7%) died; all had type A AD and died of severe hemodynamic compromise. None of the 15 survivors had aorta-related complications during a mean follow-up of 72.7 ± 46.8 months. Conclusion Iatrogenic AD is a rare but potentially lethal complication of retrograde aortic VA ablation. Comprehensive measures should be taken to reduce the risk of iatrogenic AD.

BACKGROUND:Prediction models for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) incorporate factors that influence outcomes of catheter ablation (CA) of atrial fibrillation (AF). OBJECTIVE:This study aimed to investigate the outcomes of CA of AF in patients with HCM stratified by SCD risk. METHODS:Of the 23,904 patients who underwent CA of AF, 417 patients with HCM were screened. After excluding ineligible patients, 339 patients were ultimately included in the study. Participants were classified into a low-risk (LR) group (n = 292) and a medium- to high-risk (M-HR) group (n = 47) according to the HCM risk-SCD model. Long-term outcomes were compared between the groups. RESULTS:After a median follow-up of 43.0 months (12.0-69.0), recurrence rate after a single procedure was significantly higher in the M-HR group than in the LR group (70.2% vs 41.8%, P < .001). After the last ablation, the recurrence rate was also higher in the M-HR group than in the LR group (57.4% vs 32.2%, P < .001). In multivariate analysis, M-HR of SCD was an independent predictor of recurrence(hazard ratio 1.77, 95% confidence interval 1.14-2.74, P = .010). During follow-up, no significant differences were observed in cardiac death (2.1% vs 2.1%, P = .995), heart failure hospitalization (8.5% vs 5.1%, P = .471), or stroke (10.6% vs 3.8%, P = .071). CONCLUSION:M-HR of SCD in HCM was associated with a higher recurrence rate after CA of AF.

BACKGROUND:The effectiveness of ethanol infusion of the vein of Marshall (EIVOM) for persistent atrial fibrillation (AF) in patients with mitral valve replacement (MVR) remains to be determined. OBJECTIVES:This study investigated the effectiveness and safety of EIVOM in catheter ablation of persistent AF in patients with MVR. METHODS:This is a retrospective case-control study. Patients with persistent AF and MVR who underwent the first-time catheter ablation were divided into the EIVOM group (n = 27) and the control group (n = 33). Bilateral pulmonary vein isolation and linear ablations were performed in both groups. In addition, the EIVOM group received EIVOM. Mitral isthmus (MI) block rate, procedure-related complications, and sinus rhythm maintenance rate were compared between the 2 groups in the intention-to-treat population. RESULTS:There were no significant differences in baseline characteristics between the 2 groups. Twenty-two patients successfully underwent EIVOM. The MI block rate was significantly higher in the EIVOM group (77.8% vs 51.5%; P = .036). After 13.5 months of follow-up (interquartile range, 7.0-22.2), the sinus rhythm maintenance rate was significantly higher in the EIVOM group than in the control group (63.0% vs 36.4%; P = .032). In the multivariate Cox analysis, EIVOM (hazard ratio 0.35; 95% confidence interval, 0.16-0.78; P = .009) was independently associated with the sinus rhythm maintenance rate. One patient in the EIVOM group experienced a self-resolved pericardial effusion. One patient in the control group experienced a pseudoaneurysm. CONCLUSION:EIVOM significantly improved the MI linear block rate and the sinus rhythm maintenance rate in patients with persistent AF and MVR.

Atrial fibrillation/flutter (AF/AFL) poses significant risks of heart failure and stroke. From 1990 to 2021, China's AF/AFL cases surged from 3.20 to 10.78 million. Using Global Burden Disease (GBD) 2021 data and Bayesian age-period-cohort (BAPC) modeling, we analyzed trends and projected disease burden through 2045. Age-standardized incidence and prevalence rose by 5.4% and 14.5%, respectively, while mortality and disability-adjusted life year (DALY) rates declined by 12.2% and 3.8%. By 2045, prevalent cases may reach 23.04 million, with 1.93 million new cases, 220 000 deaths, and 4.21 million DALYs. Key risk factors include hypertension, smoking, high-sodium diet, and obesity. Sex disparities emerged, with females showing better mortality/DALY improvements than males. Population aging and metabolic risks will drive future burden. Targeted interventions (blood pressure control, smoking cessation, sodium reduction) and sex-/age-specific strategies are critical. Innovations in digital health (AI monitoring) and tiered healthcare networks could mitigate risks. Prioritizing China-specific prevention frameworks is essential to address this escalating public health challenge. Geriatr Gerontol Int 2025; 25: 1047-1057.