The year in Cardiovascular Medicine

1.Segan L, Canovas R, Nanayakkara S, Chieng D, Prabhu S, Voskoboinik A, et al. New-onset atrial fibrillation prediction: the HARMS2-AF risk score. Eur Heart J 2023; 44:3443–52. 

The HARMS2-AF score ( Hypertension= 4 points- ; Age – 60–64 years = 1 point and age ≥65 years = 2 points; Raised BMI (BMI ≥30 kg/m 2 = 1 point ; Male sex = 2 points ; Sleep apnea =2 points ; Smoking = 1 point ; Alcohol 7–14 standard drinks/week = 1 point and ≥15 standard drinks/week= 2 points) maintained predictive performance  with an AUC 0.782 (0.775–0.789) in the derivation cohort and AUC 0.775 (0.769–0.781) in the  validation cohort at 5 years. This novel lifestyle risk score  may help identify individuals at risk of AF in the general community and assist population screening.

2.Lyth J, Svennberg E, Bernfort L, Aronsson M, Frykman V, Al-Khalili F, et al. Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study. Eur Heart J 2023;44:196–204.

Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation

3.Xing LY, Diederichsen SZ, Hojberg S, Krieger DW, Graff C, Frikke-Schmidt R, et al. Effects of atrial fibrillation screening according to N-terminal pro-B-type natriuretic peptide: a secondary analysis of the randomized LOOP study. Circulation 2023;147: 1788–97.

In an older population with additional stroke risk factors, ILR screening for AF was associated with a significant reduction in stroke risk among individuals with higher         NT-proBNP levels but not among those with lower levels. These findings should be considered hypothesis generating and warrant further study before clinical implementation.

4.Kirchhof P, Toennis T, Goette A, Camm AJ, Diener HC, Becher N, et al. Anticoagulation with edoxaban in patients with atrial high-rate episodes. N Engl J Med 2023;389: 1167–79.

Among patients with device-detected atrial high-rate episodes (AHREs) , anticoagulation with edoxaban did not significantly reduce the incidence of a composite of cardiovascular death, stroke, or systemic embolism as compared with placebo, but it led to a higher incidence of a composite of death or major bleeding. The incidence of stroke was low in both groups.

5.Healey JS, Lopes RD, Granger CB, Alings M, Rivard L, McIntyre WF, et al. Apixaban for stroke prevention in subclinical atrial fibrillation. N Engl J Med 2024;390:107–17.

Among patients with subclinical atrial fibrillation ( asymptomatic episodes lasting 6 minutes to 24 hours) apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding.

6.Kalman JM, Al-Kaisey AM, Parameswaran R, Hawson J, Anderson RD, Lim M, et al. Impact of early vs. delayed atrial fibrillation catheter ablation on atrial arrhythmia recurrences. Eur Heart J 2023;44:2447–54. 

Compared with an early ablation strategy, delaying AF ablation by 12 months for antiarrhythmic drug  management did not result in reduced ablation efficacy.

7.Reddy VY, Gerstenfeld EP, Natale A, Whang W, Cuoco FA, Patel C, et al. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med 2023;389: 1660–71.

Among patients with paroxysmal atrial fibrillation receiving a catheter-based therapy, pulsed field ablation was noninferior to conventional thermal ablation with respect to freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation and with respect to device- and procedure-related serious adverse events at 1 year.

8.Sohns C, Fox H, Marrouche NF, Crijns HJGM, Costard-Jaeckle A, Bergau L, et al. Catheter ablation in end-stage heart failure with atrial fibrillation. N Engl J Med 2023; 389:1380–9.

Among patients with atrial fibrillation and end-stage heart failure, the combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone

9.Andrade JG, Deyell MW, Macle L, Steinberg JS, Glotzer TV, Hawkins NM, et al. Healthcare utilization and quality of life for atrial fibrillation burden: the CIRCA-DOSE study. Eur Heart J 2023;44:765–76.  

AF recurrence, as defined by 30 s of arrhythmia, lacks clinical relevance. AF episode durations >1 h or burdens >0.1% were associated with increased rates of healthcare utilization.

10.Pappone C, Ciconte G, Anastasia L, Gaita F, Grant E, Micaglio E, et al. Right ventricular epicardial arrhythmogenic substrate in long-QT syndrome patients at risk of sudden death. Europace 2023;25:948–55. 

This study reveals that, among high-risk LQTS patients, regions localized in the epicardium of the right ventricle harbour structural electrophysiological abnormalities. Elimination of these abnormal electrical activities successfully prevented malignant ventricular arrhythmia recurrences.