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.

1.Mejia-Renteria H, Travieso A, Matias-Guiu JA, Yus M, Espejo-Paeres C, Finocchiaro F, et al. Coronary microvascular dysfunction is associated with impaired cognitive function: the cerebral-coronary connection study (C3 study). Eur Heart J 2023;44:113–25. Coronary  microcirculatory  dysfunction  is frequent in patients with coronary artery disease and correlates with cerebral small vessel  disease,  abnormal  cerebral  flow haemodynamics, and significant cognitive impairment. These findings support the hypothesis that microvascular dysfunction in the heart and the brain are part of a single  pathological  process  affecting microcirculation in patients with coronary artery disease. https://pubmed.ncbi.nlm.nih.gov/36337036/ 2. Boerhout CKM, Lee JM, de Waard GA, Mejia-Renteria H, Lee SH, Jung JH, et al. Microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry. Eur Heart J 2023; 44:2862–9. Microvascular resistance reserve seems a robust indicator of the microvascular vasodilator reserve capacity. Moreover, in line with its theoretical background, this study suggests a diagnostic advantage of microvascular resistance reserve over other indices of vasodilatory capacity in patients with hemodynamically significant epicardial coronary artery disease. https://academic.oup.com/eurheartj/article/44/30/2862/7205678 3. Dong F, Yin L, Sisakian H, Hakobyan T, Jeong LS, Joshi H, et al. Takotsubo syndrome is a coronary microvascular disease: experimental evidence. Eur Heart J 2023;44:2244–53. Abnormalities in flow regulation between the LV apex and base cause Takotsubo syndrome. When perfusion is normalized between the two regions, normal ventricular function is restored. https://academic.oup.com/eurheartj/article/44/24/2244/7160508 4. Perera D, Clayton T, O’Kane PD, Weerackody R, Ryan M, Morgan HP, et al. Percutaneous revascularization for ischemic left ventricular dysfunction. N Engl J Med 2022;387:1351–60. Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure. https://www.nejm.org/doi/10.1056/NEJMoa2206606 5. Persson J, Yan J, Angeras O, Venetsanos D, Jeppsson A, Sjögren I, et al. PCI or CABG for left main coronary artery disease: the SWEDEHEART registry. Eur Heart J 2023;44: 2833–42. In this non-randomized study, coronary artery bypass grafting in patients with left main coronary artery disease was associated with lower mortality and fewer major adverse cardiovascular and cerebrovascular events compared to PCI after multivariable adjustment for known and unknown confounders. https://academic.oup.com/eurheartj/article/44/30/2833/7191997 6. Rajkumar CA, Foley MJ, Ahmed-Jushuf F, Nowbar AN, Simader FA, Davies JR, et al. A placebo-controlled trial of percutaneous coronary intervention for stable angina. N Engl J Med 2023;389:2319–30. Among patients with stable angina who were receiving little or no antianginal medication and had objective evidence of ischemia, PCI resulted in a lower angina symptom score than a placebo procedure, indicating a better health status with respect to angina. https://www.nejm.org/doi/10.1056/NEJMoa2310610 7. Christensen DM, Schjerning AM, Smedegaard L, Charlot MG, Ravn PB, Ruwald AC, et al. Long-term mortality, cardiovascular events, and bleeding in stable patients 1 year after myocardial infarction: a Danish nationwide study. Eur Heart J 2023;44:488–98. For patients who were event-free 1 year after myocardial infarction, the long-term risks of mortality, cardiovascular events, and bleeding decreased significantly, along with an improved use of guideline-recommended treatments between 2000 and 2017. In the most recent period, 1 year after myocardial infarction, the risk of additional events was lower than previously reported. https://pubmed.ncbi.nlm.nih.gov/36433809/ 8. Stahli BE, Varbella F, Linke A, Schwarz B, Felix SB, Seiffert M, et al. Timing of complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med 2023;389: 1368–79. Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. https://www.nejm.org/doi/10.1056/NEJMoa2307823 9. Kang J, Rizas KD, Park KW, Chung J, van den Broek W, Claassens DMF, et al. Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis. Eur Heart J 2023; 44:1360–70. In this individual patient data metaanalysis, dual antiplatelet therapy-based de-escalation was associated with both decreased ischaemic and bleeding endpoints. Reduction in bleeding endpoints was more prominent for the unguided than the guided de-escalation strategy. https://academic.oup.com/eurheartj/article/44/15/1360/7072382 10. Pareek M, Kragholm KH, Kristensen AMD, Vaduganathan M, Pallisgaard JL, Byrne C, et al. Serial troponin-T and long-term outcomes in suspected acute coronary syndrome. Eur Heart J 2023;44:502–12. Individuals with suspected acute coronary syndrome and two consecutively elevated high-sensitivity troponin-T concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal high-sensitivity troponin-T concentrations, irrespective of changes between measurements. https://academic.oup.com/eurheartj/article/44/6/502/6775308

1. Rajkumar CA, Foley MJ, Ahmed-Jushuf F, Nowbar AN, Simader FA, Davies JR, et al. A placebo-controlled trial of percutaneous coronary intervention for stable angina. Among patients with stable angina who were receiving little or no antianginal medication and had objective evidence of ischemia, PCI resulted in a lower angina symptom score than a placebo procedure, indicating a better health status with respect to angina.

2. Biscaglia S, Guiducci V, Escaned J, Moreno R, Lanzilotti V, Santarelli A, et al. Complete or culprit-only PCI in older patients with myocardial infarction. N Engl J Med 2023;389: 889–98. Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemiadriven revascularization at 1 year than those who received culprit-lesion–only PCI.

3. Ali ZA, Landmesser U, Maehara A, Matsumura M, Shlofmitz RA, Guagliumi G, et al. Optical coherence tomographyguided versus angiography-guided PCI. N Engl J Med 2023;389:1466–76. Among patients undergoing PCI, OCT guidance resulted in a larger minimum stent area than angiography guidance, but there was no apparent between-group difference in the percentage of patients with targetvessel failure at 2 years.

The year in cardiovascular medicine 2022: the top 10 papers in arrhythmias.
1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
Eur Heart J 2022;43:3997–4126. https://doi.org/10.1093/ eurheartj/ehac262 This document presents an update of the 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

2. Marrouche NF, Wazni O, McGann C, Greene T, Dean JM, Dagher L, et al. Effect of MRI-guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the
DECAAF II randomized clinical trial.
JAMA 2022;327:2296–2305. https://doi.org/10.1001/jama.2022.8831
Among patients with persistent atrial fibrillation (AF), MRI-guided fibrosis ablation plus pulmonary veins isolation (PVI), compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia
recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF.

3. 3. Cerrone M, Marrón-Liñares GM, van Opbergen CJM, Costa S, Bourfiss M, Pérez-Hernández M, et al. Role of plakophilin-2 expression on exercise-related progression of arrhythmogenic right ventricular cardiomyopathy: a translational study. Eur Heart J 2022;43:1251–1264. https://
doi.org/10.1093/eurheartj/ehab772 We speculate that exercise challenges a
cardiomyocyte “desmosomal reserve” which, if impaired genetically (e.g., PKP2 loss), accelerates progression of cardiomyopathy.

1. Delgado-Lista J, Alcala-Diaz JF, Torres- Peña JD, Quintana-Navarro GM, Fuentes F, Garcia-Rios A, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet 2022;399:1876–1885. https://doi.org/10.1016/S0140-6736(22)00122-2 In secondary prevention, the Mediterranean diet was superior to the low-fat diet in preventing major cardiovascular events. Our results are relevant to clinical practice, supporting the use of the Mediterranean diet in secondary prevention.

2. Zhao B, Gan L, Graubard BI, Männistö S, Albanes D, Huang J. Associations of dietary cholesterol, Serum cholesterol, and egg consumption with overall and cause-specific mortality: systematic review and updated meta-analysis. Circulation 2022;145: 1506–1520. https://doi.org/10.1161/ CIRCULATIONAHA.121.057642.  In this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD-related mortality. Our findings support restricted consumption of dietary cholesterol as a means to improve long-term health and longevity.

The year in cardiovascular medicine 2022: The top 10 papers in acute cardiac care and ischaemic heart disease. 1. Maslove DM, Tang B, Shankar-Hari M, Lawler PR, Angus DC, Baillie JK, et al. Redefining  critical illness. Nat Med 2022;28:1141–1148. Critical illness needs to be reframed. Owing to the rapid changes and multi-organ manifestations seen in critical illness, it is likely to be more complicated and to take a correspondingly greater effort than the precedents of oncology and cardiology.