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Background and Aims The role of gender in decision-making for oral anticoagulation in patients with atrial fibrillation (AF) remains controversial. Methods The population cohort study used electronic healthcare records of 16 587 749 patients from UK primary care (2005–2020). Primary (composite of all-cause mortality, ischaemic stroke, or arterial thromboembolism) and secondary outcomes were analysed using Cox hazard ratios (HR), adjusted for age, socioeconomic status, and comorbidities. Results 78 852 patients were included with AF, aged 40–75 years, no prior stroke, and no prescription of oral anticoagulants. 28 590 (36.3%) were women, and 50 262 (63.7%) men. Median age was 65.7 years (interquartile range 58.5–70.9), with women being older and having other differences in comorbidities. During a total follow-up of 431 086 patient-years, women had a lower adjusted primary outcome rate with HR 0.89 vs. men (95% confidence interval [CI] 0.87–0.92; P <.001) and HR 0.87 after censoring for oral anticoagulation (95% CI 0.83–0.91; P <.001). This was driven by lower mortality in women (HR 0.86, 95% CI 0.83–0.89; P <.001). No difference was identified between women and men for the secondary outcomes of ischaemic stroke or arterial thromboembolism (adjusted HR 1.00, 95% CI 0.94–1.07; P =.87), any stroke or any thromboembolism (adjusted HR 1.02, 95% CI 0.96–1.07; P =.58), and incident vascular dementia (adjusted HR 1.13, 95% CI 0.97–1.32; P =.11). Clinical risk scores were only modest predictors of outcomes, with CHA2DS2-VA (ignoring gender) superior to CHA2DS2-VASc for primary outcomes in this population (receiver operating characteristic curve area 0.651 vs. 0.639; P <.001) and no interaction with gender (P =.45). Conclusions Removal of gender from clinical risk scoring could simplify the approach to which patients with AF should be offered oral anticoagulation. [ABSTRACT FROM AUTHOR]

The document titled "2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)" provides comprehensive guidelines for the management of atrial fibrillation (AF). It covers various aspects of AF, including definitions, diagnostic criteria, symptoms, patient pathways, comorbidity and risk factor management, stroke prevention, rate and rhythm control, evaluation, and dynamic reassessment. The guidelines also address specific clinical settings, such as acute coronary syndromes, stroke, pregnancy, and congenital heart disease. Additionally, it discusses screening and prevention strategies for AF. The document aims to provide evidence-based recommendations to improve the care and outcomes of patients with AF. [Extracted from the article]

Atrial fibrillation (AF) affects more than 33 million individuals worldwide1 and has a complex heritability2. We conducted the largest meta-analysis of genome-wide association studies (GWAS) for AF to date, consisting of more than half a million individuals, including 65,446 with AF. In total, we identified 97 loci significantly associated with AF, including 67 that were novel in a combined-ancestry analysis, and 3 that were novel in a European-specific analysis. We sought to identify AF-associated genes at the GWAS loci by performing RNA-sequencing and expression quantitative trait locus analyses in 101 left atrial samples, the most relevant tissue for AF. We also performed transcriptome-wide analyses that identified 57 AF-associated genes, 42 of which overlap with GWAS loci. The identified loci implicate genes enriched within cardiac developmental, electrophysiological, contractile and structural pathways. These results extend our understanding of the biological pathways underlying AF and may facilitate the development of therapeutics for AF.

Background and Aims This study aimed to evaluate clinical outcomes in patients developing post-operative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and characterize variations in oral anticoagulation (OAC) use, benefits, and complications. Methods A systematic search identified studies on new-onset POAF after CABG and OAC initiation. Outcomes included risks of thromboembolic events, bleeding, and mortality. Furthermore, a meta-analysis was conducted on these outcomes, stratified by the use or non-use of OAC. Results The identified studies were all non-randomized. Among 1 698 307 CABG patients, POAF incidence ranged from 7.9% to 37.6%. Of all POAF patients, 15.5% received OAC. Within 30 days, thromboembolic events occurred at rates of 1.0% (POAF: 0.3%; non-POAF: 0.8%) with 2.0% mortality (POAF: 1.0%; non-POAF: 0.5%). Bleeding rates were 1.1% for POAF patients and 2.7% for non-POAF patients. Over a median of 4.6 years, POAF patients had 1.73 thromboembolic events, 3.39 mortality, and 2.00 bleeding events per 100 person-years; non-POAF patients had 1.14, 2.19, and 1.60, respectively. No significant differences in thromboembolic risks [effect size −0.11 (−0.36 to 0.13)] and mortality [effect size −0.07 (−0.21 to 0.07)] were observed between OAC users and non-users. However, OAC use was associated with higher bleeding risk [effect size 0.32 (0.06–0.58)]. Conclusions In multiple timeframes following CABG, the incidence of complications in patients who develop POAF is low. The use of OAC in patients with POAF after CABG is associated with increased bleeding risk. [ABSTRACT FROM AUTHOR]

Aims Clinical concerns exist about the potential proarrhythmic effects of the sodium channel blockers (SCBs) flecainide and propafenone in patients with cardiovascular disease. Sodium channel blockers were used to deliver early rhythm control (ERC) therapy in EAST-AFNET 4. Methods and results We analysed the primary safety outcome (death, stroke, or serious adverse events related to rhythm control therapy) and primary efficacy outcome (cardiovascular death, stroke, and hospitalization for worsening of heart failure (HF) or acute coronary syndrome) during SCB intake for patients with ERC (n = 1395) in EAST-AFNET 4. The protocol discouraged flecainide and propafenone in patients with reduced left ventricular ejection fraction and suggested stopping therapy upon QRS prolongation >25% on therapy. Flecainide or propafenone was given to 689 patients [age 69 (8) years; CHA2DS2-VASc 3.2 (1); 177 with HF; 41 with prior myocardial infarction, coronary artery bypass graft, or percutaneous coronary intervention; 26 with left ventricular hypertrophy >15 mm; median therapy duration 1153 [237, 1828] days]. The primary efficacy outcome occurred less often in patients treated with SCB [3/100 (99/3316) patient-years] than in patients who never received SCB [SCBnever 4.9/100 (150/3083) patient-years, P < 0.001]. There were numerically fewer primary safety outcomes in patients receiving SCB [2.9/100 (96/3359) patient-years] than in SCBnever patients [4.2/100 (135/3220) patient-years, adjusted P = 0.015]. Sinus rhythm at 2 years was similar between groups [SCB 537/610 (88); SCBnever 472/579 (82)]. Conclusion Long-term therapy with flecainide or propafenone appeared to be safe in the EAST-AFNET 4 trial to deliver effective ERC therapy, including in selected patients with stable cardiovascular disease such as coronary artery disease and stable HF. Clinical Trial Registration ISRCTN04708680, NCT01288352, EudraCT2010-021258-20, www.easttrial.org [ABSTRACT FROM AUTHOR]

Background: In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See, patients with recent‐onset atrial fibrillation (AF) were randomized to either early or delayed cardioversion. Aim: This prespecified sub‐analysis aimed to evaluate heart rate during AF recurrences after an emergency department (ED) visit identified by an electrocardiogram (ECG)‐based handheld device. Methods: After the ED visit, included patients (n = 437) were asked to use an ECG‐based handheld device to monitor for recurrences during the 4‐week follow‐up period. 335 patients used the handheld device and were included in this analysis. Recordings from the device were collected and assessed for heart rhythm and rate. Optimal rate control was defined as a target resting heart rate of <110 beats per minute (bpm). Results: In 99 patients (29.6%, mean age 67 ± 10 years, 39.4% female, median 6 [3–12] AF recordings) a total of 314 AF recurrences (median 2 [1–3] per patient) were identified during follow‐up. The average median resting heart rate at recurrence was 100 ± 21 bpm in the delayed vs 112 ± 25 bpm in the early cardioversion group (p =.011). Optimal rate control was seen in 68.4% [21.3%–100%] and 33.3% [0%–77.5%] of recordings (p =.01), respectively. Randomization group [coefficient −12.09 (−20.55 to −3.63, p =.006) for delayed vs. early cardioversion] and heart rate on index ECG [coefficient 0.46 (0.29–0.63, p <.001) per bpm increase] were identified on multivariable analysis as factors associated with lower median heart rate during AF recurrences. Conclusion: A delayed cardioversion strategy translated into a favorable heart rate profile during AF recurrences. [ABSTRACT FROM AUTHOR]