Cardiology

Four-year ADVENT-LTO data confirm durable pulsed field ablation performance in paroxysmal AF

ADVENT-LTO followed 364 paroxysmal AF patients randomized to pulsed field or thermal ablation for about 4 years. Four-year treatment success was maintained and similar, with numerically higher success for pulsed field ablation (72.8% vs 64.3%; P = 0.12). Pulsed field ablation produced fewer repeat ablations than thermal ablation (10.4% vs 17.7%; P = 0.04). Freedom from hospital-based arrhythmia interventions and progression to persistent AF both trended in favor of pulsed field ablation. 1

Remote monitoring lowers HF hospitalization and mortality across diverse heart failure populations

This meta-analysis pooled 79 randomized trials including 31,669 heart failure patients comparing remote monitoring with usual care. Remote monitoring reduced total HF hospitalizations (incidence rate ratio 0.81; 95% CI 0.72–0.91) and first HF hospitalizations (risk ratio 0.82; 95% CI 0.76–0.88). All-cause mortality was also lower with remote monitoring (risk ratio 0.90; 95% CI 0.84–0.95). Effects were consistent across age, ejection fraction, NYHA class, sex, geography, and publication year, without significant interactions. 2

Intensive BP control reduces cardiovascular events across CKM stages 2–4 in rural China

This post hoc analysis of the China Rural Hypertension Control Project included 33,736 adults ≥40 years with hypertension and CKM stages 2–4. A comprehensive strategy targeting blood pressure <130/80 mm Hg was delivered mainly by trained nonphysician practitioners. Intensive BP control reduced major adverse cardiovascular events across CKM stages, with hazard ratios around 0.61–0.71 versus usual care. Safety outcomes included hypotension, syncope, injurious falls, and kidney events, with benefit–harm analysis indicating net clinical benefit. 3

DOACs improve survival and bleeding outcomes versus warfarin in HCM-related AF

This TriNetX cohort compared direct oral anticoagulants and vitamin K antagonists in 13,143 adults with hypertrophic cardiomyopathy and atrial fibrillation. In 2,963 matched pairs, DOACs lowered all-cause mortality (hazard ratio 0.82; 95% CI 0.73–0.93) compared with vitamin K antagonists. Major bleeding (hazard ratio 0.85; 95% CI 0.73–0.99) and intracranial hemorrhage (hazard ratio 0.54; 95% CI 0.36–0.79) were also reduced with DOACs. Ischemic stroke, stroke or systemic embolism, gastrointestinal bleeding, and all-cause hospitalizations were similar between groups. 4