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Background: Effects of intensive blood pressure (BP) control on cognitive outcomes in patients with excess orthostatic BP changes are unclear. We aimed to evaluate whether orthostatic BP changes modified the effects of BP intervention on cognitive impairment. Methods: We analyzed 8547 participants from the Systolic Blood Pressure Intervention Trial Memory and cognition IN Decreased Hypertension. Associations between orthostatic BP changes and incident cognitive outcomes were evaluated by restricted cubic spline curves based on Cox models. The interactions between orthostatic BP changes and intensive BP intervention were assessed. Results: The U‐shaped associations were observed between baseline orthostatic systolic BP changes and cognitive outcomes. However, there were insignificant interactions between either change in orthostatic systolic BP (P for interaction = 0.81) or diastolic BP (P for interaction = 0.32) and intensive BP intervention for the composite outcome of probable dementia or mild cognitive impairment (MCI). The hazard ratio of intensive versus standard target for the composite cognitive outcome was 0.82 (95% CI 0.50–1.35) in those with an orthostatic systolic BP reduction of >20 mmHg and 0.41 (95% CI 0.21–0.80) in those with an orthostatic systolic BP increase of >20 mmHg. Results were similar for probable dementia and MCI. The annual changes in global cerebral blood flow (P for interaction = 0.86) consistently favored intensive BP treatment across orthostatic systolic BP changes. Conclusion: Intensive BP control did not have a deteriorating effect on cognitive outcomes among hypertensive patients experiencing significant postural BP changes. [ABSTRACT FROM AUTHOR]

Background: Wearable devices based on the PPG algorithm can detect atrial fibrillation (AF) effectively. However, further investigation of its application on long‐term, continuous monitoring of AF burden is warranted. Method: The performance of a smartwatch with continuous photoplethysmography (PPG) and PPG‐based algorithms for AF burden estimation was evaluated in a prospective study enrolling AF patients admitted to Beijing Anzhen Hospital for catheter ablation from September to November 2022. A continuous Electrocardiograph patch (ECG) was used as the reference device to validate algorithm performance for AF detection in 30‐s intervals. Results: A total of 578669 non‐overlapping 30‐s intervals for PPG and ECG each from 245 eligible patients were generated. An interval‐level sensitivity of PPG was 96.3% (95% CI 96.2%–96.4%), and specificity was 99.5% (95% CI 99.5%–99.6%) for the estimation of AF burden. AF burden estimation by PPG was highly correlated with AF burden calculated by ECG via Pearson correlation coefficient (R2 = 0.996) with a mean difference of ‐0.59 (95% limits of agreement, ‐7.9% to 6.7%). The subgroup study showed the robust performance of the algorithm in different subgroups, including heart rate and different hours of the day. Conclusion: Our results showed the smartwatch with an algorithm‐based PPG monitor has good accuracy and stability in continuously monitoring AF burden compared with ECG patch monitors, indicating its potential for diagnosing and managing AF. [ABSTRACT FROM AUTHOR]

Background: Evidence was lacking for the early choice of radiofrequency ablation (RFA) among patients with early‐onset atrial fibrillation (AF). Hypothesis: This study aimed to explore whether earlier RFA was associated with better clinical outcomes among early‐onset AF patients. Methods: Patients, who were diagnosed with AF before 45 years and underwent their first RFA procedures at baseline of the China Atrial Fibrillation registry, were enrolled and divided into four diagnosis‐to‐ablation time (DAT) groups: DAT ≤ 1 year, 1 year < DAT ≤ 3 years, 3 years < DAT ≤ 6 years, and DAT > 6 years. Another group of nonablation patients, who were newly diagnosed with AF and younger than 45 years, were also included. Adjusted associations of groups with composite cardiovascular events (cardiovascular death, embolism, major hemorrhages, or cardiac rehospitalization) or recurrent AF were analyzed using Cox proportional hazards models. Results: Among 1694 patients who underwent their first RFA at enrollment, incidences of composite cardiovascular outcomes were increasing with extension of DAT (DAT ≤ 1 year: 6.1/100 person‐years, 1 year < DAT ≤ 3 years: 7.9/100 person‐years, 3 years < DAT ≤ 6 years: 7.6/100 person‐years, DAT > 6 years: 10.5/100 person‐years; p <.001). In comparison with DAT > 6 years group, the DAT ≤ 1 year group was associated with reduced risk of cardiovascular events (adjusted hazard ratio, HR [95% confidence interval, CI] = 0.64 [0.47–0.87], p =.005) and AF recurrence (adjusted HR [95% CI] = 0.70 [0.57–0.88], p =.002). Associations remained similar after stratified by AF types. Compared to nonablation group (n = 413), DAT ≤ 1year patients tended to show lower cardiovascular risk (adjusted HR [95% CI] = 0.78 [0.58–1.05], p =.099) and lower risk of recurrent AF (adjusted HR [95% CI] = 0.46 [0.38–0.55], p <.001). Conclusions: A shorter DAT was associated with a lower risk of cardiovascular events and recurrent AF for early‐onset AF patients. [ABSTRACT FROM AUTHOR]

Background: Cancer has become significant comorbidity in patients with atrial fibrillation (AF). However, little is known about the efficacy and safety of AF ablation, the first‐line rhythm control strategy, in patients with cancer. This study aims to evaluate the incidence and risk of AF recurrence and safety endpoints in patients with cancer compared to the non‐cancer group after ablation. Methods: From August 2011 to December 2020, we consecutively enrolled cancer patients in the China‐AF cohort. We used propensity score matching (1:3) to select the control group and assessed the risk of AF recurrence and adverse events after ablation in cancer patients using a multivariable Fine and Gray competing risk model. Results: A total of 203 patients with cancer were enrolled and 21 of them were active cancer, with a median follow‐up of 12.3 months. The cumulative incidence of AF recurrence was comparable between patients with and without cancer (43.8% vs. 51.1%; p =.88). No difference in the risk of AF recurrence, thromboembolism, major bleeding, and mortality was observed after adjusting confounders. Active cancer was not associated with an increased risk of AF recurrence compared to the stable disease (SHR = 1.32; 95% CI 0.72–2.43; p =.46). Cancer was associated with a low risk of cardiovascular hospitalization (SHR, 0.54; 95% CI, 0.36–0.81; p =.01). Subgroup analysis found that hematological malignancy was associated with a high risk of AF recurrence (SHR, 5.68; 95% CI, 3.00–10.8; p <.001). Conclusions: This study suggests that catheter ablation could be feasible for rhythm control of AF patients with concomitant cancer. [ABSTRACT FROM AUTHOR]

Summary: Alginate‐based encapsulation is an effective probiotics delivery system in the intestine. However, due to calcium ions and gastric juice damaging cell wall/membrane integrity during freeze‐drying and gastrointestinal ingestion, lots of cell lose their viability. This study, taking Lactiplantibacillus plantarum grx16 as an example, indicated that co‐encapsulation of cryoprotectants and porous starch within calcium alginate capsules (CAC) could combinedly improve the viability of probiotics encapsulated. Compared with calcium alginate‐protectant capsule (CAC‐Pro) (50.67%), the combination of porous starch increased the encapsulation rate of PS0.8‐CAC‐Pro to 82.68%. Meanwhile, the death rate constants of PS0.8‐CAC‐Pro decreased by 31.3% (−20 °C), 13.5% (4 °C) and 7.5% (25 °C), respectively. The survival rate of PS0.8‐CAC‐Pro was 81.94% after continuous simulated gastrointestinal digestion, which was significantly higher than that of CACs (69.46%) and CAC‐Pro (76.92%). This study provided an effective approach for modifying alginate capsule to reduce the loss of probiotics viability. [ABSTRACT FROM AUTHOR]

The incidence of silent cerebral emboli (SCE) associated with atrial fibrillation catheter ablation (AFCA) is much higher than that of stroke/transient ischemic attack (TIA). Interventional electrophysiologists have been increasingly alerted to asymptomatic cerebral infarction over the years. Plentiful studies revealed that diagnostic definitions, detection modalities, energy sources, ablation strategies, perioperative anticoagulation regimens, and patient‐related factors were associated with the risk of AFCA‐associated SCE. Studies related to non‐interventional procedures found that SCE may prompt stroke, cognitive decline, and dementia later in life, suggesting a possible role of AFCA‐associated SCE in the cognitive function of patients with AF. However, there is no consistent evidence for this view to date. Given that the majority of patients with AF being elderly and the increased risk of cognitive impairment in AF itself, efforts should be made to minimize the occurrence of AFCA‐associated SCE. [ABSTRACT FROM AUTHOR]

Aims: To perform a meta‐analysis to assess the effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) on major coronary events, including myocardial infarction (MI), unstable angina and coronary revascularization, in patients with type 2 diabetes mellitus (T2DM). Materials and methods: We systematically searched the PubMed, CENTRAL, EMBASE and clinicaltrial.gov databases to seek eligible studies with a cardiovascular endpoint comparing GLP‐1RAs with a placebo in T2DM patients. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated for the outcomes. Results: Nine studies, with a total of 64 236 patients, were included. GLP‐1RA treatment reduced fatal and nonfatal MI by 8% (OR 0.92, 95% CI 0.86–0.99; P = 0.02, I2 = 39%). The reduction reached 15% in human‐based GLP‐1RA‐treated patients. Similarly, once‐weekly GLP‐1RA treatment reduced the risk of MI by 13%. In contrast, GLP‐1RA treatment did not reduce the risk of hospitalization for unstable angina (OR 1.11, 95% CI 0.97–1.28; P = 0.13, I2 = 21%). GLP‐1RAs exhibited a tendency to lower the risk of coronary revascularization (OR 0.95, 95% CI 0.89–1.02; P = 0.15, I2 = 22%), but without statistical significance. Human‐based GLP‐1RAs decreased the risk by 11%. Conclusions: In high‐risk patients with T2DM, GLP‐1RAs were associated with a decrease in MI, especially the human‐based and once‐weekly GLP‐1RAs. No benefit was seen for hospitalization for unstable angina or coronary revascularization. Further research is urgently needed to ascertain improvements in coronary events. [ABSTRACT FROM AUTHOR]

BACKGROUND: Plant‐based foods are frequently heterogenous systems, containing multiple starch fractions with distinct digestion rate constants. An unbiased determination of the number and digestion pattern of these fractions is a prerequisite for understanding the digestive characteristics of food. RESULTS: A non‐linear least‐squares procedure based on a conditional selection of simple first‐order kinetics or a combination of parallel and sequential kinetics models was developed. The procedure gave robust results fitting manually generated data, and was applied to in vitro experimental digestion data of retrograded rice starches. By correlating fitting parameters with starch structural parameters, it showed that rice starches with a lower amylose content, longer amylose chains, and amylopectin intermediate chains had more digestible starch fractions after long‐term retrogradation. CONCLUSION: This procedure enables the structural basis of starch digestibility and the development of food products with slow starch digestibility to be better understood. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Different from alumina, magnesium oxide is seldom used in the synthesis of layered double hydroxide. In this work, MgAl layered double hydroxide with hierarchical structure was synthesized by using porous MgO as precursor via a facile in situ reaction at room temperature. And no chemical reagents are needed to provide an alkaline environment that allows precipitation to form during the synthesis process. Crystal structure, morphology, functional group, and surface features of the porous MgO precursor, the synthesized layered double hydroxide and its calcined product were characterized by X‐ray diffraction, Fourier transform infrared techniques. The results demonstrate that the synthesized layered double hydroxide is a pure phase and composed of nanosheets. Moreover, the synthesized layered double hydroxide inherits the morphology of the porous MgO precursor and forms a hierarchical structure. This structure has a large specific surface area (249 m2 g−1) to increase the adsorption properties. Adsorption experimental results show that the maximum adsorption capacities of Congo red and Cr(VI) ions over the synthesized layered double hydroxide were 847.5 and 103.7 mg g−1, respectively. The adsorption process follows the Langmuir and pseudo‐second equation. Both adsorption processes were found to be spontaneous and endothermic. [ABSTRACT FROM AUTHOR]

Background: Lambl's excrescences (LEs) are excrescences with an extremely low incidence, mainly ultrasound diagnosed. Increasingly, LEs are detected by transesophageal echocardiography before catheter ablation, which raises safety concerns on whether LEs were associated with an embolism event during or after ablation, but clinical data are still lacking. Methods and Results: We consecutively recruited 8081 patients with atrial fibrillation who underwent radiofrequency catheter ablation in Beijing Anzhen Hospital from Jan 1, 2017 to Dec 31, 2019. Total 21 patients (0.3%) were diagnosed as LEs with an average age of 70.8 ± 8.9 years, and 38.1% were male. Persistent atrial fibrillation (PeAF) and paroxysmal atrial fibrillation (PAF) accounted for 57.1% (12 cases) and 42.9% (nine cases), respectively. LEs were mostly frequently observed on the aortic valve (18 cases, 75%) and mitral valve (six cases, 25%). Precisely, the noncoronary cusp is ranked first in terms of the LEs presence (seven cases, 29.2%), followed by the right coronary cusp (six cases, 25.0%), the left coronary cusp (five cases, 20.8%), the anterior mitral valve (four cases, 16.7%), and the posterior mitral valve (two cases, 8.3%). During the ablation for LEs patients, the average procedure time was 96.0 ± 22.4 min; the average fluoroscopy time was 4.2 ± 0.8 min; the average total ablation time was 20.6 ± 5.6 min; and the mean hospital stay was 3.3 ± 0.6 days. No patients suffered from serious complications during the procedure. Furthermore, no cardiovascular event was observed during a follow‐up of 19.1 ± 11.8 months. Conclusions: There was no clear association between LEs with intraoperative embolism events or cardiovascular events during the follow‐up period. [ABSTRACT FROM AUTHOR]

Introduction: Linear ablation in addition to pulmonary vein antrum isolation (PVAI) has failed to improve the success rate for persistent atrial fibrillation (PeAF), due to incomplete block of ablation lines, especially in the mitral isthmus (MI). Methods and Results: The study enrolled 191 patients (66 in group 1 and 125 in group 2). In group 1, ethanol infusion into the vein of Marshall was first performed, followed by radiofrequency (RF) applications targeting bilateral PVAI and bidirectional block in the roofline, cavotricuspid isthmus, and MI. In group 2, PVAI and the three linear ablations were completed using only RF energy. MI block was achieved in 63 (95.5%) and 101 (80.8%) patients in groups 1 and 2, respectively (p =.006). Patients in group 1 had shorter ablation time for left pulmonary vein antrum (8.15 vs. 12.59 min, p <.001) and MI (7.0 vs. 11.8 min, p <.001) and required less cardioversion (50 [78.5%] vs. 113 [90.4%], p =.007). During the 12‐month follow‐up, 58 (87.9%) patients were free from atrial fibrillation/atrial tachycardia in group 1 compared with 81 (64.8%) in group 2 (p <.001). In multivariate cox regression, the "upgraded 2C3L" procedure is associated with a lower recurrence rate (hazard ratio = 0.27, 95% confidence interval = 0.12–0.59). Conclusion: Compared with the conventional "2C3L" approach, the "upgraded 2C3L" approach has higher effectiveness for ablation of PeAF. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation of perimitral atrial tachycardia (PMAT) is challenging. Epicardial conduction of the Marshall bundle (MB) across the mitral isthmus (MI) remains an important cause of recurrent tachycardia. The role of ethanol infusion into the vein of Marshall (EI‐VOM) for PMAT has not been fully elucidated. Methods: The study enrolled 28 consecutive patients with recurrent PMAT after atrial fibrillation (AF) ablation. Conventional PMAT (group 1, n = 15) and MB‐related PMAT (group 2, n = 13) were diagnosed by detailed activation mapping and entrainment mapping. VOM venography and EI‐VOM were first performed, and additional ablation was performed if necessary. Results: The VOM was accessible in 24 (85.7%) patients (12 [80%] in group 1 and 12 [92.3%] in group 2). Patients with MB‐related PMAT were more responsive to EI‐VOM (as shown by PMAT termination or tachycardia cycle length prolongation) (92.4% vs 53.3%, P =.038). In the 16 patients requiring additional ablation after EI‐VOM, all residual MI conduction gaps were located on the annular side of the MI. At the end of the procedure, MI bidirectional block was achieved in 14 (93.3%) patients in group 1 and in 12 (92.3%) patients in group 2 (P = 1.000). After a mean follow‐up of 7.5 ± 3.1 months, three (10.7%) patients had recurrent AT. Conclusions: EI‐VOM is feasible and effective in the treatment of PMAT after AF ablation, especially in patients with MB‐related PMAT. [ABSTRACT FROM AUTHOR]

Background: To evaluate the impact of family history of atrial fibrillation (FAF) on postablation atrial tachyarrhythmia (AT) recurrence. Methods: All the 8198 patients undergoing initial AF ablation registered in the Chinese Atrial Fibrillation Registry study were analyzed. FAF was defined as having first‐degree relatives diagnosed as AF at age 65 years or younger, and before the time the case in this study was diagnosed. Cox proportional hazards models were used to evaluate the impact of FAF on postablation AT recurrence. Age, sex, body mass index, AF type, history of congestive heart failure, hypertension, diabetes mellitus, prior stroke/transient ischemic attack/systemic embolism, vascular diseases, use of contact force‐sensing catheter, and completion of high school were adjusted. The definition of AT recurrence was any documented AF, atrial flutter, or AT lasting more than or equal to 30 s after 3 months blanking period. Results: After a mean follow‐up of 26.2 ± 19.6 months, 318 out of the 645 patients (49.3%) with FAF and 3339 out of the 7553 patients (44.2%) without FAF experienced AT recurrence, corresponding to annual recurrence rates of 22.8% and 20.2%, respectively. Patients with FAF had a significant higher risk of AT recurrence (adjusted hazard ratio 1.129, 95% confidence interval 1.005–1.267) in multivariable analysis. Moreover, FAF had a significant higher impact on AT recurrence in the subgroup of patients diagnosed with AF at age 50 years or younger (p for interaction =.036). Conclusion: FAF is a risk factor for postablation AT recurrence. This is especially true in those with AF diagnosed at 50 years or younger. [ABSTRACT FROM AUTHOR]

Background: Existing data on the effectiveness and safety of atrial fibrillation (AF) ablation in females are limited to studies of small sample size, lacking longer term follow‐up or adjustment for potential confounders. Methods: A total of 6421 patients (2072 females) undergoing a first AF ablation procedure after enrollment in the Chinese Atrial Fibrillation Registry (China‐AF) study between August 2011 and December 2017 were analyzed. We evaluated the effectiveness (recurrence of documented [symptomatic or not] atrial tachyarrhythmia (AT)) and the safety (incidence of procedure‐related complications) of AF ablation in female patients compared to male patients. Sensitivity analyses based on routine data were also utilized to avoid potential sex differences in reporting of AF symptoms. Results: Females were about 5 years older than males at the time of ablation (mean age 63.4 ± 9.5 vs 58.3 ± 10.8, P <.0001). A higher proportion of female patients had paroxysmal AF (74.3% vs 56.7%, P <.0001), hypertension (69.7% vs 61.3%, P <.0001), and hyperlipidemia (57.2% vs 52.9%, P =.001). Female sex was found to be an independent risk factor of AT recurrence in multivariate analyses (HR = 1.26, 95% CI 1.15‐1.38, P <.0001). These findings were confirmed in sensitivity analyses using only Holter data. Female sex was also associated with a higher risk of periprocedural complications after adjustment for baseline variables (OR = 1.41, 95% CI 1.03‐1.94, P =.03). Conclusions: Female sex is an independent risk factor of AT recurrence and periprocedural complications after AF ablation. [ABSTRACT FROM AUTHOR]

Background Cryoballoon (CB) ablation of pulmonary vein ostia often induces a vagal response. This prospective study was designed to assess the effectiveness of prophylactic intravenous administration of atropine on hemodynamic impairment induced by CB ablation in patients with atrial fibrillation. Methods Twenty-five patients with paroxysmal atrial fibrillation undergoing CB ablation were prospectively enrolled and assigned to one of two groups. First 12 patients (trial group) were administered 1 mg of atropine before deflation of the CB, while the following 13 patients (control group) were given atropine only after the onset of the hemodynamic variation (decrease in heart rate and/or blood pressure). Treatment was considered effective when the hemodynamic variations were restored. Results In the trial group, three patients with transient hypotension did not require supportive care throughout the procedures, and one patient with hypotension required supportive care. In the control group, hypotension, bradycardia, and mixed bradycardia with hypotension requiring supportive care occurred in six, three, and three patients, respectively. Overall, the rate of marked vagal responses was significantly lower when prophylactic atropine was administrated (4/12 patients vs 12/13 patients, respectively; P < 0.01). Conclusions Atropine is significantly effective in the prevention of all types of vasovagal responses induced by CB ablation in patients with atrial fibrillation. [ABSTRACT FROM AUTHOR]

Flower-like hydroxyapatite ( HA) was prepared by a solvothermal method using calcined eggshells as calcium source and hydrogen peroxide/ N, N-dimethylformamide ( DMF) as solvent. The products are characterized by X-ray diffraction ( XRD), Fourier transform infrared spectroscopy ( FTIR), and Scanning electron microscopy ( SEM). All the above-mentioned instrumental analysis such as XRD and FT-IR showed the purity of HA. The SEM indicates that the as-obtained flower-like HA are composed of microsheets. These nanosheets interleaved each other to form the uniform flower-like morphology. The influence of precipitation temperature and ratio of hydrogen peroxide to DMF were systematically investigated by SEM analysis. [ABSTRACT FROM AUTHOR]

Background: The association between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and atrial fibrillation (AF) recurrence after catheter ablation among patients with diabetes and AF remains unclear., Methods and Results: Patients with AF undergoing initial catheter ablation with a history of diabetes from the China AF registry were included. Patients using SGLT2i were identified and matched by propensity score with non-SGLT2i patients in a 1:3 ratio. The main outcome was AF recurrence during the 18-month follow-up. A total of 138 patients with diabetes with SGLT2i therapy and 387 without SGLT2i were analyzed. AF recurrence occurred in 37 patients (26.8%) in the SGLT2i group and 152 patients (39.3%) in the non-SGLT2i group during a total of 593.3 person-years follow-up. The SGLT2i group was associated with lower AF recurrence compared with the non-SGLT2i group (hazard ratio, 0.63 [95% CI, 0.44-0.90], P =0.007). A total of 4 studies were analyzed in our meta-analysis demonstrating that SGLT2i was associated with lower AF recurrence after catheter ablation (odds ratio, 0.61 [95% CI, 0.54-0.69]; P <0.001, I 2 =0.0%)., Conclusions: Our prospective study coupled with a meta-analysis demonstrated a lower risk of AF recurrence with the use of SGLT2i among patients with diabetes after AF ablation.

Background The knowledge gap regarding whether the correlation between atrial fibrillation (AF) and dementia in observational studies is causation or driven by other shared risk factors remains substantially unfilled. Methods and Results We performed a comprehensive 2-sample Mendelian randomization study to evaluate the causal effect of AF on overall dementia and its subtypes, including vascular dementia, Alzheimer dementia, Lewy body dementia, and frontotemporal dementia. The primary results in inverse variance-weighted analyses were further validated by various Mendelian randomization sensitivity analyses. Additionally, we conducted multivariable Mendelian randomization to examine 10 candidate mediators of the causal association of AF and dementia. Genetic predisposition to AF was modestly associated with an increased risk of overall dementia (odds ratio, 1.140 [95% CI, 1.023-1.271]; P =0.018) and strongly associated with vascular dementia (odds ratio, 1.350 [95% CI, 1.076-1.695]; P =0.010). Genetically predicted AF indicated neutral effects on Alzheimer dementia, Lewy body dementia, and frontotemporal dementia. In multivariable Mendelian randomization analysis, the total effect of AF on overall dementia was remarkably attenuated by adjusting for genetic effect for ischemic stroke (odds ratio, 1.068 [95% CI, 0.953-1.197]; P =0.259) and low cardiac output (odds ratio, 1.046 [95% CI, 0.926-1.181]; P =0.475), indicating that the causal association of genetically predicted AF with dementia was potentially mediated by ischemic stroke and low cardiac output. The causal effect of genetically predicted AF on dementia was independent of cerebral small-vessel disease and brain volume phenotypes. Conclusions Our findings provided novel evidence supporting the causal effect of genetically predicted AF on dementia mediated by ischemic stroke and low cardiac output. Future clinical trials are warranted to evaluate the potential role of appropriate AF management in dementia prevention.