Pub Date : 2025-07-01Epub Date: 2025-06-10DOI: 10.1016/j.pcad.2025.06.003
Muhammad Shahzeb Khan , Syed Sarmad Javaid , Robert J. Mentz , JoAnn Lindenfeld , Hau-Tieng Wu , Jürgen H. Prochaska , Jens Brock Johansen , Philipp S. Wild , Dominik Linz , Wilfried Dinh , Marat Fudim
Heart rate variability (HRV) has been reported to predict overall mortality and the risk of cardiovascular disease events in patients, including those with heart failure. However, inconsistent methods of recording and analyzing HRV parameters, along with a lack of randomized data substantiating its clinical efficacy and potential to guide treatment decisions for improved patient outcomes, have limited its use in clinical settings. With the advancements in technologies such as artificial intelligence and machine learning, and emergence of ablation procedures that can alter autonomic function, this article re-explores HRV assessment methods, their potential for clinical application, the issues encountered in using them in clinical research, and potential approaches to studying HRV in the future (Graphical Abstract).
{"title":"Heart rate variability in patients with cardiovascular diseases","authors":"Muhammad Shahzeb Khan , Syed Sarmad Javaid , Robert J. Mentz , JoAnn Lindenfeld , Hau-Tieng Wu , Jürgen H. Prochaska , Jens Brock Johansen , Philipp S. Wild , Dominik Linz , Wilfried Dinh , Marat Fudim","doi":"10.1016/j.pcad.2025.06.003","DOIUrl":"10.1016/j.pcad.2025.06.003","url":null,"abstract":"<div><div>Heart rate variability (HRV) has been reported to predict overall mortality and the risk of cardiovascular disease events in patients, including those with heart failure. However, inconsistent methods of recording and analyzing HRV parameters, along with a lack of randomized data substantiating its clinical efficacy and potential to guide treatment decisions for improved patient outcomes, have limited its use in clinical settings. With the advancements in technologies such as artificial intelligence and machine learning, and emergence of ablation procedures that can alter autonomic function, this article re-explores HRV assessment methods, their potential for clinical application, the issues encountered in using them in clinical research, and potential approaches to studying HRV in the future (Graphical Abstract).</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 67-79"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-06-18DOI: 10.1016/j.pcad.2025.06.005
Sudarshan Srivats , Fawzi Zghyer , Zaid Shahrori , Christine Albert , Sana M. Al-Khatib , Sumeet Chugh , Susan P. Etheridge , Zachary D. Goldberger , Rakesh Gopinathannair , Dhanunjaya Lakkireddy , Daniel P. Morin , Marco V. Perez , Markus Rottmann , Jacob E. Sunshine , Paul J. Wang , Mina K. Chung
Sudden cardiac death (SCD) remains a pervasive public health challenge, accounting for a significant proportion of cardiac and all-cause mortality worldwide. Despite notable advancements in cardiovascular therapies and reductions in overall cardiac mortality, survival following sudden cardiac arrest (SCA) remains dismally low, and prediction strategies remain inadequate. This comprehensive review examines the current landscape of SCD etiologies and the latest guidelines for primary and secondary prevention of SCD with implantable cardioverter defibrillators (ICDs). Particular attention is given to the limitations of left ventricular ejection fraction (LVEF) as the primary tool for risk stratification, given its low sensitivity, specificity, and limited applicability to the broader population in which most SCDs occur. Emerging risk scores and machine learning (ML) driven prediction models have begun to efficiently integrate clinical, electrical, imaging, genetic and laboratory parameters to improve SCD risk stratification. This review highlights examples of such artificial intelligence (AI) prediction models and discusses their potential role in the near-term and long-term prediction of SCD in both in-hospital and out-of-hospital settings, while emphasizing the need for external validation of such models. The review also discusses critical system-level gaps in the chain of survival from cardiac arrest, particularly the need for automated emergency medical services (EMS) activation, community responder engagement, high-quality cardiopulmonary resuscitation (CPR) and improved access to defibrillation. It explores the role of digital technologies such as wearable sensors, smartwatches, smartphone applications and implantable devices in improving real-time SCA detection and enhancing early aspects of the chain of survival from cardiac arrest. Finally, the review calls for a multidisciplinary, multi-sectoral approach including regulatory, technological, and public health stakeholders to bridge gaps in SCD prevention, detection, and response.
{"title":"Sudden cardiac arrest: Limitations in risk-stratification and treatment, and the potential for digital technologies and artificial intelligence to improve prediction and outcomes","authors":"Sudarshan Srivats , Fawzi Zghyer , Zaid Shahrori , Christine Albert , Sana M. Al-Khatib , Sumeet Chugh , Susan P. Etheridge , Zachary D. Goldberger , Rakesh Gopinathannair , Dhanunjaya Lakkireddy , Daniel P. Morin , Marco V. Perez , Markus Rottmann , Jacob E. Sunshine , Paul J. Wang , Mina K. Chung","doi":"10.1016/j.pcad.2025.06.005","DOIUrl":"10.1016/j.pcad.2025.06.005","url":null,"abstract":"<div><div>Sudden cardiac death (SCD) remains a pervasive public health challenge, accounting for a significant proportion of cardiac and all-cause mortality worldwide. Despite notable advancements in cardiovascular therapies and reductions in overall cardiac mortality, survival following sudden cardiac arrest (SCA) remains dismally low, and prediction strategies remain inadequate. This comprehensive review examines the current landscape of SCD etiologies and the latest guidelines for primary and secondary prevention of SCD with implantable cardioverter defibrillators (ICDs). Particular attention is given to the limitations of left ventricular ejection fraction (LVEF) as the primary tool for risk stratification, given its low sensitivity, specificity, and limited applicability to the broader population in which most SCDs occur. Emerging risk scores and machine learning (ML) driven prediction models have begun to efficiently integrate clinical, electrical, imaging, genetic and laboratory parameters to improve SCD risk stratification. This review highlights examples of such artificial intelligence (AI) prediction models and discusses their potential role in the near-term and long-term prediction of SCD in both in-hospital and out-of-hospital settings, while emphasizing the need for external validation of such models. The review also discusses critical system-level gaps in the chain of survival from cardiac arrest, particularly the need for automated emergency medical services (EMS) activation, community responder engagement, high-quality cardiopulmonary resuscitation (CPR) and improved access to defibrillation. It explores the role of digital technologies such as wearable sensors, smartwatches, smartphone applications and implantable devices in improving real-time SCA detection and enhancing early aspects of the chain of survival from cardiac arrest. Finally, the review calls for a multidisciplinary, multi-sectoral approach including regulatory, technological, and public health stakeholders to bridge gaps in SCD prevention, detection, and response.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 144-166"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-04-04DOI: 10.1016/j.pcad.2025.04.003
Medhat Farwati , Tolga Aksu , Enrique I. Pachon , Tomas Santillana , Carlos Thiene Pachon , Pasquale Santangeli , Jose Carlos Pachon
Cardioneuroablation (CNA) is an emerging therapy for patients with vasovagal syncope with predominant cardioinhibitory responses. The procedure targets the neuromyocardial connections localized in specific regions of the right and left atrium as well as the adjacent ganglionated plexi (GP) providing parasympathetic innervation to the sinus and atrioventricular nodes. The target regions for CNA can be determined with various techniques, which result in heterogenous procedural approaches and endpoints in different centers specialized in this procedure. In this review we summarize the rationale and details of the procedural approach for three different techniques for CNA, namely: CNA controlled by extra-cardiac vagal stimulation, CNA guided by analysis of fractionated electrograms, and an anatomical approach to CNA.
{"title":"Cardioneuroablation: Three different approaches","authors":"Medhat Farwati , Tolga Aksu , Enrique I. Pachon , Tomas Santillana , Carlos Thiene Pachon , Pasquale Santangeli , Jose Carlos Pachon","doi":"10.1016/j.pcad.2025.04.003","DOIUrl":"10.1016/j.pcad.2025.04.003","url":null,"abstract":"<div><div><span><span>Cardioneuroablation (CNA) is an emerging therapy for patients with vasovagal syncope with predominant cardioinhibitory responses. The procedure targets the neuromyocardial connections localized in specific regions of the right and left atrium<span> as well as the adjacent ganglionated plexi (GP) providing parasympathetic innervation to the sinus and </span></span>atrioventricular nodes. The target regions for CNA can be determined with various techniques, which result in heterogenous procedural approaches and endpoints in different centers specialized in this procedure. In this review we summarize the rationale and details of the procedural approach for three different techniques for CNA, namely: CNA controlled by extra-cardiac vagal stimulation, CNA guided by analysis of fractionated </span>electrograms, and an anatomical approach to CNA.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 80-89"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-07-09DOI: 10.1016/j.pcad.2025.07.001
Jacopo Marazzato , Fengwei Zou , Marco Schiavone , Vincenzo Mirco La Fazia , Giovanni Forleo , Sanghamitra Mohanty , Aung Lin , Domingo Ynoa Garcia , Andrea Natale , Xiaodong Zhang , Luigi Di Biase
Pulsed field ablation (PFA) is a novel and minimally thermal energy source that exploits the biophysics of irreversible electroporation (IRE) to cause cell death. Differently from radiofrequency ablation (RFA) where adequate catheter-tissue contact proved paramount in lesion formation, the additional role of contact force (CF) during PFA is under debate due to the inherent myocardial selectivity and the customizable nature of IRE. In fact, it is not clear whether the amount of contact exerted during PFA delivery is as pivotal in achieving optimal lesion size as during RFA. Moreover, the variety of PFA catheters and the myriads of IRE ablation settings available would further potentially limit the role of CF in this scenario. However, beyond CF, specific ablation parameters, such as the PFA dose, number of pulses, catheter tip orientation and specific PFA workflows, proved to act in synergy with CF in achieving wide and deep ablation lesions even during PFA delivery. Therefore, the aim of this systematic review is to provide a better understanding on which ablation parameters – CF included - can help to obtain effective lesion formation during PFA.
{"title":"Impact of contact force and pulsed field ablation parameters on myocardial lesion formation during pulsed field ablation: A systematic review of pre-clinical studies","authors":"Jacopo Marazzato , Fengwei Zou , Marco Schiavone , Vincenzo Mirco La Fazia , Giovanni Forleo , Sanghamitra Mohanty , Aung Lin , Domingo Ynoa Garcia , Andrea Natale , Xiaodong Zhang , Luigi Di Biase","doi":"10.1016/j.pcad.2025.07.001","DOIUrl":"10.1016/j.pcad.2025.07.001","url":null,"abstract":"<div><div>Pulsed field ablation (PFA) is a novel and minimally thermal energy source that exploits the biophysics of irreversible electroporation (IRE) to cause cell death. Differently from radiofrequency ablation (RFA) where adequate catheter-tissue contact proved paramount in lesion formation, the additional role of contact force (CF) during PFA is under debate due to the inherent myocardial selectivity and the customizable nature of IRE. In fact, it is not clear whether the amount of contact exerted during PFA delivery is as pivotal in achieving optimal lesion size as during RFA. Moreover, the variety of PFA catheters and the myriads of IRE ablation settings available would further potentially limit the role of CF in this scenario. However, beyond CF, specific ablation parameters, such as the PFA dose, number of pulses, catheter tip orientation and specific PFA workflows, proved to act in synergy with CF in achieving wide and deep ablation lesions even during PFA delivery. Therefore, the aim of this systematic review is to provide a better understanding on which ablation parameters – CF included - can help to obtain effective lesion formation during PFA.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 49-61"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-06-30DOI: 10.1016/j.pcad.2025.06.009
Sahil Bharwani , Mina K. Chung , Daniel P. Morin
Direct current cardioversion (DCCV) is a cornerstone in the management of atrial fibrillation (AF) and is the quickest way to convert AF to sinus rhythm. Overall, the procedure is effective and safe, but the efficacy of DCCV can be reduced due to modifiable and non-modifiable patient characteristics, or procedural factors. Additionally, inadequate preparation, such as a lack of QRS-synchronization or omitting preprocedural imaging of the left atrial appendage (LAA), could lead to significant harm. This manuscript discusses a brief history of electrical cardioversion, the currently available cardioverter settings/configuration with the highest success rate, the common barriers to successful cardioversion, strategies to overcome these barriers, and suggested protocols to ensure a high level of patient safety.
{"title":"Strategies for optimizing efficacy of electrical cardioversion of atrial fibrillation","authors":"Sahil Bharwani , Mina K. Chung , Daniel P. Morin","doi":"10.1016/j.pcad.2025.06.009","DOIUrl":"10.1016/j.pcad.2025.06.009","url":null,"abstract":"<div><div><span>Direct current </span>cardioversion<span><span><span> (DCCV) is a cornerstone in the management of atrial fibrillation<span> (AF) and is the quickest way to convert AF to sinus rhythm. Overall, the procedure is effective and safe, but the efficacy of DCCV can be reduced due to modifiable and non-modifiable </span></span>patient characteristics, or procedural factors. Additionally, inadequate preparation, such as a lack of QRS-synchronization or omitting preprocedural imaging of the left atrial appendage (LAA), could lead to significant harm. This manuscript discusses a brief history of electrical cardioversion, the currently available cardioverter settings/configuration with the highest success rate, the common barriers to successful cardioversion, strategies to overcome these barriers, and suggested protocols to ensure a high level of </span>patient safety.</span></div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 18-27"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-09-09DOI: 10.1016/S0033-0620(25)00121-5
{"title":"List of recent issues","authors":"","doi":"10.1016/S0033-0620(25)00121-5","DOIUrl":"10.1016/S0033-0620(25)00121-5","url":null,"abstract":"","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Page A3"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-19DOI: 10.1016/j.pcad.2025.05.007
Sara Vázquez-Calvo, Deepti Ranganathan, Atul Verma
Pulsed field ablation (PFA) represents an innovative energy delivery approach for cardiac arrhythmia treatment, characterized by a favorable safety profile and effective myocardial lesion formation. It has demonstrated high acute pulmonary vein isolation rates with a reduced incidence of injury to adjacent anatomical structures. Nonetheless, procedure-specific complications such as haemolysis, intravascular gas formation, and coronary vasospasm have been observed and warrant further evaluation. Clinical evidence supports efficacy comparable to conventional thermal ablation in terms of arrhythmia recurrence. Ongoing advancements in catheter engineering, pulse modulation, and multimodal energy strategies aim to enhance lesion durability and transmurality. These developments position PFA as a promising technology in the field of cardiac ablation.
{"title":"Pulsed field ablation: The basics relating to effectiveness, durability, and safety","authors":"Sara Vázquez-Calvo, Deepti Ranganathan, Atul Verma","doi":"10.1016/j.pcad.2025.05.007","DOIUrl":"10.1016/j.pcad.2025.05.007","url":null,"abstract":"<div><div><span>Pulsed field ablation (PFA) represents an innovative energy delivery approach for cardiac arrhythmia treatment, characterized by a favorable safety profile and effective </span>myocardial lesion<span><span> formation. It has demonstrated high acute pulmonary vein isolation<span> rates with a reduced incidence of injury to adjacent </span></span>anatomical structures<span>. Nonetheless, procedure-specific complications such as haemolysis, intravascular gas formation, and coronary vasospasm<span> have been observed and warrant further evaluation. Clinical evidence supports efficacy comparable to conventional thermal ablation in terms of arrhythmia recurrence. Ongoing advancements in catheter engineering, pulse modulation, and multimodal energy strategies aim to enhance lesion durability and transmurality. These developments position PFA as a promising technology in the field of cardiac ablation.</span></span></span></div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 38-48"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-05-14DOI: 10.1016/j.pcad.2025.05.005
Douglas Y. Mah, John K. Triedman
Pediatric patients and children and adults with congenital heart disease often will require implantation of cardiac implantable electronic devices (CIEDs) for management of a variety of cardiac rhythm pathologies. The safe and effective use of CIEDs in these patients requires an awareness of important differences between this special population and the adult populations for whom these devices were primarily developed and in whom they have been most thoroughly studied. These include issues of body size and growth, anticipated lifespan, anatomical issues related to implantation and the epidemiology of underlying rhythm issues. In this paper, we discuss these issues in the context of the current state of the art in pediatric and congenital heart disease patients with respect to implant and lead extraction strategies, physiological cardiac pacing and resynchronization, ICD indications and use of transvenous and subcutaneous devices, and the use of implantable monitoring devices.
{"title":"Cardiac implantable electronic devices in pediatric and congenital populations","authors":"Douglas Y. Mah, John K. Triedman","doi":"10.1016/j.pcad.2025.05.005","DOIUrl":"10.1016/j.pcad.2025.05.005","url":null,"abstract":"<div><div><span><span>Pediatric patients and children and adults with congenital heart disease often will require implantation of cardiac implantable electronic devices (CIEDs) for management of a variety of cardiac rhythm pathologies. The safe and effective use of CIEDs in these patients requires an awareness of important differences between this special population and the adult populations for whom these devices were primarily developed and in whom they have been most thoroughly studied. These include issues of body size and growth, anticipated lifespan, anatomical issues related to implantation and the </span>epidemiology of underlying rhythm issues. In this paper, we discuss these issues in the context of the current state of the art in </span>pediatric and congenital heart disease patients with respect to implant and lead extraction strategies, physiological cardiac pacing and resynchronization, ICD indications and use of transvenous and subcutaneous devices, and the use of implantable monitoring devices.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 121-129"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2024-11-30DOI: 10.1016/j.pcad.2024.11.003
Evan L. O'Keefe , James H. O'Keefe , Hussam Abuissa , Mark Metzinger , Ellen Murray , Grant Franco , Carl J. Lavie , William S. Harris
Objective
Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF.
Patients and methods
A PubMed search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, vagal tone. We summarized findings from randomized clinical trials (RCTs), epidemiology studies, and meta-analyses evaluating effects/associations of DHA + EPA on risk of AF. Also, vagal tone was explored as a mediator between omega-3 and risk of AF.
Results
Meta-analyses of 8 RCTs and 17 prospective cohort studies comprised of 83,112 and 54,799 individuals, respectively, investigated the link between omega-3 intake and incident AF. The RCTs reported that treatment with DHA and/or EPA was associated with a 24 % increased relative risk of AF (absolute risk 4.0 % vs 3.3 %; relative risk [RR] 1.24, 95 % confidence interval [CI] 1.11–1.38, p = 0.0002). This was dose-dependent; DHA + EPA doses of ∼1000 mg/d increased AF risk ∼12 %, whereas 1800 to 4000 mg/d increased AF risk by ∼50 %. In contrast, observational studies focused on DHA + EPA blood levels or dietary intake have generally reported that higher omega-3 levels/consumption are associated with lower AF risk. Maximal AF risk reduction.
(12 %) occurred at ∼650 mg/d of dietary DHA + EPA. Other studies have indicated that omega-3 fatty acids can dose-dependently increase vagal tone, which could explain the biphasic relationship between DHA + EPA and AF risk. Experimental studies show that low-level vagal stimulation decreases risk of AF, whereas high-level vagal stimulation increases risk of AF.
Conclusion
Higher consumption of dietary omega-3 is associated with decreased AF risk. In contrast, pharmaceutical dosing of omega-3 increases AF in a dose-dependent manner, which may be mediated by vagal tone.
{"title":"Omega-3 and Risk of atrial fibrillation: Vagally-mediated double-edged sword","authors":"Evan L. O'Keefe , James H. O'Keefe , Hussam Abuissa , Mark Metzinger , Ellen Murray , Grant Franco , Carl J. Lavie , William S. Harris","doi":"10.1016/j.pcad.2024.11.003","DOIUrl":"10.1016/j.pcad.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid<span><span> (EPA) and docosahexaenoic acid (DHA), on risk of </span>atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF.</span></div></div><div><h3>Patients and methods</h3><div><span>A PubMed<span> search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, </span></span>vagal tone<span>. We summarized findings from randomized clinical trials<span> (RCTs), epidemiology studies, and meta-analyses evaluating effects/associations of DHA + EPA on risk of AF. Also, vagal tone was explored as a mediator between omega-3 and risk of AF.</span></span></div></div><div><h3>Results</h3><div><span>Meta-analyses of 8 RCTs and 17 prospective cohort studies comprised of 83,112 and 54,799 individuals, respectively, investigated the link between omega-3 intake and incident AF. The RCTs reported that treatment with DHA and/or EPA was associated with a 24 % increased relative risk of AF (absolute risk 4.0 % vs 3.3 %; relative risk [RR] 1.24, 95 % confidence interval [CI] 1.11–1.38, </span><em>p</em><span> = 0.0002). This was dose-dependent; DHA + EPA doses of ∼1000 mg/d increased AF risk ∼12 %, whereas 1800 to 4000 mg/d increased AF risk by ∼50 %. In contrast, observational studies focused on DHA + EPA blood levels or dietary intake have generally reported that higher omega-3 levels/consumption are associated with lower AF risk. Maximal AF risk reduction.</span></div><div>(12 %) occurred at ∼650 mg/d of dietary DHA + EPA. Other studies have indicated that omega-3 fatty acids can dose-dependently increase vagal tone, which could explain the biphasic relationship between DHA + EPA and AF risk. Experimental studies show that low-level vagal stimulation decreases risk of AF, whereas high-level vagal stimulation increases risk of AF.</div></div><div><h3>Conclusion</h3><div>Higher consumption of dietary omega-3 is associated with decreased AF risk. In contrast, pharmaceutical dosing of omega-3 increases AF in a dose-dependent manner, which may be mediated by vagal tone.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 3-9"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01Epub Date: 2025-07-22DOI: 10.1016/j.pcad.2025.07.009
Maham F. Karatela, Hugh Calkins
The treatment for atrial fibrillation has evolved significantly over time. Previously, medication management was the mainstay of treatment. As we have developed more robust technologies and modalities for catheter ablation, these treatment recommendations have changed. Catheter ablation is a safe and effective strategy for treating atrial fibrillation that is now considered first-line therapy in some patient populations. In this review, we discuss historical perspectives regarding the treatment and management of atrial fibrillation. We review the literature on studies investigating catheter ablation as first-line therapy, including the impact of catheter ablation on arrhythmia recurrence, cardiovascular outcomes, and healthcare utilization. Finally, we discuss future directions for the management of atrial fibrillation as the technology for catheter ablation continues to grow and progress.
{"title":"Catheter ablation as first line therapy for atrial fibrillation","authors":"Maham F. Karatela, Hugh Calkins","doi":"10.1016/j.pcad.2025.07.009","DOIUrl":"10.1016/j.pcad.2025.07.009","url":null,"abstract":"<div><div>The treatment for atrial fibrillation has evolved significantly over time. Previously, medication management was the mainstay of treatment. As we have developed more robust technologies and modalities for catheter ablation, these treatment recommendations have changed. Catheter ablation is a safe and effective strategy for treating atrial fibrillation that is now considered first-line therapy in some patient populations. In this review, we discuss historical perspectives regarding the treatment and management of atrial fibrillation. We review the literature on studies investigating catheter ablation as first-line therapy, including the impact of catheter ablation on arrhythmia recurrence, cardiovascular outcomes, and healthcare utilization. Finally, we discuss future directions for the management of atrial fibrillation as the technology for catheter ablation continues to grow and progress.</div></div>","PeriodicalId":21156,"journal":{"name":"Progress in cardiovascular diseases","volume":"91 ","pages":"Pages 33-37"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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