Ling Kuo

Lee CC, et al. Korean Circ J. 2027 ;57:e14. https://doi.org/10.4070/kcj.2025.0547

The 2026 Asia Pacific Heart Rhythm Society (APHRS) Guidelines represent the first comprehensive APHRS guidelines dedicated to the management of atrial fibrillation (AF) and comprise four parts covering epidemiology, detection/screening and integrated care; stroke prevention; rate and rhythm control; and lifestyle risk factor and comorbidity management. Part II focuses on stroke prevention in AF, integrating contemporary global evidence with data and clinical considerations specific to the Asia‐Pacific region. It provides evidence‐based and practical recommendations for stroke and bleeding risk assessment, oral anticoagulation, selection and appropriate dosing of direct oral anticoagulants, management of patients with special or complex clinical characteristics, and left atrial appendage occlusion. Particular attention is given to issues (and evidence) highly relevant to Asia‐Pacific populations, including the evolving risk of ischemic stroke, appropriate anticoagulant dosing, renal function assessment, and balancing thromboembolic and bleeding risks. These recommendations aim to support individualized clinical decision‐making, promote appropriate use of stroke‐prevention strategies, and improve outcomes for patients with AF across the Asia‐Pacific region.

Introduction: Brugada syndrome epicardial RVOT ablation reduces VF, but procedural endpoints remain debated. Automated fractionation maps are often interpreted as scattered points, which may reflect artifacts. Objectives: We propose Islands of Fractionation (IOF), a framework comparing EnSite X fractionation count settings against voltage‐defined lesion‐effect reference region. Methods: This case series included six Brugada syndrome patients undergoing epicardial substrate ablation. Mapping was performed in sinus rhythm using EnSite X with an Advisor HD Grid catheter. Automated fractionation maps were generated with the EnSite X CFE‐count algorithm using refractory settings of 14 and 20 ms. Abnormal points were defined as fractionation count ≥3; lesion‐effect reference region was defined by voltage change (pre >0.5 mV, post 2 ). The 20‐ms setting produced more compact islands with markedly reduced extraneous area (0.0–34.8 cm ² ) but lower coverage (59.9% [IQR 37.2–74.7]). In parallel, fractionation burden within the ablated region decreased substantially after ablation in both settings (median total burden reduction 86% vs 93%), supporting lesion‐effect concordance of automated fractionation metrics. Conclusion: IOF provides an island‐based framework for interpreting automated fractionation mapping and describing its spatial concordance with lesion‐effect regions. In this retrospective series, 14 ms favored broader coverage, whereas 20 ms favored greater parsimony.

Bautista JA, et al. Korean Circ J. 2025 Dec;56:e36. https://doi.org/10.4070/kcj.2025.0181