Yichao Xiao

Aims: The burden of atrial fibrillation and atrial flutter (AF/AFL) has increased, but age-specific patterns across World Bank income levels (WBILs) remain unclear. Methods and results: Using the Global Burden of Disease 2023 estimates, we assessed age- and WBIL-stratified trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for AF/AFL from 1990 to 2023, employing age–period–cohort analysis and joinpoint regression. Mortality attributable to six modifiable risk factors was quantified based on comparative risk assessment estimates. Projections of AF/AFL burden for 2024–48 were generated using Bayesian age–period–cohort models. In 2023, AF/AFL affected 58.99 million prevalent cases, 5.02 million incident cases, 376 862 deaths, and 9.26 million DALYs, with the absolute burden concentrated in adults aged ≥ 65 years. From 1990 to 2023, age-standardized prevalence (ASPR) and incidence rate (ASIR) increased, while mortality rate (ASMR) and disability-adjusted life year rate (ASDR) remained stable. High-income countries showed increases across all metrics, upper-middle-income countries had rising ASPR/ASIR and decreasing ASMR/ASDR, and lower-middle- and low-income countries showed consistent increases across all metrics. Among younger (30–44 years) and middle-aged (45–64 years) adults, all metrics increased, while in older adults, only ASPR rose. High systolic blood pressure was the leading attributable risk factor, with larger contributions from high body mass index, smoking, and alcohol use in younger and middle-aged adults. Projections indicated modest declines in ASPR, stable ASIR, and increasing ASMR/ASDR through 2048. Conclusion: Despite the concentrated burden in older adults, mortality- and disability-related burden is rising in younger and middle-aged populations, with significant variation across WBILs.

Background: The stress hyperglycemia ratio (SHR) has emerged as a potential marker for predicting cardiovascular disease (CVD) and mortality. However, its relationship with CVD and all-cause mortality in middle-aged and older Chinese populations remains unclear. Methods: This study analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including individuals aged 45 years and older. Cross-sectional analysis assessed the associations between SHR and CVD incidence, whereas longitudinal Cox regression models evaluated the relationships between SHR, CVD risk, and all-cause mortality. Restricted cubic spline analyses were employed to explore potential non-linear relationships. The predictive performance of SHR was compared with that of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c). Results: The cross-sectional analysis identified an inverse association between the SHR and CVD incidence. Longitudinal analysis indicated that SHR was independently associated with an increased risk of CVD, with a significant L-shaped relationship (non-linear P = 0.001). Threshold effect analysis identified 0.985 as the inflection point for SHR, with hazard ratios (HRs) increasing sharply below this level (HR: 0.32, 95% CI: 0.17–0.61, P = 0.001). However, no significant non-linear relationship was observed between SHR and all-cause mortality (non-linear P = 0.942). FBG, HbA1c, and SHR provided similar predictive value for all-cause mortality (area under the curve: 0.526 vs. 0.535 vs. 0.513), without significant incremental predictive value. Conclusions: The SHR is an independent predictor of CVD risk in middle-aged and older Chinese adults, with an L-shaped relationship. Future large-scale, multicenter studies are needed to validate these findings.

Helicobacter pylori (H. pylori) infection and atrial fibrillation (AF) are prevalent global health concerns that significantly impact societal and economic well-being. This study explored the potential associations between H. pylori infection and the incidence and progression of AF. Emerging research suggests that H. pylori may influence AF through various pathways, including systemic inflammation, metabolic disturbances, immune responses, and changes in the gut microbiota. These pathways provide a novel perspective on the etiology of AF, suggesting that chronic H. pylori infection could exacerbate or even initiate the arrhythmic events typical of AF. Current evidence, while preliminary, points to significant correlations, particularly through changes in markers such as C-reactive protein (CRP) and lipid metabolism, which are heightened in individuals with active H. pylori infection. However, the exact mechanisms and causal nature of this relationship remain elusive, with studies showing conflicting results. This inconsistency underscores the need for more comprehensive and rigorously designed clinical and experimental research to elucidate fully the interactions between H. pylori infection and AF. Understanding these connections is crucial for developing innovative treatments and management strategies targeting microbial influences in AF patients. Future research should focus on defining the role of H. pylori eradication in the clinical management of AF assessing its impact on disease progression and patient outcomes.

This case report presents a notable instance of subcutaneous implantable cardioverter defibrillator (S-ICD) implantation in a 9-year-old patient diagnosed with Timothy syndrome (TS), which is a rare condition characterized by mutations in the CACNA1c gene. Conventional therapies often have limited efficacy in managing TS. This case is significant, as it represents the youngest age for S-ICD implantation recorded in mainland China. While the absence of ventricular arrhythmias during hospitalization and follow-up is encouraging, it is not sufficient to conclusively establish the safety and feasibility of this intervention in young TS patients. Further research is needed to evaluate the long-term outcomes and to consider S-ICD as a potential standard treatment option for TS. Additionally, there is a need for a more detailed exploration of the molecular mechanisms underlying gene therapy and personalized interventions.

Heart failure with preserved ejection fraction (HFpEF) is a common subtype of heart failure marked by impaired left ventricular diastolic function and decreased myocardial compliance. Given the limited availability of evidence-based pharmacological treatments for HFpEF, there is a growing interest in nonpharmacological interventions as viable therapeutic alternatives. This review aims to explore the pathophysiology of HFpEF and present recent advancements in nonpharmacological management approaches, encompassing noninvasive therapies, invasive procedures and targeted treatments for comorbidities. An extensive literature review was undertaken to identify and synthesize emerging nonpharmacological treatment options for HFpEF, assessing their potential to enhance patient outcomes. Nonpharmacological strategies, such as vagus nerve stimulation, percutaneous pulmonary artery denervation, renal denervation, transcatheter insertion of atrial shunts and pericardial resection, demonstrate promising potential for alleviating HFpEF symptoms and improving patient prognosis. Moreover, addressing comorbidities, such as hypertension and diabetes, may offer additional therapeutic benefits. These cutting-edge techniques, in conjunction with well-established exercise therapies, pave the way for future research and clinical applications in the field. Nonpharmacological interventions hold promise for advancing HFpEF patient care and fostering a deeper understanding of these treatment approaches, which will facilitate new clinical applications and contribute to the development of more targeted therapies.

Pulsed field ablation with irreversible electroporation for the treatment of atrial fibrillation involves tissue-specific and non-thermal energy-induced cell necrosis, which helps avoid complications, such as pulmonary vein stenosis, atrial collateral tissue damage, and extensive atrial structural damage, often encountered with traditional thermal ablation. In existing clinical trials, pulsed field ablation has shown excellent effects on pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. Pulsed field ablation is easy, simple, and quick and can reduce iatrogenic injury. Therefore, the application of pulsed field ablation technology in the treatment of atrial fibrillation has a promising future. Notably, the adjustment of parameters in pulsed field ablation with different ablation catheter systems can strongly affect the area and depth of the necrotic myocardium, which greatly affects the likelihood of atrial fibrillation recurrence and incidence of adverse complications after ablation. In this paper, we review the mechanisms, advantages, and limitations of pulsed field ablation based on the results of a series of previous studies and provide ideas and directions for future research.