Zejun Yang

Background: Despite the growing use of catheter ablation for atrial fibrillation, large‐scale studies assessing the efficacy and safety of oral anticoagulation (OAC) after ablation, particularly in patients with high stroke risk, remain limited. Methods: This prospective study enrolled consecutive patients from the China‐AF (China Atrial Fibrillation) registry between August 2011 and June 2022. Stroke risk was stratified by CHA ₂ DS ₂ ‐VA score as low (0–1), intermediate (2), or high (≥3). The study end points were thromboembolism (ischemic stroke or systemic embolism), and bleeding (International Society on Thrombosis and Hemostasis major bleeding and clinically relevant non‐major bleeding). A 6‐month landmark analysis was applied to evaluate the association of OAC with end points using incidence rates and Cox models. Results: Among 13 669 patients (median follow‐up, 4.0 years), 2637 continued and 11 032 discontinued OAC at the 6‐month landmark. OAC was not associated with reduced thromboembolism risk across low‐ (adjusted hazard ratio [aHR], 1.11 [95% CI, 0.70–1.77]; P =0.649), intermediate‐ (aHR, 0.64 [95% CI, 0.36–1.16]; P =0.141) or high‐stroke risk patients (aHR, 1.05 [95% CI, 0.74–1.48]; P =0.801). In contrast, continued OAC was associated with higher bleeding risk, including clinically relevant non‐major bleeding across stroke risk strata, and International Society on Thrombosis and Hemostasis major bleeding among high‐risk patients (aHR, 2.32 [95% CI, 1.19–4.50]; P =0.013). These results were consistent across subgroups and sensitivity analyses. Conclusions: In this large, real‐world cohort of patients with atrial fibrillation undergoing catheter ablation, continued OAC was not associated with lower thromboembolic risk, but with higher major bleeding risk among patients with CHA ₂ DS ₂ ‐VA scores ≥3. These findings support individualized post‐ablation anticoagulation strategies and warrant future investigation. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT06987825.

Aims: Optimal management of oral anticoagulation (OAC) after atrial fibrillation (AF) ablation remains uncertain. We evaluated thromboembolic and bleeding outcomes associated with OAC discontinuation vs. continuation at a clinically relevant 6-month post-ablation landmark. Methods and results: This target trial emulation used data from a multicentre prospective registry in China. Patients with CHA2DS2-VA scores ≥2, no prior thromboembolism, and no atrial arrhythmia recurrence within 6 months after ablation were classified according to OAC discontinuation or continuation at the 6-month landmark. The primary outcome was the composite of stroke, systemic embolism, and major bleeding. Inverse probability weighting was applied, with intention-to-treat as the primary analysis. Among 8339 patients (mean age 68 years; 40.5% women), 4406 discontinued and 3933 continued OAC. The risk of the primary outcome did not differ significantly between groups [weighted hazard ratio (HR) 0.93; 95% CI 0.67–1.29]. Thromboembolic risk was similarly comparable (HR 0.96; 95% CI 0.69–1.35). Clinically relevant non-major bleeding occurred less frequently after OAC discontinuation (HR 0.68; 95% CI 0.47–0.97). Findings were consistent in sensitivity analyses. Annualized thromboembolic rates after discontinuation were <1% in patients with CHA2DS2-VA scores 2–3 but 1.52% in those with scores ≥4. Conclusion: Among patients without prior thromboembolism who remained arrhythmia-free at 6 months after AF ablation, OAC discontinuation was not associated with a difference in the composite outcome of stroke, systemic embolism and major bleeding compared with OAC continuation. Residual risk remained low in patients with CHA2DS2-VA scores 2–3 but exceeded conventional thresholds in those with scores ≥4.

BACKGROUND: Observational studies have suggested that SGLT2 (sodium-glucose cotransporter 2) inhibitors are associated with a lower risk of atrial fibrillation (AF) recurrence after catheter ablation in patients with AF with concomitant diabetes, heart failure, or chronic kidney disease. However, no randomized trial to date has tested whether SGLT2 inhibitors reduce AF recurrence after ablation in patients without established indications. We therefore investigated the effect of dapagliflozin on prevention of early recurrence of AF after catheter ablation in patients without current indications for SGLT2 inhibitors. METHODS: The DARE-AF trial (Dapagliflozin on Recurrence After Catheter Ablation for Atrial Fibrillation) was a prospective, open-label, parallel-assignment randomized controlled trial that enrolled 200 patients with persistent AF between July 2024 and March 2025, scheduled to undergo a first catheter ablation procedure and without established indications for dapagliflozin (diabetes, heart failure, or chronic kidney disease). Patients were randomly assigned at a 1:1 ratio to dapagliflozin (10 mg once daily for 3 months after the ablation) or control. The primary end point was AF burden at 3 months after ablation, assessed by 7-day single-lead ECG patches. Secondary outcomes included time to events, quality of life, and improvement of atrial remodeling. RESULTS: A total of 200 patients (mean age 58.5 years, 19.5% women, 29.0% with persistent AF ≥1 year) were randomized, and 198 patients (98 in the dapagliflozin group, 100 in the control group) were included in the primary analysis. Three months after ablation, the difference in AF burden was insignificant between the dapagliflozin group and the control group (7.5±23.6% versus 8.1±25.5%; P =0.48). Atrial arrhythmia recurrence occurred in 29 patients (29.6%) in the dapagliflozin group and 28 patients (28.0%) in the control group (hazard ratio, 1.11 [95% CI, 0.66–1.86]; P =0.70). No significant between-group differences were observed in changes in quality of life or left atrial diameter. CONCLUSIONS: Three-month treatment with dapagliflozin did not reduce the early recurrence of arrhythmia after catheter ablation in patients with persistent AF. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06433479.

Background: Atrial arrhythmia recurrence after atrial fibrillation (AF) catheter ablation is conventionally assessed as a binary end point. However, the prognostic value of recurrence patterns is less studied. Methods and Results: This study included patients undergoing catheter ablation from the multicenter China Atrial Fibrillation Registry study (2011–2022). Postablation AF patterns within 1 year were categorized as nonrecurrence, paroxysmal AF recurrence, or persistent AF (PersAF) recurrence. Cardiovascular outcomes included cardiovascular death, thromboembolism, and cardiovascular hospitalization. Cox proportional models with landmark analysis were used to assess the relationship between recurrence patterns and outcomes. Sensitivity analyses were conducted using Fine‐Gray models, considering death unrelated to the outcomes as the competing risk and evaluating 2‐year recurrence patterns. Among 13 811 patients (mean age, 60.5±10.8 years; 66.1% men), those with preablation PersAF, prior stroke/transient ischemic attack/systemic embolism, and increased left atrial diameter were more likely to develop PersAF postablation. Compared with nonrecurrence, PersAF recurrence was associated with higher risks of cardiovascular death (hazard ratio [HR], 2.03 [95% CI, 1.20–3.43]; P =0.009), thromboembolism (HR, 1.50 [95% CI, 1.09–2.06]; P =0.012), and cardiovascular hospitalization (HR, 1.74 [95% CI, 1.56–1.94]; P P <0.001). Sensitivity analyses yielded consistent results. Conclusions: Postablation PersAF recurrence was associated with significantly higher risks of cardiovascular death and thromboembolism, compared with paroxysmal AF recurrence and nonrecurrence, indicating the prognostic importance of recurrence patterns. Registration: URL: www.chictr.org.cn/ ; unique identifier: ChiCTR‐OCH‐13003729.

Dendritic cells (DCs), including conventional DCs (cDCs) and plasmacytoid DCs (pDCs), serve as the sentinel cells of the immune system and are responsible for presenting antigen information. Moreover, the role of DCs derived from monocytes (moDCs) in the development of inflammation has been emphasized. Several studies have shown that the function of DCs can be influenced by gut microbes including gut bacteria and viruses. Abnormal changes/reactions in intestinal DCs are potentially associated with diseases such as inflammatory bowel disease (IBD) and intestinal tumors, allowing DCs to be a new target for the treatment of these diseases. In this review, we summarized the physiological functions of DCs in the intestinal micro-environment, their regulatory relationship with intestinal microorganisms and their regulatory mechanism in intestinal diseases.