JungMin Choi

Aims: The association between socioeconomic deprivation and atrial fibrillation (AF) remains debated, with limited evidence on its interaction with genetic predisposition. We aimed to evaluate the combined effect of socioeconomic deprivation and genetic risk on incident AF. Methods and results: Participants without prior AF from the UK Biobank were included. Socioeconomic deprivation was defined as the top 5% of the Index of Multiple Deprivation (IMD). Genetic risk was assessed using a polygenic risk score (PRS) for AF. The primary outcome was incident AF. Findings were replicated in an independent South Korean cohort. Among 425 423 participants (mean age 56.5 ± 8.1 years; 45.2% male), 21 264 were in the deprived group. The deprived group was younger and had more comorbidities. Atrial fibrillation incidence was higher in the deprived vs. non-deprived group [incidence rate 5.8 vs. 4.7/1000 person-years; adjusted hazard ratio (aHR) 1.16 (95% confidence interval 1.09–1.24), P < 0.001]. Most IMD components (except housing and living environment) were linked to increased AF risk (aHR ranging from 1.13 to 1.19). Deprivation had a stronger effect in those with low genetic risk [lowest PRS tertile: aHR 1.36 (1.19–1.56)] compared with those with high genetic risk [highest PRS tertile: aHR 1.11 (1.01–1.22); interaction P = 0.0013]. Results were consistent in the Korean cohort (n = 7898). Conclusion: Socioeconomically deprived individuals have a significantly higher risk of AF, with this risk further influenced by genetic predisposition. Targeted public health policies and personalized AF screening for high-risk groups may help lessen the burden of AF and improve cardiovascular health.

Background and Aims: A recent European trial found that in frail elderly patients with atrial fibrillation (AF), switching from well-managed warfarin to direct oral anticoagulants (DOACs) was associated with higher bleeding risk. This study aimed to evaluate the safety and effectiveness of switching from warfarin to DOACs in frail elderly Asian AF patients. Methods: The Korean national claims database was used to identify AF patients aged ≥75 years who were prescribed warfarin between January 2013 and August 2015, had Hospital Frailty Risk Score ≥ 5, and experienced no major bleeding or thromboembolic events during this period. To evaluate the effect of switching from warfarin to a DOAC, a time-varying approach based on anticoagulant exposure was applied. The primary outcome was major bleeding. Secondary outcomes included thromboembolic events, net clinical outcome (NCO; composite of major bleeding and thromboembolic events), and all-cause death. Results: Among 12 461 patients, 9112 patients remained on warfarin, whereas 3349 switched to DOACs at least once. During a total follow-up of 11 842 person-years, DOAC treatment was associated with higher risks of major bleeding (hazard ratio 1.36, 95% confidence interval 1.01–1.81), thromboembolic events (1.61, 1.30–2.00), NCO (1.58, 1.29–1.94), and all-cause death (1.20, 1.02–1.42). In various subgroup analyses, DOAC treatment tended to show higher risks of all outcomes compared with warfarin treatment. Conclusions: In frail elderly Asian AF patients stably maintained on warfarin, switching to DOACs was associated with higher risks of adverse clinical events, suggesting the need for careful consideration before routine switching.

Lee KY, et al. Int J Arrhythm. 2026 ;27:e10. https://doi.org/10.18501/ija.2026.27.e10

Park J, et al. J Korean Med Sci. 2026 Oct;41:e277. https://doi.org/10.3346/jkms.2026.41.e277

Lee KY, et al. J Korean Med Sci. 2026 Sep;41:e243. https://doi.org/10.3346/jkms.2026.41.e243

Aims: To investigate the relationship between continuously monitored atrial fibrillation (AF) burden after cryoballoon ablation (CBA) and improvements in AF-related symptoms, quality of life (QoL), and AF-related healthcare resource utilization (HCRU) in early persistent AF. Methods and results: This secondary analysis of the multicentre COOL-PER trial included patients with early persistent AF who underwent CBA and continuous monitoring via an implantable loop recorder. Post-CBA AF burden was defined as the percentage of time in AF between 9- and 12-month after CBA, categorized as <0.1%, 0.1 to <10%, and ≥10%. Symptom improvement was assessed using the European Heart Rhythm Association symptom score and QoL with the SF-36 survey. AF-related HCRU was defined as rhythm control interventions after the 90-day blanking period and cardiovascular-related hospitalizations or emergency room visits. Among 130 patients (mean baseline AF burden 77 ± 34%), AF burden significantly decreased post-CBA, with 50.0% achieving <0.1%, 28.5% in 0.1 to <10%, and 21.5% ≥ 10%. Symptom improvement rate was highest in the <0.1% group (89.2%), followed by the 0.1 to <10% (78.4%) and ≥10% (46.4%) groups (P < 0.001). Significant QoL improvement was observed in the <0.1% and 0.1 to <10% groups but not in the ≥10% group. Rhythm control interventions and cardiovascular-related hospitalizations or emergency room visits were more frequent in the ≥10% group (29%, 43%) than in the 0.1 to <10% (5.4%, 22%) and <0.1% (1.5%, 7.7%) groups (both P < 0.001). Conclusion: In early persistent AF, lower AF burden 1-year post-CBA was associated with greater AF-related symptom improvement, significant QoL enhancement, and reduced HCRU during follow-up.

Background: Although early rhythm control (ERC) is effective in reducing stroke in patients with atrial fibrillation (AF), its benefits have not been well elucidated in cancer survivors. This study aimed to compare the risk of ischemic stroke between ERC and usual care in cancer survivors with AF. Methods: This nationwide observational study was conducted using the Korean National Health Insurance Service database. Patients aged ≥20 years with newly diagnosed AF between 2009 and 2018 were included. Patients who received rhythm control therapy within 1 year of AF diagnosis were defined as the ERC group, while the remaining patients were defined as usual care group. The risk of ischemic stroke in the ERC group was compared with those of the usual care group in cancer survivors (cancer diagnosis ≥5 years) and the noncancer group. Results: A total of 591 692 patients were included in the study (18 747 patients [3.2%] with cancer; mean age, 65.7±14.6 years; 53.7% men). During a mean 4‐year follow‐up, stroke occurred in 52 500 patients (1338 cancer survivors and 51 182 noncancer survivors). The ERC group showed a lower risk of stroke than the usual care group, regardless of the presence of a cancer history (adjusted hazard ratio, 0.67 [95% CI, 0.58–0.76] in cancer survivors versus 0.76 [95% CI, 0.74–0.78] in the noncancer group). Conclusions: ERC is associated with a lower risk of ischemic stroke among cancer survivors. An integrated approach that incorporates appropriate rhythm control strategies should be considered for cancer survivors with newly diagnosed AF.

Aims: Based on the diagnostic sequence in relation to stroke, a recent classification of atrial fibrillation (AF) categorizes AF into known AF (KAF) and AF detected after stroke or transient ischaemic attack (AFDAS). However, relatively little is known about AF ‘concurrently diagnosed with stroke’—perhaps the ‘grey zone’ of AF between KAF and AFDAS, which has been less characterized in terms of its resemblance to clinical characteristics and outcomes compared with AFDAS or KAF. Methods and results: Patients with AF who were admitted for acute ischaemic stroke (IS) in 2010–20 were retrospectively reviewed. Clinical characteristics and net clinical outcome (NCO)—the composite of recurrent stroke, major bleeding, hospitalization or emergency department visits for cardiovascular events, and death—were compared between AF diagnosed before stroke (prior AF) and incident AF diagnosed concurrently with IS (AFDCS). A total of 720 patients with AF and acute IS (mean age, 72.5 ± 10.1 years; 60.3% male) were included: prior AF, 62.6% (n = 451), and AFDCS, 37.4% (n = 269). Prior AF presented with more prevalent diabetes, heart failure, vascular disease, and valvular heart disease than AFDCS (all P < 0.05). The AFDCS had a significantly higher left ventricular ejection fraction and smaller left atrial diameter than prior AF. During a median follow-up of 2.0 (interquartile range 0.6–4.6) years, AFDCS was associated with a lower risk of NCO than prior AF without significant differences in the risk of recurrent stroke: adjusted hazard ratio (95% confidence interval), 0.776 (0.611–0.986), P = 0.038 for NCO and 0.784 (0.450–1.365), P = 0.389 for recurrent stroke. Conclusion: Prior AF and AFDCS have distinctive clinical profiles supporting AF is a disease of continuum according to its diagnostic vicinity to the IS. In terms of recurrent IS, AFDCS has a comparable risk with prior AF, indicating the importance of early detection and integrated management of AF for patients with IS.