Bing Yang

Aims: Oesophageal fistula (OF) is a rare but life-threatening complication of atrial fibrillation (AF) ablation. Data on sex-related differences in its management and outcomes are limited. Methods and results: The PrOgnosis following oesophageal fisTula formaTion in patients undergoing cathetER ablation for AF study is a global, multicentre study evaluating the incidence, management, and outcome of OF following AF ablation. Among 553 729 patients treated across 214 centres in 35 countries between 1996 and 2022, 138 developed OF. Sex-specific data on management and outcome were available in 117 cases and are analysed herein. Females comprised 47% of the analysed cohort. Baseline characteristics, ablation modality, and use of oesophageal temperature monitoring were not different between sexes in patients developing OF. Fewer women received proton pump inhibitors post-procedure (64.8% vs. 84.7%; P = 0.017). Among patients with OF, less women developed atrio-OF (90.9% vs. 100%; P = 0.021). Oesophageal perforation and oesophageal–pericardial fistula occurred exclusively in females. The median duration until symptoms onset was 20 days for women and 16.5 days for men (P = 0.14). Echocardiography was more frequently used in women (36.4% vs. 15%; P = 0.01). Stroke was more common in women (32.7% vs. 14.8%; P = 0.040), however only before adjusting for potential cofounders. Other complications were comparable. Women underwent endoscopic therapy more often (35.8% vs. 17.7%; P = 0.034) and surgical treatment alone less frequently (28.3% vs. 51.6%; P = 0.014). Fatality rates were high and not different (63.6% in women vs. 67.2% in men; P = 0.70). Conclusion: While OF incidence for each sex could not be calculated, nearly half of all patients with OF were female. Women underwent more often endoscopic and less often surgical interventions; outcomes were comparable.

Background: The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and cardiovascular disease risk, but its impact on later coronary artery calcium (CAC) progression is unclear. This study aimed to identify DASH score trajectories from early to middle adulthood and assess their association with CAC progression in middle age, exploring the potential mediating factors. Methods: We conducted a prospective analysis of 2238 Black and White adults who were aged 18 to 30 years at CARDIA (Coronary Artery Risk Development in Young Adults) baseline and were followed from study year 20 to year 25. DASH score trajectories from early to middle adulthood were determined using latent class analysis. The primary end point was CAC progression, a validated measure of plaque progression, defined as a >2.5 square root increase in CAC score between years 20 and 25. Results: Two distinct DASH score trajectories were identified: the low‐increasing and high‐decreasing trajectories. In the fully adjusted model, participants in the high‐decreasing trajectory had a 21% lower risk of CAC progression compared with those in the low‐increasing trajectory (hazard ratio, 0.79 [95% CI, 0.65–0.98]; P =0.028). The association was partially mediated by diastolic blood pressure, insulin, uric acid, and lipid profiles. Conclusions: DASH score trajectories vary from early to middle adulthood. Maintaining high adherence to the DASH diet from early to middle adulthood is associated with reduced CAC progression in middle age, partially mediated by cardiometabolic risk factors. These findings support the importance of long‐term adherence to a healthy dietary pattern for cardiovascular disease primary prevention. REGISTRATION: URL: https://www.clinicaltrials.gov ; unique identifier: NCT00005130.

BACKGROUND: Premature atrial contractions (PACs) are independently associated with atrial fibrillation, stroke, and heart failure, yet no pharmacological therapy is approved for PAC suppression. Experimental studies have identified a functional cardiac glutamatergic system in which N-methyl-D-aspartate receptors regulate atrial electrophysiology. Preclinical studies show that pharmacological antagonism of N-methyl-D-aspartate receptors with memantine suppresses atrial arrhythmias. METHODS: We conducted an investigator-initiated, phase 2, multicenter, randomized, double-blind, placebo-controlled trial. Symptomatic adults with frequent PACs (≥1000/24 h) were randomly assigned to receive memantine or placebo for 6 weeks. The primary end point was the percentage change in mean 24-hour PAC count from baseline to the end of treatment. The primary analysis was performed in the intention-to-treat population. Prespecified secondary end points included the responder rate (≥50% PAC reduction), percentage change in nonsustained atrial tachycardia burden, and cumulative incidence of new-onset atrial fibrillation. RESULTS: Among 241 patients included in the efficacy analysis, memantine resulted in a greater reduction in PAC count than placebo (between-group difference, 47.1 percentage points; P =0.0045). The responder rate was higher with memantine than with placebo (52.4% versus 23.1%; P P =0.0043) and was associated with a lower cumulative incidence of new-onset atrial fibrillation (4.8% versus 23.9%; P <0.0001). No clinically meaningful differences were observed in electrocardiographic intervals or left ventricular function, and no drug-related serious adverse events occurred. CONCLUSIONS: In patients with frequent symptomatic PACs, memantine reduced atrial ectopy and atrial tachyarrhythmia burden and demonstrated a favorable safety profile. These findings provide proof of concept for a novel, non–ion channel–based therapeutic strategy targeting the cardiac glutamatergic system. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06501638.

The aim of this study was to investigate the associations between sleep duration, sleep disturbances and falls in different cardiovascular disease (CVD) states in a Chinese middle-aged and older adult population. This study used two waves (2011 wave1 and 2013 wave2) of data from the China Health and Retirement Longitudinal Study (CHARLS) to collect information on social, economic, and health status by tracking Chinese individuals aged 45 and above. The study used a logistic regression model to examine the association between sleep parameters and falls. Restricted cubic spline was used to analyze the association of sleep duration with falls in the overall population, and in the population with or without CVD. The overall incidence of new falls among all subjects was 18.35%. It was 24.54% in the population with CVD and 17.36% in the population without CVD. After adjusting for multiple factors, short sleep duration (less than 6 h) was significantly associated with an elevated risk of falls in total populations and with or without CVD, with OR values (95%CI) of 1.267(1.143,1.405), 1.227(1.095,1.376) and 1.442(1.130,1.841), respectively. Long sleep duration (longer than 9 h) was significantly associated with an increased risk of falls only in the CVD population, with OR values of 2.042(1.175,3.550). Sleep disturbance more than 3 days per week was significantly associated with elevated fall risk in the total population and in the population without CVD, and more than 5 days was significantly associated with elevated fall risk in the CVD population. This study reveals the association between sleep parameters and falls, particularly among patients with cardiovascular disease, where long sleep duration is associated with falls. This suggests that long sleep may be an important factor in the risk of falls in CVD patients. The online version contains supplementary material available at 10.1186/s12872-026-05663-6.

Background: Hypertension is associated with a high rate of disability and mortality and leads to a substantial socioeconomic burden. Moxibustion is an external treatment in traditional Chinese medicine that has been used to treat mild to moderate hypertension in individuals with phlegm-dampness constitution and has demonstrated acupoint specificity. However, a standard large-scale randomized controlled trial is still needed to verify its effectiveness. This study is proposed to examine the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness hypertension. Objective: The objective of this trial is to evaluate the cardio-cerebral protective clinical efficacy of moxibustion for phlegm-dampness type hypertension and to explore its acupoint specific effects. Methods: This study is a multicenter, randomized controlled trial. A total of 120 patients with mild to moderate hypertension and phlegm-dampness constitution will be recruited and randomly assigned in a 1:1 ratio to the treatment group (acupoint: Zusanli, ST36) or the control group (acupoint: Xuanzhong, GB39). All patients will receive 12 weeks of treatment and a 12-week follow-up period. The primary outcome measure is the change in morning systolic blood pressure from baseline to week 12. The secondary outcome measures include blood pressure–related indicators (morning diastolic blood pressure, average systolic blood pressure, average diastolic blood pressure, nighttime systolic blood pressure, nighttime diastolic blood pressure, and blood pressure circadian rhythm) and short-term blood pressure variability coefficient, all of which will be measured by 24-hour ambulatory blood pressure monitoring. Additionally, cardiac-related indicators measured by 24-hour Holter monitoring, metabolic disorder-related indicators, liver and kidney function indicators, transformed scores of the traditional Chinese medicine phlegm-dampness constitution scale, and the Montreal Cognitive Assessment will also be evaluated. Results: This study was registered on July 5, 2024, with the Chinese Clinical Trial Registry. Data collection began in June 2023 and ended in February 2025. Currently, data from this trial are in the collection phase, and no data analysis has been performed. As of January 2025, we have collected data from 118 patients. The results of this trial are expected to be submitted for publication in May 2026. Conclusions: This multicenter, randomized, controlled clinical trial will provide evidence on the clinical effectiveness and potential cardioprotective benefits of moxibustion performed at home as a treatment for individuals with phlegm-dampness type of hypertension. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400086582; https://www.chictr.org.cn/showproj.html?proj=211688 International Registered Report Identifier (IRRID): DERR1-10.2196/79158

Inflammation and the nervous system play pivotal roles in cardiac remodeling after myocardial infarction (MI). Recent study showed renal denervation (RDN) could reduce cardiac inflammation, however, the specific mechanism remains unclear. We firstly reanalyzed the previous heart single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics to examine the alterations in immune cell subsets following MI. Subsequently, we carried out diverse denervation procedures to explore the relationship between the nerve axis and the inflammatory response. Finally, we performed bulk RNA-seq and neurotransmitter analysis to explore the molecular mechanisms implicated in the migration of splenic myeloid cells after MI. Myeloid cells manifested the most substantial changes following MI and accumulated in the vicinity of the infarct area. The afferent renal nerve - splenic nerve axis regulates the migratory capacities of splenic myeloid cells after MI. RDN decreased the norepinephrine (NE) levels in the spleen after MI and attenuated the expression of ITGA9 on splenic myeloid cells, which impaired their interaction with VCAM-1 on cardiac endothelial cells and thereby reduced their migration to the heart. Our study highlights the crucial role of the afferent renal nerve-splenic nerve axis in regulating cardiac inflammation and provides a interventional target for improving cardiac function after myocardial ischemic injury.

Background and aims: Data on the safety of direct current cardioversion (DCCV) in patients with left atrial appendage occlusion (LAAO) devices and its impact on thromboembolic prevention are limited. This study aimed to investigate the safety and efficacy of DCCV in patients with LAAO devices. Methods: This single-center, ambispective cohort included patients undergoing one-stop procedures [LAAO combined with radiofrequency catheter ablation (RFCA)], where LAAO was performed first. DCCV was performed to restore sinus rhythm after LAAO. Patients were divided into the DCCV group and the no-DCCV group. Safety endpoints included DCCV-related death, device dislodgment, device embolization, and major bleeding events. Efficacy endpoints contained all-cause death, cardiovascular death, stroke/transient ischemic attack, and systemic embolism. Results: A total of 196 patients (age 72.5 ± 7.4 years, 51.0% male) were enrolled, with 95 patients undergoing DCCV after LAAO. No DCCV-related death, device dislodgement, or device embolism was observed. At 12 months, the safety endpoints occurred in 3.2% of the DCCV group vs. 6.9% of the no-DCCV group ( p = 0.238). Similarly, the efficacy endpoints were observed in 1.1% of the DCCV group vs. 4.0% of the no-DCCV group ( p = 0.339). By performing pre- and post-DCCV transesophageal echocardiography (TEE) in the prospective cohort, a significant increase in device diameter at 45° and 90° ( p = 0.044; 0.027), and an insignificant decline trend of peri-device leak and shoulder at 135° were noted ( p = 0.051; 0.103). Conclusions: No signal of excess risk was observed when performing DCCV in patients with LAAO devices. Tiny changes in device diameter after DCCV were noted on TEE at 45° and 90°, but these were not associated with adverse effects.