This study aims to compare the effectiveness of using discrete heartbeats versus an entire 12-lead electrocardiogram (ECG) as the input for predicting future occurrences of arrhythmia and atrial fibrillation using deep learning models. Experiments were conducted using two types of inputs: a combination of discrete heartbeats extracted from 12-lead ECG and an entire 12-lead ECG signal of 10 s. This study utilized 326,904 ECG signals from 134,447 patients and categorized them into three groups: true–normal sinus rhythm (T-NSR), atrial fibrillation–normal sinus rhythm (AF-NSR), and clinically important arrhythmia–normal sinus rhythm (CIA-NSR). The T-NSR group comprised patients with at least three normal rhythms in a year and no atrial fibrillation or arrhythmias history. Clinically important arrhythmia included atrial fibrillation, atrial flutter, atrial premature contraction, atrial tachycardia, ventricular premature contraction, ventricular tachycardia, right and left bundle branch block, and atrioventricular block over the second degree. The AF-NSR group included normal sinus rhythm paired with atrial fibrillation or atrial flutter within 14 days, and the CIA-NSR group comprised normal sinus rhythm paired with CIA occurring within 14 days. Three deep learning models, ResNet-18, LSTM, and Transformer-based models, were utilized to distinguish T-NSR from AF-NSR and T-NSR from CIA-NSR. The experiments demonstrated the potential of using discrete heartbeats in predicting future arrhythmia and atrial fibrillation incidences extracted from 12-lead electrocardiogram (ECG) signals alone, without any additional patient information. The analysis reveals that these discrete heartbeats contain subtle patterns that deep learning models can identify. Focusing on discrete heartbeats may lead to more timely and accurate diagnoses of these conditions, improving patient outcomes and enabling automated diagnosis using ECG signals as a biomarker.

Kim Y, et al. Korean Circ J. 2027 ;57:e2. https://doi.org/10.4070/kcj.2025.0259

Sex disparities in cardiogenic shock (CS) treatment are controversial, and the prognostic implications of sex remain unclear in CS caused by acute myocardial infarction (AMI). This study aimed to evaluate prognostic effect of sex according to severity of CS in patients undergoing percutaneous coronary intervention (PCI) for AMI complicated by CS. We assessed 695 patients from 12 tertiary centers in South Korea who underwent PCI for AMI complicated by CS, and analyzed outcomes by sex (female [n=184] vs. male [n=511]). We compared a 12-month patient-oriented composite endpoint (POCE, defined as a composite of all-cause mortality, myocardial infarction, re-hospitalization due to heart failure, and repeat revascularization) between the sexes, respective of SCAI shock stage C&D or E. Propensity-score matched analysis was performed to reduce bias. We found that the female group was older and had higher vasoactive inotropic and IABP-SHOCK II scores than the male group, with findings consistent across SCAI shock stages. During the 12-month follow-up period, multivariate analysis revealed no significant differences in POCE (HR 1.01, 95% CI 0.67-1.53, p=0.963 for SCAI stage C&D, HR 1.24, 95% CI 0.84-1.84, p=0.286 for SCAI stage E) between females and males. After propensity-score matching, the incidence of POCE (HR 1.47, 95% CI 0.79-2.72, p=0.220 for SCAI stage C&D, HR 0.88, 95% CI 0.49-1.57, p=0.665 for SCAI stage E) was similar between sexes. Sex does not appear to influence the risk of 12-month POCE in patients treated with PCI for CS caused by AMI, irrespective of shock severity. ClinicalTrials.gov NCT02985008.

Recent randomized studies suggest that oral anticoagulation may be safely discontinued in carefully selected patients who maintain durable sinus rhythm (SR) after atrial fibrillation (AF) ablation. However, patients with previous drug-eluting stent (DES) implantation represent a distinct population in whom residual coronary ischemic risk persists and long-term antiplatelet therapy remains clinically relevant. The optimal antithrombotic strategy in this setting remains uncertain. The Optimal Postablation Therapy for Ischemic and Arrhythmic Risk in Atrial Fibrillation (OPTIA-AF) trial was designed to evaluate whether discontinuation of non–vitamin K antagonist oral anticoagulation (NOAC) with transition to single antiplatelet therapy is noninferior to continued NOAC therapy in patients with durable SR after AF ablation and previous DES implantation. OPTIA-AF is a prospective, multicenter, randomized controlled trial enrolling patients with nonvalvular AF who have maintained ≥12 months of documented SR after catheter ablation and are ≥12 months removed from DES implantation. Participants are randomized 1:1 to continued NOAC therapy or NOAC discontinuation with single antiplatelet therapy. Structured rhythm surveillance using electrocardiography and ambulatory monitoring is mandated throughout follow-up. The primary end point is a 24-month net clinical outcome composite of ischemic stroke, systemic embolism, myocardial infarction, definite or probable stent thrombosis, cardiovascular death, and major bleeding. Key secondary end points include individual components of the composite endpoint, clinically relevant nonmajor bleeding, AF recurrence, AF burden, arrhythmia-related hospitalization, and repeat ablation. Approximately 1000 patients will be enrolled to provide adequate power for noninferiority testing. OPTIA-AF will provide randomized evidence to inform a rhythm-guided, individualized antithrombotic strategy after AF ablation in patients with concomitant coronary artery disease and previous DES implantation.

Objectives: There is limited knowledge regarding the impact of lifestyle changes on cardiovascular events and mortality among individuals with prehypertension or prediabetes. Methods: This was a serial retrospective cohort study utilizing data from the Korean National Health Insurance Service Health Screening Cohort. The primary outcome considered in the study was major adverse cardiovascular events (MACE). Results: A higher risk of MACE was found in men with prehypertension whose unhealthy lifestyle deteriorated (hazard ratio [HR], 1.13; 95% CI, 1.04–1.23; P=0.004), those who gained weight (HR, 1.15; 95% CI, 1.03–1.28; P=0.010), and those who began smoking (HR, 1.34; 95% CI, 1.17–1.55; P<0.001). Conversely, a reduced risk of MACE was observed in men with prehypertension who improved their unhealthy lifestyle, quit smoking, reduced alcohol consumption, or increased the frequency of physical activity. In men with prediabetes, the risk of MACE was higher in those whose unhealthy lifestyle worsened (HR, 1.23; 95% CI, 1.12–1.35; P<0.001), those who gained weight (HR, 1.19; 95% CI, 1.06–1.33; P=0.003), those who started smoking (HR, 1.41; 95% CI, 1.22–1.64; P<0.001), and those who decreased their physical activity frequency (HR, 1.21; 95% CI, 1.09–1.35; P<0.001). Conclusion: Preventive lifestyle changes reduce cardiovascular events and mortality, particularly in men at risk of developing hypertension or type 2 diabetes.