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Trials — All Articles

782 articles
Research2026 Mar 25

Atrial Fibrillation in Athletes: Mechanisms, Management, and Future Directions.

JACC. Case reports— Alameh I, Al Fout G, Ezekowitz MD, Kamareddine M

BACKGROUND: High-volume endurance training may shift exercise from cardioprotective to arrhythmogenic, increasing the risk of atrial fibrillation (AF) in healthy athletes. CASE SUMMARY: A 38-year-old marathon runner with a 15-year history of high-intensity endurance training presented with episodic palpitations and reduced athletic performance. Electrocardiogram showed paroxysmal AF; echocardiography revealed mild left atrial enlargement without structural heart disease. Symptoms worsened during the recovery phase after runs, suggesting vagally mediated AF. After unsuccessful flecainide therapy, he underwent pulmonary vein isolation. Twelve months later, he remained free of recurrent AF on Holter monitoring and successfully resumed endurance training following an 8-week recovery period. However, ongoing high-volume exercise may still carry a residual risk of arrhythmia. REVIEW SUMMARY: AF in athletes is associated with a 2- to 5-fold increased prevalence linked to atrial remodeling, autonomic imbalance, and inflammation. Rhythm control, especially catheter ablation, preserves performance and quality of life. TAKE-HOME MESSAGE: Excessive endurance training increases AF risk; early rhythm control and structured return-to-play strategies optimize outcomes.

Research2026 Feb

Breaking the Hesitation: Bromocriptine Use in Peripartum Cardiomyopathy with Preeclampsia-A Case Series.

Journal of obstetrics and gynaecology of India— Lewis PF, Rathod M, Upadhyay D

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare, potentially fatal form of systolic heart failure occurring in late pregnancy or early postpartum, typically without prior structural heart disease. In India, its incidence is estimated to be 1 in 1374 live births, with maternal mortality up to 15% in resource-limited settings. When coexisting with preeclampsia, PPCM presents diagnostic and therapeutic dilemmas. Although bromocriptine is supported by trials and European Society of Cardiology (ESC) guidelines, its use in India remains limited, especially in hypertensive pregnancies due to safety concerns. CASE PRESENTATION: We describe three antenatal patients with PPCM and severe preeclampsia managed at a tertiary referral hospital. All had moderate-to-severe left ventricular dysfunction (left ventricular ejection fraction LVEF 25-35%). One, treated without bromocriptine, had persistent dyspnoea and LVEF < 45% at two weeks postpartum. Two others received bromocriptine (2.5 mg daily); one initiated early showed full recovery (LVEF 60% by day 14), while the other, started on day 8 postpartum, showed partial recovery (LVEF 50%). DISCUSSION: The series underscores the importance of early echocardiography in distinguishing PPCM from preeclampsia-induced pulmonary oedema. It supports the "two-hit hypothesis", where preeclampsia acts as a second insult, triggering oxidative stress and formation of a cardiotoxic 16-kDa prolactin fragment. Bromocriptine, by inhibiting prolactin, may interrupt this pathogenesis. CONCLUSION: Early recognition of PPCM in preeclamptic patients and timely initiation of bromocriptine with standard therapy can improve cardiac recovery. Multidisciplinary management is key to addressing treatment hesitancy and improving maternal outcomes in Indian settings.

Research2026 Apr 01

Cardiac arrest as the initial presentation of thyrotoxicosis in a young woman.

Endocrinology, diabetes & metabolism case reports— Siqueira Tavares de Melo MH, Barnett MJL, Rego MLM, Isaacs E, Desta E et al.

SUMMARY: Thyroid storm is a life-threatening endocrine emergency characterized by severe thyrotoxicosis and multisystem decompensation. Cardiovascular involvement is common and the leading cause of mortality, most commonly presenting with atrial fibrillation or high-output heart failure. Malignant ventricular arrhythmias, however, are exceedingly rare, reported in 0.07% of hospitalizations for thyroid dysfunction and 13% of patients with thyroid storm admitted to intensive care units. We present a case of a previously healthy young woman with uncontrolled Graves' disease who developed out-of-hospital cardiac arrest due to ventricular fibrillation. Coronary angiography revealed diffuse coronary vasospasm without obstructive coronary artery disease, suggesting myocardial ischemia as the precipitating mechanism. She achieved complete neurological and hemodynamic recovery following resuscitation, initiation of antithyroid therapy, beta-blockade, corticosteroids, and restoration of euthyroidism. This case underscores the potential of thyroid storm to induce life-threatening ventricular arrhythmias through a combination of coronary vasospasm, sympathetic overactivity, and altered myocardial excitability. Recognition of thyrotoxicosis as a potential cause of cardiac arrest is crucial, particularly in patients without structural heart disease, since early diagnosis and timely treatment are key to survival and prevention of recurrence. LEARNING POINTS: Ventricular fibrillation and cardiac arrest, even in patients without structural heart disease, can be a presentation of thyroid storm. Coronary vasospasm represents a potential mechanism linking thyrotoxicosis to malignant ventricular arrhythmias. Prompt recognition and restoration of euthyroidism are essential for reversing hemodynamic instability and preventing recurrence. Nonadherence to antithyroid therapy remains a major preventable trigger of thyroid storm.

Research2026 Apr

Multicenter, randomized controlled study evaluating percutaneous and non-fluoroscopic procedure of atrial septal defects-study protocol of the PANASD randomized controlled trial.

American heart journal plus : cardiology research and practice— Chang J, Dong J, Zhang F, Wang C, Ouyang W et al.

BACKGROUND: Atrial septal defect (ASD) is one of the most common congenital heart diseases. Radiation exposure during transcatheter ASD closure poses cumulative risks for both patients and operators. We have pioneered a percutaneous and non-fluoroscopic procedure (PAN procedure) for a broad spectrum of cardiovascular interventional therapies, which eliminates the need for radiation and contrast. The PANASD trial is designed to compare PAN procedure with the traditional fluoroscopy procedure for transcatheter ASD closure. This article outlines the protocol of the study. TRIAL DESIGN: PANASD is a prospective, multicenter, randomized controlled trial enrolling approximately 660 patients for elective percutaneous ASD closure from eight participating centers in China. In this RCT, patients diagnosed with secundum ASD are randomized into two groups: one undergoing echocardiography-guided percutaneous ASD closure without the use of radiation and the other following the conventional fluoroscopy-guided procedure. The primary endpoint is the success rate of occlusion, defined as no conversion to surgery, a well-positioned occluder during hospitalization, and no major adverse events. Secondary endpoints include complication rates, costs, length of hospital stay, etc. Follow-up of the last enrolled patients will be completed in early 2026, and results will be available by late 2026. Data will be collected via an electronic data capture (EDC) system, and adverse events will be systematically recorded and monitored. Adherence to ethical principles, including informed consent and confidentiality, is maintained. CONCLUSION: This RCT protocol represents the first clinical trial to compare the safety and efficacy of percutaneous and non-fluoroscopic ASD closure with the conventional fluoroscopic method.