Articles and issues

Background. Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery and is associated with stroke and mortality, yet rhythm monitoring usually ends when telemetry is discontinued or the patient is discharged. We assessed how many additional cases are detected by continuous wearable electrocardiogram (ECG) patch monitoring. Methods. In this prospective cohort study, consecutive adults without previous atrial fibrillation undergoing coronary artery bypass grafting (CABG), valve surgery, or both at a tertiary heart center between March 2024 and February 2025 wore a single-lead ECG patch for 14 days, applied at the end of surgery, in addition to standard care with in-hospital telemetry, daily 12-lead ECGs, and symptom-driven assessment. The primary outcome was atrial fibrillation lasting 30 seconds or longer. Results. Of 412 enrolled patients, 398 (96.6%) had at least 72 hours of analyzable recording (mean age 66.2 ± 9.4 years; 24.6% women). Standard care detected POAF in 112 patients (28.1%), whereas the patch detected it in 151 (37.9%), identifying 39 additional patients (9.8%). In 27 of these 39 patients (69.2%), the first episode occurred after discharge, and 31 (79.5%) were asymptomatic. Episodes lasted 24 hours or longer in 6 patients, and oral anticoagulation was started in 14 (35.9%). Skin irritation occurred in 7.3% of patients. Conclusions. Extended patch monitoring detected POAF in about one in ten patients in whom standard care found none, mostly after discharge and without symptoms. Its effect on anticoagulation decisions and clinical outcomes should be evaluated in randomized trials.

Lipoprotein(a), or Lp(a), is a low-density lipoprotein-like particle in which apolipoprotein B-100 is covalently linked to apolipoprotein(a). Its plasma concentration is determined largely by variation in the LPA gene, is stable throughout adult life, and is not substantially affected by diet or exercise. Evidence from large prospective cohorts and Mendelian randomization studies supports a causal role for Lp(a) in atherosclerotic cardiovascular disease and calcific aortic valve stenosis, with risk increasing continuously across the concentration range. About one in five people worldwide has a concentration high enough to raise risk meaningfully, and levels are higher on average in people of African ancestry and lower in those of East Asian ancestry. Recent consensus statements recommend measuring Lp(a) at least once in every adult, using isoform-insensitive assays reported in molar units, and using the result to refine risk estimates and intensify management of other modifiable risk factors. No therapy has yet been approved specifically to lower Lp(a) for the prevention of cardiovascular events. Statins do not lower it, PCSK9 inhibitors reduce it modestly, and lipoprotein apheresis is reserved for selected patients with progressive disease. Antisense oligonucleotides, small interfering RNAs, and an oral inhibitor of Lp(a) assembly reduce concentrations by 65% to more than 90%, and phase 3 outcome trials will determine whether these reductions prevent events. This review summarizes the biology, epidemiology, measurement, and management of Lp(a) and discusses how clinicians can use it in practice while outcome data are awaited.