Can AI Predict AF Recurrence After Cardioversion? | JACC Baran

Can AI Predict AF Recurrence After Cardioversion? | JACC Baran

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Keisuke Usuda, MD (Massachusetts General Hospital / Broad Institute of MIT and Harvard) to discuss his JACC: Clinical Electrophysiology study, “Electrocardiogram-Based Artificial Intelligence to Predict Recurrence After Cardioversion for Newly Diagnosed Atrial Fibrillation.” Using a large electronic health record cohort of patients undergoing first-time direct current cardioversion (DCCV) for newly diagnosed atrial fibrillation, this study quantified long-term recurrence risk and evaluated whether an ECG-based AI model could improve prediction of AF recurrence. Over a median 4.4 years of follow-up, AF recurrence occurred in more than half of patients, with marked age-related differences in risk. Notably, an AI model derived from a single 12-lead ECG outperformed conventional clinical prediction models for recurrence discrimination. The episode explores how AI-driven ECG analysis may help personalize rhythm control strategies, identify patients who may benefit from intensified monitoring or early intervention, and reshape post-cardioversion management in atrial fibrillation.

Mitral Stenosis: Beyond Rheumatic Disease | JACC Baran

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD welcome Dr. Nahoko Kato, MD, PhD (Tokyo Bay Urayasu Ichikawa Medical Center) and Dr. Hiroyuki Okura, MD, PhD (Gifu University) to discuss their JACC study, “Mitral Annular Calcification-Related Mitral Stenosis: 5-Year Outcomes and Prognostic Determinants in the JAMAC Study.” Using multicenter Japanese data from the JAMAC Study, this episode explores why calcific mitral stenosis differs fundamentally from rheumatic mitral stenosis, with poorer 5-year survival and a striking burden of noncardiac death. The discussion highlights how MAC-related MS may reflect systemic degenerative and metabolic disease rather than an isolated valve problem, why mitral valve area may be more informative than transmitral gradient for risk stratification, and what future prospective studies may reveal about progression, intervention, and patient selection.

AF Ablation and the Brain: Does It Improve Blood Flow and Cognition? | JACC Baran

Hosts Mitsuaki Sawano, MD, Satoshi Shoji, MD, Nobuhiro Ikemura, MD, and Hiroyuki Sato, MD welcome Dr. Tasuku Yamamoto, MD (Cleveland Clinic) to discuss his JACC: Clinical Electrophysiology study, “Neurocognitive Function, Cerebral Blood Flow, and Hippocampal Volume After Catheter Ablation of Atrial Fibrillation.” Using detailed digital cognitive testing with CANTAB alongside brain MRI in a prospective cohort, the study explores whether AF ablation is associated with changes in cognition, cerebral blood flow, and hippocampal volume. While the primary cognitive endpoints were neutral, ablation was linked to increased cerebral blood flow and greater hippocampal volume change—both correlating with improvements in memory-related measures. This episode delves into the mechanistic implications, highlighting how AF-related cognitive decline may extend beyond overt stroke, and how rhythm control, brain perfusion, and antiarrhythmic drug exposure may collectively shape long-term neurocognitive outcomes.

Acute PE in Practice: An APAC View on the New AHA/ACC Guideline | JACC Baran

Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD, welcome Dr. Yugo Yamashita, MD (Kyoto University) to discuss the newly released 2026 AHA/ACC Guideline for Acute Pulmonary Embolism and its accompanying JACC commentary from an Asia-Pacific perspective. This special episode first breaks down the major updates in the guideline, including the new A-to-E clinical classification, outpatient management of selected low-risk patients, evolving use of advanced therapies such as mechanical thrombectomy, and practical questions around anticoagulation duration. The discussion then turns to regional realities across Asia-Pacific, highlighting differences in epidemiology, imaging practices, drug availability, thrombolytic strategies, and guideline implementation. Through this lens, the episode explores why pulmonary embolism care cannot simply be imported from Western practice, and what evidence is still needed to build more precise, regionally relevant management strategies for acute PE.

Marfan Syndrome: Timing Surgery Through Genetics | JACC Baran

Hosts Mitsuaki Sawano, MD, welcome Dr. Yuki Kawashima, MD and Dr. Ryo Inuzuka, MD (The University of Tokyo) to discuss their JACC study on how genetic variants in FBN1 can predict the timing and risk of mitral valve surgery in Marfan syndrome. Using one of the world’s largest longitudinal Marfan cohorts, the study shows that not all mutations carry equal risk: specific in-frame variants within the DNCD region are associated with earlier and higher surgical risk, while other variants follow distinct age-dependent trajectories. This episode highlights a key shift—from uniform surveillance to genotype-driven precision care, where genetics can inform who to follow more closely, and when intervention may be needed.