Clonal hematopoiesis of indeterminate potential is a novel, nontraditional risk factor linked to coronary heart disease. DNMT3A and TET2 are the 2 most prevalent clonal hematopoiesis of indeterminate potential-associated driver genes. This study aims to evaluate their effects on plaque characteristics and prognosis in patients with ST-segment-elevation myocardial infarction.

Extending cardiovascular disease prevention beyond health care settings is needed to improve population health and to advance health equity. Furthermore, evidence-based practices in community settings leverage assets and strengths (eg, community trust, reach) of organizations and practitioners. Using the Roadmap for Leveraging Implementation Science to Achieve Cardiovascular Health Equity, we conducted a narrative review to determine the scope of studies describing implementation strategies of cardiovascular health evidence-based practices in community settings and to identify bright spots and gaps in what is known about implementing cardiovascular health evidence-based practices in community settings. Evidence for the effect of interventions delivered in community settings to improve cardiovascular health behaviors is emerging in various community settings. Evidence-based practices were identified, selected, and culturally adapted through community engagement, particularly in faith-based and social service/other settings (eg, salons/barbershops). We found several interventions and adaptations aimed at improving outcomes in groups that have historically been excluded by the health care system. The Designing for Dissemination and Sustainability approach supports consideration of contextual factors (eg, alignment of evidence-based practice with the mission, workflow, time, and priorities of the setting) in selecting and adapting evidence-based practices. Development of implementation strategies must engage those who will be asked to implement the intervention and the organization in which it will be implemented. Key research opportunities include high-quality studies that explicitly compare well-specified implementation strategies in various community settings. Taken together, there are bright spots and opportunities for enhanced impact through implementation of evidence-based practices for cardiovascular disease prevention in community settings.

Pulsed field ablation (PFA) has been developed as a largely nonthermal ablation technology with a unique biophysical profile to treat atrial fibrillation. Existing evidence has shown that PFA offers a safe and efficient atrial fibrillation ablation procedure. Among different PFA technologies, the pentaspline FARAPULSE system has been the most extensively used and investigated; however, notable variability exists in workflow, fluoroscopy time, and lesion durability. While innovations such as 3-dimensional electroanatomic mapping systems and intracardiac echocardiography can enhance procedural precision in catheter ablation, fluoroscopy remains the primary imaging modality for guiding pentaspline PFA in many electrophysiology labs worldwide. This is particularly true in centers where limitations in cost, infrastructure, or training may preclude the routine use of advanced imaging technologies. This article summarizes general practical considerations and presents a primarily fluoroscopy-based, refined workflow developed by a group of experts. The goal is to provide a procedural foundation and practical guide for using the pentaspline FARAPULSE PFA system in atrial fibrillation ablation procedures. Developing a fluoroscopy-based practical guide would: (1) Democratize access to PFA technology, enabling safe and effective implementation across a broader range of clinical settings, including those without intracardiac echocardiography or 3-dimensional mapping support; (2) Reduce procedural heterogeneity by offering reproducible best practices; (3) Facilitate meaningful intercenter comparisons of procedural efficacy and safety, aiding in the identification of optimal approaches and improving the quality of clinical data for ongoing research, registries, and real-world performance monitoring of PFA technologies; and (4) Ultimately improve patient outcomes through standardized, accessible, and evidence-based practices.

Coronary artery obstruction is a rare but devastating complication of transcatheter aortic valve replacement. Current techniques (transcatheter leaflet modification or snorkel stenting) cannot prevent obstruction in all cases.