The prognostic utility of quantitative positron emission tomography (PET) with myocardial blood flow (MBF) measurements in patients with prior coronary artery bypass grafting remains unestablished. We evaluated PET-derived myocardial flow reserve (MFR) and coronary vascular resistance (CVR) for risk stratification in coronary artery bypass grafting patients.

The current study aims to describe outcomes after transcatheter valve replacement in adults with congenital heart disease.

The optimal antithrombotic treatment following transcatheter left atrial appendage closure (LAAC) remains to be determined. The objective of this trial was to compare anticoagulation and antiplatelet therapy for preventing device-related thrombosis (DRT) following LAAC.

Background: Impaired flow following percutaneous coronary intervention (PCI) is a known predictor of adverse outcomes. The pullback pressure gradient (PPG) is a novel physiological metric that differentiates focal from diffuse disease and enables prediction of post-PCI fractional flow reserve (FFR). This post-hoc analysis of the PPG Global (NCT04789317) study aimed to evaluate the prognostic performance of a PPG model for predicting post-PCI FFR and to determine whether the predicted physiological outcome is associated with adverse events following PCI. Methods: Prospective and multicenter study including patients with hemodynamically significant coronary artery disease (CAD) undergoing PCI. A prediction model based on FFR and PPG was used to estimate post-PCI FFR. Based on the predicted values, vessels were classified as having either optimal or suboptimal post-PCI physiology. The primary endpoint was target vessel failure (TVF) at 1 year. TVF was defined as a composite of cardiac death, target-vessel myocardial infarction (MI), and ischemia-driven target vessel revascularization. Results: A total of 855 patients (890 vessels) were analyzed. The mean difference between predicted and measured post-PCI FFR was 0.001 (limits of agreement -0.10 to 0.10). There was a strong correlation between predicted and measured delta FFR (r = 0.92; 95% CI: 0.91-0.93; p < 0.001). Vessels with predicted suboptimal post-PCI physiology had a significantly higher incidence of TVF (adjusted hazard ratio [HR]: 1.97; 95% CI: 1.24-3.15; p = 0.004). Predicted suboptimal physiology was independently associated with adverse clinical outcomes. Conclusions: PPG-predicted post-PCI physiology was associated with TVF at one year. These findings extend the role of coronary physiology beyond diagnostic assessment to include risk stratification and outcome prediction following PCI.

There is a paucity of data regarding the longer-term durability of transcatheter heart valves. This analysis aimed to describe the 5-year clinical outcomes and valve durability for patients treated with the Portico transcatheter heart valves across 3 studies harmonized in their prospective enrollment, inclusion/exclusion criteria, centralized independent core laboratory echocardiographic analysis, and independent clinical events committee adjudication.

Pulsed field ablation (PFA) has been available in Europe since 2021. In the United States, PFA became commercially available in 2024, and practice patterns are expected to differ from those in Europe. The objective of this study was to describe acute procedural efficiency and safety outcomes, clinical workflow patterns, and the physician learning curve associated with PFA for paroxysmal and nonparoxysmal atrial fibrillation in the first US real-world registry.

Invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are common procedures for the diagnosis and treatment of coronary artery disease (CAD). These procedures are typically performed within the parameters of insurance coverage, but little is known about how insurance policies align with guidelines and landmark randomized clinical trials.

Developed by the American Heart Association, these Guidelines represent the first comprehensive update of education recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these are guidelines for the design and delivery of resuscitation training for health care professionals and lay rescuers. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include the use of cardiopulmonary resuscitation feedback devices in training, rapid-cycle deliberate practice, teamwork and leadership training, manikin fidelity, gamified learning, virtual and augmented reality, use of cognitive aids, stepwise training, blended learning, scripted debriefing, instructor training, alternative objects for lay rescuer chest compression training, and special considerations for training in the management of opioid overdose. How certain personal considerations may influence the overall impact of education are also reviewed, including disparities accordingly related to gender, race, socioeconomic status, and language; the impact of training for school children; and factors that act as barriers or facilitators to lay rescuer willingness to perform cardiopulmonary resuscitation. We conclude with a summary of current knowledge gaps in resuscitation education science and a discussion of future directions for optimizing the impact of resuscitation training programs.

Cardiac arrest is common and deadly, affecting up to 700 000 people in the United States annually. Advanced cardiac life support measures are commonly employed to improve outcomes. This 2025 guideline on adult post-cardiac arrest care from the American Heart Association summarizes the most recent published evidence for and recommendations on several important areas of post-cardiac arrest management. Based on structured evidence reviews, guidelines are provided for initial blood pressure, oxygen, ventilation, and glucose goals. Evidence evaluating the routine use of antibiotics after return of spontaneous circulation is reviewed. The update also reviews diagnostic testing modalities, temperature control goals and duration, and the use of percutaneous coronary intervention and mechanical circulatory support in the patient resuscitated from cardiac arrest. New data regarding the detection and management of seizures have been incorporated, along with updates regarding the timing and modalities used in neuroprognostication. These guidelines now differentiate prognostication for favorable versus unfavorable outcome. New sections on the utility of advanced neuromonitoring, along with definitions and treatment options for myoclonus, are included to guide the clinician. Expanded recommendations regarding how to optimize survivorship for patients, caregivers, and rescuers are reviewed. Finally, the potential role of organ donation in the patient resuscitated from cardiac arrest is reviewed.

This executive summary provides an overview of the 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which is organized around the Utstein Formula for Survival and provides updated recommendations aimed at improving survival rates and neurological outcomes following cardiac arrest. This executive summary outlines key changes, emphasizing the importance of high-quality chest compressions, early defibrillation, and the integration of advanced resuscitation techniques. These Guidelines also highlight critical post-cardiac arrest care strategies, including targeted temperature management and hemodynamic stabilization. Additionally, they stress the need for population-specific resuscitation approaches, particularly for pediatric patients, pregnant individuals, and individuals with cardiac arrest due to special circumstances. A strong focus is placed on continuous training and education for both medical professionals and lay rescuers to enhance the implementation and effectiveness of these lifesaving interventions. The 2025 Guidelines also highlight the importance of an integrated system of people, protocols, policies, and resources to achieve quality improvement in cardiac arrest care. An overview of ethical considerations relevant to emergency cardiovascular care, resuscitation, and approaches to decision-making surrounding cardiac arrest is also included. By following these updated recommendations, the American Heart Association seeks to optimize resuscitation efforts and improve patient outcomes in cardiac emergencies.

The 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care is based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation. The Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Resuscitation, Resuscitation Education Science, Special Circumstances, Post-Cardiac Arrest Care, Ethics, and Systems of Care Writing Groups drafted, reviewed, and approved recommendations, assigning to each recommendation a Class of Recommendation (ie, strength) and Level of Evidence (ie, quality). The 2025 Guidelines are organized in knowledge chunks that are grouped into discrete modules of information on specific topics or management issues. Each chapter of the 2025 Guidelines underwent blinded peer review by subject matter experts and was also reviewed and approved for publication by the American Heart Association Science Advisory and Coordinating Committee and the American Heart Association Executive Committee. Chapters with pediatric content (Neonatal Resuscitation, Pediatric Basic and Advanced Life Support) were also co-led by the American Academy of Pediatrics, and thereby the content was reviewed and approved by the American Academy of Pediatrics Board of Directors. The American Heart Association has rigorous conflict of interest policies and procedures to minimize the risk of bias or improper influence during development of the guidelines. Anyone involved in any part of the guideline development process disclosed all commercial relationships and other potential conflicts of interest.

Codeveloped by the American Heart Association and the American Academy of Pediatrics, this publication presents the 2025 guidelines for basic life support during cardiopulmonary resuscitation and emergency cardiovascular care of the pediatric patient, excluding the newborn infant, and represents the first comprehensive update of treatment recommendations since 2020. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines are for lay rescuers and health care professionals with recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. Existing guidelines remain relevant unless specifically updated in this publication. Topics reviewed include the initiation of cardiopulmonary resuscitation; pulse check; components of high-quality cardiopulmonary resuscitation; chest compression technique; support surfaces for cardiopulmonary resuscitation; opening the airway; coordination of shock and cardiopulmonary resuscitation; types of defibrillators or automated external defibrillators; defibrillator paddle or pad size, type, position; treatment of inadequate breathing with a pulse; and foreign-body airway obstruction. Key topics that are new, are substantially revised, or have significant new literature include the elimination of 2-finger chest compressions in infants due to ineffectiveness of achieving proper depth with a recommendation of 1-hand or 2 thumb-encircling hands technique; the immediate application and use of an automated external defibrillator with a pediatric attenuator if available for cardiac arrest; and in infants with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 chest thrusts (no abdominal thrusts), and in children with severe foreign-body airway obstruction repeated cycles of 5 back blows alternating with 5 abdominal thrusts.

In this chapter, the American Heart Association provides guidance on ethical considerations relevant to cardiopulmonary resuscitation and emergency cardiovascular care. An overview is provided of ethical frameworks that provide a structure through which difficult decisions can be analyzed. These include principlism, currently the predominant medical ethical framework, which considers moral principles of beneficence, nonmaleficence, respect for autonomy, and justice. Additional consideration is given to the value of dignity, and other ethical frameworks such as narrative ethics, crisis standards of care, utilitarianism, virtue ethics, and deontology. The importance of equity and the imperative for health care professionals and their organizations to actively address structural inequities, social determinants of health and resulting disparities related to Emergency Cardiovascular Care is highlighted. Processes for decision-making are discussed, including guidance on advance directives and shared decision-making. Decisions to initiate or withhold and subsequently to continue or terminate resuscitation are reviewed at length. In addition to considering this decision in adults and geriatric patients, specific attention is given to decision-making in children, newborn infants, and pregnant patients. The impact of prognostic uncertainty on these decisions is discussed, as well as the evaluation of potentially ineffective therapies and cultural and religious considerations. Other ethical topics are addressed briefly, including processes for research and knowledge generation; the impact of resuscitation on health care professionals, survivors, laypersons, families, and caregivers; family presence during resuscitation; crisis standards of care; advanced therapies, including extracorporeal support; and organ and tissue donation.

https://www.ahajournals.org/journal/circ In these guidelines, the American Heart Association provides updated guidance for resuscitation of adults and children in cardiac arrest or with a life-threatening condition due to special circumstances, including anaphylaxis, asthma, cardiac arrest in the cardiac intervention suite, cardiac arrest following cardiac surgery, drowning, electrocution, gas embolism, high-consequence respiratory pathogens, hyperkalemia, hyperthermia, hypothermia, left ventricular assist device failure, pregnancy, pulmonary embolism, and poisoning due to benzodiazepines, β-blockers, calcium channel blockers, cocaine, cyanide, digoxin and related cardiac glycosides, local anesthetic systemic toxicity, methemoglobinemia, opioids, organophosphates and carbamates, sodium channel blockers, sympathomimetics, and volatile hydrocarbons. Recommendations are also provided for alternatives to cardiopulmonary resuscitation and the use of extracorporeal membrane oxygenation for poisoned patients. Adults and children with these conditions require modification of basic life support and advanced life support. These guidelines are based on systematic evidence reviews and provide separate graded recommendations for adults and children.