Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 10 07 167 169 Ali Bozorgi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 07 The European Society of Cardiology Congress (ESC) 2025 in Madrid delivered a concentrated set of clinical trials with immediate relevance to practice across cardiology subspecialties. While the congress spanned topics from hypertension and coronary disease to cardiomyopathies and device therapy, a subset of trials is especially salient for electrophysiologists: comparative outcomes of pulsed-field vs radiofrequency ablation in atrial fibrillation (AF); strategies for anticoagulation after successful AF ablation; and broader therapeutic advances (oral myosin inhibitors for obstructive hypertrophic cardiomyopathy [HCM]) that shift paradigms in medical management. Here, I summarize these trial findings, discuss their electrophysiology implications, and propose priorities for future research and guideline consideration. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2373 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2373/1222

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 79 88 Feride Taskin Yilmaz Sakarya University of Applied Sciences Selma Sabanciogullari Sivas Cumhuriyet University Ahmet Kerim Turesin Susehri State Hospital Secil Copur Susehri State Hospital 2023 09 22 2025 05 25 Background: Health literacy is an important factor in facilitating disease management among individuals with hypertension. This study aimed to determine the effect of health literacy on adherence to antihypertensive treatment in elderly patients with controlled and uncontrolled hypertension. Methods: This descriptive and comparative study included 203 elderly patients diagnosed with hypertension for at least 6 months who were on antihypertensive treatment. Data were collected using a patient information form, the Health Literacy Scale (HLS), and the Medication Adherence Self-Efficacy Scale Short Form (MASES-SF). Results: The mean age of the participants was 69.70±12.49 years. Age, duration of disease, and duration of medication use were higher in patients with uncontrolled hypertension. Moreover, patients with controlled hypertension were more likely to have regular health check-ups, watch health-related programs in the media, and research the accuracy of disease-related information (P<0.05). In addition, patients with controlled hypertension were more likely to use medication once daily, have another chronic disease, and have a family history of hypertension (P<0.05). The mean MASES-SF and HLS scores of patients with controlled hypertension were statistically higher than those of patients with uncontrolled hypertension (P<0.01). Conclusions: Controlled hypertension showed a positive correlation with health literacy and treatment adherence. Furthermore, the health literacy level was identified as a determinant of medication adherence in elderly patients. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1934 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1934/1200

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 89 96 EN Maryam Moradian Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Rafie Khorgami Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Avisa Tabib Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Dalili Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Fariba Rashidighader Assistant professor of pediatric cardiology , Rajaei cardiovascular medical and research center, school of medicine, Iran University of Medical Sciences Shabnam Boudagh Echocardiography research center،Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Mahdavi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Reza Abbaszadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Yasaman Khalili Assistant Professor of Community Medicine Heart Research Center Rajaie Cardiovascular, Medical and Research Center Soheila Hoseinzadeh Moghadam Department of Pediatric Cardiology, Rajaei Cardiovascular Research and Medical Center, School of Medicine, Iran University of Medical Sciences, Intersection of Niayesh Highway and Valiasr St, Tehran 1995614331, Iran. 2024 01 17 2025 05 04 Objective: To evaluate the impact of radiofrequency ablation (RFA) on dyssynchrony in children with Wolff-Parkinson-White (WPW) syndrome. Methods: This pre-post interventional study was conducted at Rajaie Cardiovascular Institute in Tehran, Iran, and included patients with WPW syndrome who had accessory pathways and were candidates for RFA. Demographic and baseline data, such as age and sex, were recorded. Patients underwent ECG studies and RFA of their accessory pathways. Twelve-lead ECG was performed before and one day after RFA. Standard echocardiographic views were obtained using a Vivid S60 system with appropriate transducers in 1D (M-mode) and 2D modes, along with Doppler evaluation. Intraventricular and interventricular dyssynchrony indices were assessed, and 2D strain analysis was performed. Data were analyzed using IBM SPSS Statistics for Windows, version 26.0. Results: This study included 54 patients with WPW syndrome, 17 of whom had ventricular dyssynchrony. Ablation significantly affected QRS duration, PR interval, fractional shortening, left ventricular ejection fraction, and septal-to-posterior wall motion delay but did not significantly alter interventricular mechanical delay. The most common accessory pathways were left lateral, right posteroseptal, and left posteroseptal. The location of the accessory pathway was not significantly associated with the occurrence of dyssynchrony. Conclusions: Based on the findings of this study, RF ablation eliminated dyssynchrony in all WPW patients and improved functional and strain parameters in this population. These improvements enhance cardiac function and reduce associated risks, particularly in pediatric patients. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2005 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2005/1201

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 97 104 Rojin Yaghubi Tabriz University of Medical Sciences Naser Khezerlou Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Soheil Nemati Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Hanieh Faraji Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Elnaz Javanshir Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Zahra Shamsian Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2024 12 28 2025 06 23 Background: Mitral stenosis (MS) is typically assessed using both echocardiographic and invasive methods, which are critical for treatment planning. The present study analyzed the correlation between invasively measured left atrial pressure (LAP) and mitral valve area (MVA) assessed by three-dimensional transesophageal echocardiography (3D-TEE) in patients with rheumatic MS undergoing percutaneous transluminal mitral commissurotomy (PTMC). Methods: We conducted a cross-sectional study of 135 patients with severe rheumatic MS who were candidates for PTMC at Shahid Madani Heart Hospital, Tabriz, Iran, between April 2023 and April 2024. All patients underwent two-dimensional transthoracic echocardiography (2D-TTE) and 3D-TEE for MVA measurement. Invasive LAP and pulmonary pressures were recorded pre-procedure. Comparisons were made between patients with MVA<1 cm² and those with MVA≥1 cm². Results: The mean MVA measured by 3D-TEE was 1.03±0.07 cm². LAP was significantly higher in patients with MVA<1 cm² than in those with MVA≥1 cm² (P=0.040). Pulmonary artery pressures also differed significantly between the groups (P=0.016 and P=0.012). Among the 135 participants, 109 patients (63.3% with MVA<1 cm² and 93.6% with LAP>15 mm Hg) reported dyspnea, while 20 patients (65% with MVA<1 cm² and 100% with LAP>15 mm Hg) reported fatigue. Conclusions: In this study, we observed a significant correlation between invasive LAP and MVA measured by 3D-TEE. These findings suggest that invasive LAP measurement offers additional value in assessing the hemodynamic burden of severe MS. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2214 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2214/1202

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 105 115 EN Hai Dang The Faculty of Medicine, Duy Tan University, Da Nang, Vietnam Thang Luong University of Medicine and Pharmacy, Hue University, Hue, Vietnam Bang Ho University of Medicine and Pharmacy, Hue University, Hue, Vietnam Tien Hoang University of Medicine and Pharmacy, Hue University, Hue, Vietnam Anh Mai Cardiovascular Center, Hue Central Hospital, Hue, Vietnam Hung Nguyen Bach Mai Hospital, Ha Noi, Vietnam 2025 01 27 2025 06 04 Background: Heart failure with preserved ejection fraction (HFpEF) has a high hospitalization rate. While recent guidelines recommend parameters like E/e’ and e’ velocity for diagnosis, their accuracy remains limited. Left atrial (LA) strain is a potential diagnostic parameter, yet its role in the Vietnamese population is unclear. This study aims to evaluate LA strain’s diagnostic value in HFpEF among Vietnamese patients, exploring its relationship with established parameters of left ventricle diastolic function. Methods: A cross-sectional study (15/04/2022 - 01/12/2023) included 49 patients with HFpEF and 69 individuals without cardiac dysfunction. The study subjects were evaluated for LA strain and HFA-PEFF score. Diagnostic criteria for HFpEF were based on the 2021 European Society of Cardiology guidelines for diagnosing and treating acute and chronic heart failure. Results: LA strain including LA reservoir (LASr), conduit (LAScd), and contractile (LASct) functions, in the HFpEF group were 20.80% [13.30-26.50], 10.89±5.16%, and 9.08±6.18%, respectively. The control group had corresponding LASr, LAScd, and LASct values of 34.45% [31.14-38.07], 17.38±4.41%, and 17.33±5.72% (p<0.001). The area under the curve (AUC) for LASr, LAScd, LAScr, and HFA-PEFF score to diagnose HFpEF was 0.852, 0.770, 0.778, and 0.890, respectively. Comparing the AUCs for diagnosing HFpEF between LASr and HFA-PEFF score, no difference was found with p=0.419. Conclusion: LASr has a diagnostic value equivalent to the HFA-PEFF score in diagnosing HFpEF and could be incorporated into the existing HFpEF diagnostic guidelines. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2227 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2227/1203

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2025 09 27 116 125 Noor Mohammad Noori 1. Professor in Pediatric Cardiology. Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan , Iran Elham Zarifi Ali Asghar Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Alireza Teimouri 2- M.Phil, PhD in Demography, Children and Adolescents Health research center, Research Institute of cellular and Molecular Science in Infectious Diseases , Zahedan University of Medical Science's, Zahedan, Iran 2025 05 30 2025 08 03 Background: Nephrotic syndrome (NS) is a common pediatric glomerular disorder traditionally considered renal-limited. Nonetheless, growing evidence suggests systemic implications, including subclinical cardiovascular involvement. This study aimed to evaluate early myocardial dysfunction in children with idiopathic NS using Doppler tissue echocardiography (DTE). Methods: In a case-control study, 87 children with idiopathic NS and 87 age- and sex-matched healthy controls were enrolled between 2021 and 2023 at Ali Asghar Pediatric Hospital in Zahedan, Iran. All participants underwent comprehensive DTE from apical four-chamber views to assess systolic and diastolic function. Key parameters included S′, E′, and A′ velocities; isovolumetric contraction time (ICT); isovolumetric relaxation time (IRT); ejection time (ET); myocardial performance index (MPI); and E/E′ and A/A′ ratios. Laboratory data and treatment response were also analyzed. Data were analyzed using SPSS version 26, with a significance level set at 0.05. Results: Children with NS demonstrated significantly reduced S′, E′, and A′ velocities; prolonged left ventricular IRT; shortened ICT and ET; and elevated MPI values, indicating early biventricular dysfunction. The right ventricular E/E′ ratio was significantly lower in treatment responders, suggesting improved diastolic function. MPI and timing parameters showed strong correlations with renal and metabolic markers, including blood urea nitrogen, serum albumin, and lipid levels. Conclusions: DTE-derived MPI serves as a valuable noninvasive marker for the early detection of subclinical cardiac dysfunction in pediatric NS. Incorporating MPI into routine cardiac assessments may improve risk stratification and guide therapeutic monitoring in this population. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2273 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2273/1204

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 2 2024 04 08 126 136 Marzieh s can mark a paradigm shift; however, significant weaknesses persist in diagnostic and therapeutic areas. Further progress depends on phenotype-specific, multimodal, and patient-centered strategies that combine clinical care, digital innovation, and molecular research. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2377 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2377/1250

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 1 2024 06 22 111 115 Farnaz Ahmadi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Raha Parnia Simon Fraser University, Vancouver, British Columbia, Canada Bahamin Astani Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad-Sadegh Keshmiri Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shakiba Khodadad Department of Gynecology Oncology, Erfan Hospital, Tehran, Iran Hakimeh Sheikhzadeh Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Daneshmandi Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faezeh Ansari Mofid Children’s Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mahsa Riahi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sima Noorali Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hannaneh Yousefi-Koma Masih Daneshvari Hospital, Tehran, Iran Babak Sharif-Kashani Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shadi Shafaghi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 07 04 2024 09 22 Background: Pregnancy in women with pulmonary hypertension (PH) is contraindicated because of high mortality rates associated with physiological changes, particularly in the peripartum and postpartum periods. Termination is recommended early if pregnancy occurs. Consequently, clinical experience with continued pregnancy in patients with PH is scarce. Case Presentation: A 31-year-old woman was diagnosed with multiple bilateral pulmonary and right ventricular hydatid cysts. After surgical and pharmacologic treatments, she developed PH due to pulmonary artery obstruction 8 years later. Because of her condition, she was ineligible for surgery and received medical therapy, including tadalafil, bosentan, and eplerenone. After 3 years, she conceived despite advice to avoid pregnancy. At 37 weeks’ gestation, she underwent successful emergency cesarean delivery because of maternal dyspnea and tachycardia. Conclusion: Prompt treatment and regular follow-up in a tertiary care center using a multidisciplinary approach are crucial for managing pregnant patients with PH. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2118 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2118/1252

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 1 2026 04 26 20 31 Rizki Hilman Department of Cardiology, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia Adi Purnawarman Department of Cardiology, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia Haris Munirwan Department of Cardiology, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia Muhammad Ridwan Department of Cardiology, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia Herlina Dimiati Department of Pediatric, Faculty of Medicine, Dr. Zainoel Abidin Hospital, Universitas Syiah Kuala, Banda Aceh, Indonesia 2025 12 26 2026 02 03 Background: Arrhythmia is a common and clinically significant complication during hospitalization for ST-segment elevation myocardial infarction (STEMI). This study aimed to identify factors associated with the occurrence of arrhythmia in the acute phase of STEMI. Methods: This single-center cross-sectional study was conducted among adult patients hospitalized with STEMI. Demographic and clinical variables, including cardiovascular risk factors and disease severity (Killip class, Thrombolysis in Myocardial Infarction [TIMI] score, and Global Registry of Acute Coronary Events [GRACE] score), were obtained from medical records. The primary outcome was in-hospital arrhythmia, defined as documented atrial or ventricular tachyarrhythmia or clinically significant bradyarrhythmia. Factors associated with arrhythmia were assessed using bivariate analyses followed by multivariable logistic regression. Results: This study involved 113 patients, with a mean age of 56.4 (11.1) years. Arrhythmia occurred in 26.5% (30 patients) during hospitalization. In bivariate analyses, arrhythmia was associated with higher Killip class (P<0.001), higher TIMI score (P=0.005), higher GRACE score (P=0.001), lower tricuspid annular plane systolic excursion (P=0.002), elevated serum potassium level (P=0.010), and impaired renal function, reflected by higher urea (P=0.005) and creatinine levels (P = 0.004). After multivariable adjustment, only Killip class remained independently associated with arrhythmia: patients presenting with Killip class I had a significantly lower risk of arrhythmia than those with higher Killip classes (adjusted OR, 0.404; 95% CI, 0.20 to 0.80; P=0.009). Conclusion: In hospitalized patients with STEMI, arrhythmic risk is chiefly driven by early clinical severity. Killip class is a simple bedside predictor of in-hospital arrhythmia and can aid early risk stratification and monitoring. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2417 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2417/1242

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 1 2026 04 26 32 39 Ali Mirzaei Department of Pharmacology & Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran Maryam Mehrpooya Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran Akram Ranjbar Department of Pharmacology & Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran Sajad Naghdi Farshchian Cardiovascular Subspecialty Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran Afsaneh Familmotaghi Farshchian Cardiovascular Subspecialty Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran Seyed Saman Talebi Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Seyed Kianoosh Hosseini Department of Cardiology, School of Medicine, Farshchian Cardiovascular Subspecialty Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran 2025 07 26 2025 12 16 Background: Ischemic heart disease is the leading cause of death worldwide. Oxidative stress plays a key role in myocardial infarction (MI). Ferroptosis, a type of iron-dependent regulated cell death caused by lipid peroxide accumulation, has been identified as a key mechanism in ischemic injury. This study aimed to investigate the association between oxidative stress and ferroptosis in patients with non–ST-segment-elevation myocardial infarction (NSTEMI). Methods: In this case-control study, 25 patients with NSTEMI and 25 controls were included. In serum samples, cardiac markers (troponin I and CK-MB), oxidative stress biomarkers including lipid peroxidation (LPO), total antioxidant capacity (TAC), total thiol groups (TTG), superoxide dismutase (SOD) activity, glutathione peroxidase (GPx) activity, and iron and ferritin levels were measured. Results: In patients with NSTEMI, serum levels of cardiac markers (troponin I and CK-MB), LPO, iron, and ferritin were significantly higher than in controls. In contrast, TAC, TTG, and SOD and GPx activities were significantly lower in patients with NSTEMI. Conclusion: This study demonstrated a possible role of oxidative stress in the pathophysiology of NSTEMI. Elevated iron and LPO levels and reduced GPx activity may contribute to cardiac cell death through ferroptosis. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2319 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2319/1243

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 1 2026 04 26 40 49 Fadhlan Rahman Citra Husada Jember Hospital Suryono Suryono Department of Cardiology and Vascular Medicine, Faculty of Medicine, Jember University, Jember, Indonesia; Dr. Soebandi General Hospital, Jember, Indonesia Aditha Maulana Department of Cardiology and Vascular Medicine, Faculty of Medicine, Jember University, Jember, Indonesia; Dr. Soebandi General Hospital, Jember, Indonesia Pipiet Wulandari Department of Cardiology and Vascular Medicine, Faculty of Medicine, Jember University, Jember, Indonesia; Dr. Soebandi General Hospital, Jember, Indonesia 2025 12 15 2026 02 02 Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial morbidity and mortality. AF occurring in individuals without structural heart disease or conventional risk factors, currently referred to as AF without overt comorbidity, remains poorly understood. Genetic susceptibility is thought to contribute, but the underlying molecular mechanisms are incompletely defined. This study aimed to identify key genes and biological processes associated with AF without overt comorbidity using an in-silico bioinformatics approach. Methods: Genes associated with AF without overt comorbidity were retrieved from the GeneCards database using a knowledge-based, database-driven strategy. Functional enrichment analysis of Gene Ontology biological processes was performed using WebGestalt. Protein-protein interaction (PPI) analysis was conducted using STRING and visualized in Cytoscape. Hub genes were identified exclusively using the Density of Maximum Neighborhood Component (DMNC) algorithm via the CytoHubba plugin. Three-dimensional protein structures of selected hub genes were modeled using SWISS-MODEL and evaluated using PROCHECK for exploratory structural characterization. Results: Eighty-one genes associated with AF without overt comorbidity were identified. PPI analysis demonstrated significant interaction enrichment (P<1.0×10⁻¹⁶), indicating a nonrandom and biologically coherent network. Functional enrichment analysis revealed cardiac muscle cell action potential and cardiac muscle contraction as the most significantly enriched biological processes. Ten hub genes were identified based on DMNC ranking. Among these, GPD1L, SCN1B, SCN4B, and KCNE2 showed central network positions and acceptable stereochemical quality in exploratory structural evaluation. Conclusion: This in silico study identifies candidate genes and biological processes potentially involved in AF without overt comorbidity. The findings are hypothesis generating and warrant further functional and clinical validation. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2407 https://rhythm.tums.ac.ir/index.php/jthc/article/download/2407/1244

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