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Adults were included in three separate 1:1 propensity score\u2013matched cohorts: (1) PG vs non-PG to assess incident AF and relevant arrhythmogenic heart disease; (2) PG with vs without AF to examine AF-related outcomes within PG; and (3) AF with vs without PG to examine the impact of PG within AF. Patients were followed for up to 5\u00a0years. Cox proportional hazards models, 90-day sensitivity analyses, and negative control outcomes enhance robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 11,351 adults with PG and 2,132,938 without PG, matching yielded 11,216 well-balanced in each cohort. PG was associated with higher 5-year AF incidence (HR 1.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Among 1286 PG patients with AF and 10,834 without AF, 1133 pairs were matched. In the PG population, AF was associated with higher risks of systemic thromboembolism (HR 2.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), heart failure (HR 4.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and all-cause mortality (HR 1.59,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In the AF population (1286 AF patients with PG; 2,400,413 without PG), PSM yielded 1265 pairs. PG was associated with increased systemic embolism (HR 2.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), heart failure (HR 2.17,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and mortality (HR 1.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Negative control outcomes were consistently null; Cox proportional hazards models and sensitivity analyses showed similar patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PG was associated with increased incident AF and, among patients with AF, identified a high-risk phenotype with substantially higher thromboembolic events, heart failure, and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02996-2","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:41:19Z","timestamp":1785753679000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incident atrial fibrillation and pyoderma gangrenosum: long-term thromboembolic, heart failure, and mortality risk"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6430-0252","authenticated-orcid":false,"given":"Hatim","family":"Kerniss","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Curman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Olbrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha","family":"St\u00e4nder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalaf","family":"Kridin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rottner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Wakili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Leistner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf J.","family":"Ludwig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"issue":"23","key":"2996_CR1","doi-asserted-by":"publisher","first-page":"2349","DOI":"10.1016\/j.jacc.2022.03.379","volume":"79","author":"A Ajoolabady","year":"2022","unstructured":"Ajoolabady A, Nattel S, Lip GYH, Ren J (2022) Inflammasome signaling in atrial fibrillation: JACC State-of-the-Art Review. 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All other authors declare no competing interests. RJL reports research funding from EUROIMMUN, Domp\u00e9 pharma, Novartis, and Sanofi . All other authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}