{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:11:37Z","timestamp":1781813497265,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Paroxysmal atrial fibrillation (PAF) presents significant challenges in management due to its unpredictable recurrence and associated complications. Current prognostic tools lack precision in predicting PAF outcomes, highlighting the need for a comprehensive approach integrating multiple diagnostic modalities. Methods: The PLACEBO pilot study is a prospective observational investigation enrolling 80 adults with PAF from a tertiary hospital. Baseline assessments include cardiopulmonary exercise testing (CPET), a complete echocardiographic evaluation, 24-h ambulatory electrocardiographic monitoring, and plasma biomarker analysis. Participants will be followed for 12 months, with the primary outcome being AF recurrence. Secondary outcomes include cardiovascular events and other clinical indicators relevant to disease progression. Results: The study will assess the feasibility of integrating CPET parameters, echocardiographic indices, and plasma biomarkers into clinical practice for prognostic evaluation. Data analysis will focus on identifying potential associations between these modalities and PAF recurrence, contributing to improved risk stratification. Conclusions: By integrating CPET, echocardiographic parameters, and plasma biomarkers, the PLACEBO pilot study aims to enhance risk stratification and improve the prognostic assessment of patients with PAF. The findings from this study may pave the way for future research, ultimately contributing to the development of personalized management strategies.<\/jats:p>","DOI":"10.3390\/jcm14051690","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T03:22:44Z","timestamp":1740972164000},"page":"1690","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Exploring the Feasibility of Integrating Cardiopulmonary Exercise Testing, Echocardiography, and Biomarkers for Predicting Atrial Fibrillation Recurrence: Rationale, Design and Protocol for a Prospective Cohort Study (The PLACEBO Trial)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5008-114X","authenticated-orcid":false,"given":"Aristi","family":"Boulmpou","sequence":"first","affiliation":[{"name":"Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1673-196X","authenticated-orcid":false,"given":"Theodoros","family":"Moysiadis","sequence":"additional","affiliation":[{"name":"Department of Computer Science, School of Sciences and Engineering, University of Nicosia, Nicosia 2417, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Zormpas","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2146-1194","authenticated-orcid":false,"given":"Eleftherios","family":"Teperikidis","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-9170","authenticated-orcid":false,"given":"Vassilios","family":"Vassilikos","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7491-6319","authenticated-orcid":false,"given":"Georgios","family":"Giannakoulas","sequence":"additional","affiliation":[{"name":"First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9643-9066","authenticated-orcid":false,"given":"Christodoulos","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1093\/europace\/eus087","article-title":"Prevalence of atrial fibrillation in the general population and in high-risk groups: The ECHOES study","volume":"14","author":"Davis","year":"2012","journal-title":"Europace"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1093\/europace\/euab113","article-title":"Prognostic markers of all-cause mortality in patients with atrial fibrillation: Data from the prospective long-term registry of the German Atrial Fibrillation NETwork (AFNET)","volume":"23","author":"Nabauer","year":"2021","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1093\/eurheartj\/ehad375","article-title":"New-onset atrial fibrillation prediction: The HARMS2-AF risk score","volume":"44","author":"Segan","year":"2023","journal-title":"Eur. 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