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Efficient Real-World Dehazing via Physics-Inspired Global-Local Decoupling
Real-world single image dehazing is highly ill-posed due to spatially and spectrally varying scattering, while practical deployment demands lightweight and low-latency models. Existing approaches either rely on fragile physical inversion under simplified assumptions or adopt heavy blind architectures unsuitable for edge deployment. To overcome these limitations, we propose PGL-Net (Physics-Inspired Global-Local Decoupling Network), a lightweight framework that incorporates physical inductive biases via operator-level emulation, avoiding explicit parameter estimation. It decouples dehazing into global distribution rectification and local structural refinement. A Physics-Inspired Affine Fusion (PAF) module performs globally conditioned alignment across hierarchical skip connections to compensate for haze-induced bias, while a compact Degradation-Aware Modulation (DAM) block adaptively restores spatially and spectrally variant details through dynamic feature modulation. Extensive experiments on multiple real-world benchmarks demonstrate that PGL-Net achieves state-of-the-art restoration quality with significantly reduced complexity. Compared with the recent SOTA SGDN, the Tiny variant (PGL-Net-T) improves PSNR by up to 2.6dB and consistently enhances downstream object detection accuracy, while achieving over a 10x reduction in inference latency. Code is publicly available at: https://github.com/sc-30-bit/PGL-Net.
ScoreGate: Adaptive Chunk Selection for Retrieval-Augmented Generation via Dual-Score Statistical Fusion
Fixed-cardinality retrieval injects a constant top-K chunks into the generator regardless of query complexity, causing over-retrieval for narrow queries and under-retrieval for compositional ones. We describe ScoreGate, a lightweight score-space decision mechanism that controls retrieval cardinality at inference time using two scores already produced by the standard pipeline: bi-encoder similarity s_i and cross-encoder reranker score r_i, with no additional model inference calls required. Its core insight is that cross-encoder affirmation can rescue semantically relevant chunks that bi-encoder retrieval ranks poorly due to vocabulary mismatch – a failure mode unaddressed by fixed-K or single-score thresholding. On MS MARCO (200 dev queries), ScoreGate achieves MRR@10 = 0.401 with 35% fewer retained chunks than Standard Top-K. On an internal benchmark (n=300, Fleiss' kappa=0.87), ScoreGate observed zero false positives (95% CI [96.4%, 100%]) at 97.77-99.34% recall, with 34.8% fewer tokens per query and only 31ms added latency. Results on both MS MARCO and real-world production traffic suggest that adaptive retrieval cardinality can improve retrieval efficiency without degrading retrieval quality.
Dual-Uncertainty Guided Policy Learning for Multimodal Reasoning
Reinforcement learning with verifiable rewards (RLVR) has advanced reasoning capabilities in multimodal large language models. However, existing methods typically treat visual inputs as deterministic, overlooking the perceptual ambiguity inherent to the visual modality. Consequently, they fail to distinguish whether a model's uncertainty stems from complex reasoning or ambiguous perception, preventing the targeted allocation of exploration or learning signals. To address this gap, we introduce DUPL, a dual-uncertainty guided policy learning approach for multimodal RLVR that quantifies and leverages both perceptual uncertainty (via symmetric KL divergence) and output uncertainty (via policy entropy) to guide policy updates. By establishing an uncertainty-driven feedback loop and employing a dynamic branch prioritization mechanism, DUPL recalibrates the policy advantage to focus learning on states with high perceptual or decisional ambiguity, enabling effective targeted exploration beyond passive data augmentation. Evaluated on diverse multimodal reasoning benchmarks spanning mathematical and general domains, DUPL achieves solid gains. It improves Qwen2.5-VL accuracy by up to $12.3%$ (3B) and $7.9%$ (7B), and Qwen3-VL-Instruct by up to $10.7%$ (4B) and $12.4%$ (8B), consistently outperforming GRPO, while seamlessly generalizing to alternative algorithms (DAPO, $+6.5%$ avg) and architectures (LLaVA-OneVision-1.5, $+4.7%$ avg). These results demonstrate that DUPL is an effective and generalizable approach for multimodal RLVR.
Nemotron 3 Ultra: Open, Efficient Mixture-of-Experts Hybrid Mamba-Transformer Model for Agentic Reasoning
We introduce Nemotron 3 Ultra, a 550 billion total and 55 billion active parameter Mixture-of-Experts Hybrid Mamba-Attention language model. We pre-trained Nemotron 3 Ultra on 20 trillion text tokens, then extended the context length to 1M tokens, and post-trained using Supervised Fine Tuning (SFT), Reinforcement Learning (RL), and Multi-teacher On-Policy Distillation (MOPD). Nemotron 3 Ultra is our most capable model yet, employing multiple key technologies - LatentMoE, Multi Token Prediction (MTP), NVFP4 pre-training, multi-environment RLVR, MOPD, and reasoning budget control. Nemotron 3 Ultra achieves up to ~6x higher inference throughput as compared to state-of-the-art publicly available LLMs while attaining on-par accuracy. The state-of-the-art accuracy, high inference throughput, and 1M token context length make Nemotron 3 Ultra ideal for long-running autonomous agentic tasks. We open-source the base, post-trained, and quantized checkpoints, along with the training data and recipe on HuggingFace.
Enhancing Decision-Making with Large Language Models through Multi-Agent Fictitious Play
Large language model (LLM)-based multi-agent systems (MAS) have demonstrated great potential in solving tasks with execution complexity, by distributing subtasks across cooperative agents. However, this divide-and-conquer paradigm falls short on decision-making tasks that are also prevalent in the real world. These tasks require simultaneous reasoning from the stances of all involved stakeholders whose decisions are mutually dependent and thus cannot be solved in isolation. We characterize this challenge as stance entanglement, a form of decision complexity distinct from execution complexity. To address it, we propose Multi-Agent Fictitious Play (MAFP), a novel MAS paradigm that represents stakeholder stances as agents and formulates decision-making as an equilibrium-seeking process. Built on the game-theoretic principle of fictitious play, MAFP iteratively updates each agent's decision by best responding to the empirical mixture of other agents' past decisions. This enables agents to expose and address one another's weaknesses, progressively improving decision quality and robustness. We evaluate MAFP on challenging decision-making tasks that test the capability of deciding strategies for competitive scenarios prior to acting. MAFP outperforms both single-round and multi-round baselines on two complementary metrics, tournament strength and robustness, demonstrating its effectiveness in addressing stance entanglement.
How Should World Models Be Evaluated? A Decision-Making-Centric Position
arXiv:2606.15032v1 Announce Type: new Abstract: World models have rapidly become one of the central abstractions in modern AI. Yet the term now refers to several different objects: action-conditioned environment models, latent imagination models, future-video predictors, interactive neural simulators, latent predictive representations, and synthetic-data engines. Evaluation has broadened with the term. Recent papers measure video realism, perceptual similarity, instruction following, physical plausibility, policy ranking, executability, planning success, and downstream policy improvement. The result is not only metric diversity but also a recurring problem of claim/evidence mismatch: papers frequently make a stronger claim about what their model is useful for than their evaluation can actually establish. This paper surveys the recent literature and argues that the central question is use-dependent. When a model is presented as a world model for embodied decision-making, a more decisive issue is not whether it generates visually compelling videos, but whether it supports reliable counterfactual reasoning, policy evaluation, planning, and policy optimization under intervention, policy-induced distribution shift, and long-horizon rollout. We organize the literature using an L0–L7 ladder that ranges from visual plausibility to policy optimization utility. In our interpretation, L0–L3 are most naturally read as diagnostics of generated artifacts, L4 is often the first genuinely interventional test, and L5–L7 provide the most direct evidence of decision usefulness. Based on this diagnosis, we propose a decision-making-centric evaluation framework and a benchmark protocol that foreground counterfactual action fidelity, closed-loop rollout validity, reward/value prediction, policy-ranking agreement, optimization lift, model exploitability, and uncertainty calibration.
A Tool for the Synthesis of Adaptive Probabilistic Processors Based on the Ising Model
arXiv:2606.19533v1 Announce Type: cross Abstract: This work presents a tool for the synthesis and simulation of probabilistic architectures for solving combinatorial optimization problems by mapping them to the Ising model. The proposed approach automatically constructs the Ising Hamiltonian and determines the number of probabilistic elements (p-bits) based on problem characteristics such as size and topology. Furthermore, the tool introduces an adaptive strategy for selecting the most suitable update algorithm among Gibbs Sampling, Simulated Annealing (SA), Simulated Quantum Annealing (SQA), and cluster-based methods. Experimental results using benchmark problems demonstrate improved convergence behavior and flexibility compared to fixed approaches. The proposed framework enables systematic evaluation of probabilistic computing strategies and supports the development of future hardware implementations based on MTJs and p-bits.
Phase transitions for contact processes on sparse random graphs via metastability and local limits
arXiv:2505.22471v2 Announce Type: replace Abstract: We propose a new perspective on the asymptotic regimes of fast and slow extinction in the contact process on locally converging sequences of sparse finite graphs. We characterise the phase boundary by the existence of a metastable density, which makes the study of the phase transition particularly amenable to local-convergence techniques. We use this approach to derive general conditions for the coincidence of the critical threshold with the survival/extinction threshold in the local limit. We further argue that the correct time scale to separate fast extinction from slow extinction in sparse graphs is, in general, the exponential scale, by showing that fast extinction may occur on stretched exponential time scales in sparse scale-free spatial networks. Together with {the results of} Nam, Nguyen and Sly (Trans.\ Am.\ Math.\ Soc.\ 375, 2022), our methods can be applied to deduce that the fast/slow threshold in sparse configuration models coincides with the survival/extinction threshold on the limiting Galton-Watson tree.
What Type of Inference is Active Inference?
arXiv:2606.04935v2 Announce Type: replace Abstract: Active inference casts decision-making as inference, with the Expected Free Energy (EFE) unifying goal-directed and information-seeking behavior. Recent work showed that EFE minimization can be written as Variational Free Energy (VFE) minimization on a generative model augmented with epistemic priors. We prove that the VFE of the augmented model can be rewritten as the VFE of the predictive model plus explicit entropy-correction terms, making the EFE contribution transparent. We then show that proper EFE-based planning requires combining these epistemic corrections with a planning correction that turns marginal inference into policy optimization, yielding a full variational characterization of EFE-based planning. This clarifies which corrections are needed for cross-entropy planning and for full EFE-based planning. The same entropy-corrected formulation leads to a detailed message-passing scheme for EFE-based planning together with simpler ablations. Experiments on three grid-world environments show that full EFE-based planning outperforms ablations that omit either the planning correction or the epistemic corrections.
Enhanced Tantalum Superconducting Resonator Performance via All-Surface Organic Monolayer Passivation
arXiv:2604.22112v2 Announce Type: replace-cross Abstract: Tantalum is a promising platform for superconducting quantum circuits, yet coherence times remain limited by dielectric losses from interfacial two-level systems (TLS), exacerbated by native oxide regrowth. Here, we implement molecular surface passivation using self-assembled organic monolayers on freshly etched tantalum and silicon in coplanar waveguide resonators. Surface characterization by contact angle, XPS, FTIR and TEM confirm the formation of ordered, nanometer-thick films that suppress oxide formation. Microwave measurements in the ~5-9 GHz range reveal internal quality factors up to 1.8x10^6 in the single-photon regime at 100 mK, representing a ~140% improvement over untreated devices with native oxide. Power and temperature dependent measurements attribute this enhancement to reduced TLS-induced losses. These results demonstrate that molecular passivation effectively engineers low-loss interfaces and provides a scalable route toward high-coherence superconducting quantum devices.
The $\omega$-Effect from a Multimode Squeezed Graviton State
arXiv:2606.24613v1 Announce Type: cross Abstract: The $\omega$-effect in entangled neutral-meson systems provides a sensitive probe of CPT violation induced by quantum-gravitational environments. In open quantum systems, interactions with inaccessible gravitational degrees of freedom can render the reduced meson dynamics non-unitary, causing the CPT operator to become ill-defined, even when the underlying microscopic Hamiltonian is CPT invariant. We present a microscopic derivation of the $\omega$-effect arising from a multimode squeezed gravitational environment generated by an axion cloud around a Kerr black hole. Using the Takagi decomposition of the associated complex symmetric squeezing kernel, the graviton field is expressed in terms of independent squeezed supermodes possessing anomalous correlators. These correlators provide a microscopic quantum counterpart of the stochastic fluctuations that appear in earlier D-particle foam descriptions of the $\omega$-effect, replacing phenomenological variances of flavour-changing D-particle recoil by calculable graviton correlation functions. After tracing over the graviton bath, the anomalous correlators and the weak-interactions-induced mixing combine to generate transitions between the antisymmetric and symmetric two-meson sectors. This results in a small exchange-symmetric admixture, parametrised by $\omega$, in the otherwise antisymmetric EPR state. We obtain an explicit expression for $\omega$ in terms of a sum over Takagi supermodes weighted by their squeezing amplitudes and phases together with the weak-interaction flavour-mixing matrix element. The resulting framework suggests that the $\omega$-effect may be a generic signature of non-classical states of gravitational environments, extending beyond the specific axion-cloud scenario considered here. The observability of the $\omega$-effect from other astrophysical and microscopic black-hole sources is discussed.
The Amazon can be saved — with concerted action inside and outside Brazil
As deforestation in the Amazon falls, fresh evidence shows that the rainforest can withstand global warming, but only if there is a worldwide effort to stop cutting it down. As deforestation in the Amazon falls, fresh evidence shows that the rainforest can withstand global warming, but only if there is a worldwide effort to stop cutting it down.
Simple Domain Generalization Methods are Strong Baselines for Open Domain Generalization
In real-world applications, a machine learning model is required to handle an open-set recognition (OSR), where unknown classes appear during the inference, in addition to a domain shift, where the data distribution differs between the training and inference phases. Domain generalization (DG) aims to handle the domain shift situation where the target domain of the inference phase is inaccessible during the model training. Open domain generalization (ODG) considers DG and OSR. Domain-augmented meta-learning (DAML) is a method targeting ODG; however, it has a complicated learning process. By contrast, although various DG methods have been proposed, they have not been evaluated in ODG situations. In this study, we comprehensively evaluate the existing DG methods in ODG and show that the two simple DG methods, CORrelation ALignment (CORAL) and maximum mean discrepancy (MMD), are competitive with DAML in several cases. In addition, we propose simple extensions of CORAL and MMD by introducing the techniques used in DAML, such as ensemble learning and Dirichlet mixup data augmentation. The experimental evaluation demonstrates that the extended CORAL and MMD can perform comparably to DAML with lower computational costs. This suggests that the simple DG methods and their simple extensions are strong baselines for ODG.
HalluDesign-NA: Extending HalluDesign for De Novo Nucleic Acid Design
AlphaFold3 has revolutionized the prediction of biomolecular structures and interactions, including atomic-level modeling of nucleic acids. However, the de novo design of structured and functional nucleic acids remains a significant challenge. Here, we extend our HalluDesign framework to nucleic acid design by integrating NA-MPNN for nucleic acid sequence optimization and design. This new framework, HalluDesign-NA, enables iterative sequence-structure co-optimization, facilitating the de novo design of nucleic acids. Computational benchmarking across ssDNA, ssRNA, and aptamer design tasks demonstrates consistent improvements in confidence scores (pLDDT, ipTM), supporting the feasibility of de novo nucleic acid design under various constraints, such as sequence length, symmetry, and protein structure context. We anticipate that HalluDesign-NA will accelerate the de novo design of functional nucleic acids for applications in biotechnology and medicine. The source code for HalluDesign-NA is available at https://github.com/MinchaoFang/HalluDesign_NA.
Calibrated Triage, Not Autonomy: Confidence Estimation for Medical Vision-Language Models
A vision-language model can answer a question about a medical image fluently and confidently while barely using the image, leaning instead on language priors. In medicine this is the failure that matters most, because the answer looks trustworthy and is not, and the only protection is a confidence score reliable enough to tell the system when to abstain. We ask a deployment question rather than an accuracy one: how much imaging work a model can safely handle alone, and which confidence signal makes that possible. We evaluate seven confidence estimators across five open-weight LVLMs and three medical visual-question-answering datasets spanning broad clinical imaging, radiology, and pathology, with every probe trained only on natural images and applied without adaptation. Recast as bounded selective prediction (automate a case only when confidence clears a threshold, defer the rest), the comparison is cautionary. The standard metrics are poor guides: discrimination barely separates the methods, and the weak calibration of a cheap self-report is cheaply removed by off-domain temperature scaling without changing deployable yield. What distinguishes a usable estimator is the high-confidence region a clinician acts on: the weakest baselines are confidently wrong on 41 to 45 percent of their errors against 1 to 4 percent for the best probe, and no estimator is reliably best across domains or models. Safe handoff is governed at two levels: base-model competence sets a ceiling, so a well-calibrated score recovers roughly a third of radiology cases at a 20 percent error tolerance but almost none of pathology; the confidence layer then decides how much of that ceiling is reachable. The usable role today is calibrated triage, not autonomy: automate the cases a calibrated score marks safe, route the rest to a clinician. We release all outputs, correctness judgments, and confidence scores, with code.
Agentic evolution of physically constrained foundation models
arXiv:2606.25532v1 Announce Type: new Abstract: Artificial intelligence increasingly drives automated scientific discovery, yet contemporary generalist agents lack physical grounding, frequently hallucinating hardware-incompatible designs. Here, we present a physically grounded, multi-agent discovery engine that autonomously architects hardware-compliant computing systems. Anchored by an Evolutionary Knowledge Graph structuring past scientific innovations, the framework extracts an "algorithmic Chain-of-Thought" to transform blind stochastic search into directed structural evolution. Applied to the extreme testbed of foundation model deployment, the engine evolved two hardware-aware compression methodologies surpassing human-engineered heuristics: Q-Enhance mitigates long-context accuracy loss in dense models, and MoE-Salient-AQ outperforms state-of-the-art manual sparse Mixture-of-Experts designs by 3.7% at sub-3-bit regimes. Utilizing a bandwidth-efficient Sensitivity Profile, we successfully deployed a massive 235-billion-parameter model onto a constrained dual-A100 server, reducing memory requirements by 75% with a marginal 0.64% accuracy degradation. By transforming unconstrained combinatorial search into knowledge-driven autonomy, this establishes a scalable hardware-software co-design paradigm for machine-driven discovery within strict physical boundaries.
Near–Real-Time Conflict-Related Fire Detection in Sudan Using Unsupervised Deep Learning
Ongoing armed conflict in Sudan highlights the need for rapid monitoring of conflict-related fire-affected areas. Recent advances in deep learning and high-frequency satellite imagery enable near–real-time assessment of active fires and burn scars in war zones. This study presents a near–real-time monitoring approach using a lightweight Variational Auto-Encoder (VAE)–based model integrated with 4-band Planet Labs imagery at 3 m spatial resolution. We demonstrate that these impacted regions can be detected within approximately 24 to 30 hours under favorable observational conditions using accessible, commercially available satellite data. To achieve this, we adapt a VAE–based model, originally designed for 10-band imagery, to operate effectively on high-resolution 4-band inputs. The model is trained in an unsupervised manner to learn compact latent representations of nominal land-surface conditions and identify burn signatures by quantifying changes between temporally paired latent embeddings. Performance is evaluated across five case studies in Sudan and compared against cosine distance, CVA, and IR-MAD using precision, recall, F1-score, and the area under the precision-recall curve (AUPRC) computed between temporally paired image tiles. Results show that the proposed approach consistently outperforms the other methods, achieving higher recall and F1-scores while maintaining viable precision in highly imbalanced fire-detection scenarios. Experiments with 8-band imagery and temporal image sequences yield only marginal performance gains over single 4-band inputs, underscoring the effectiveness of the proposed lightweight approach for scalable, near–real-time conflict monitoring.
Hybrid Acousto-Optical Double Dressing of a Two-Level System
arXiv:2509.25847v2 Announce Type: replace Abstract: We experimentally investigate resonance fluorescence from a two-level system in a novel configuration where a strong laser drives an optical Rabi oscillation while an acoustic field parametrically modulates the frequency of the two-level system. We observe emission spectra that deviate markedly from the standard Mollow triplet, including dynamical cancellation of the central peak. A doubly dressed state model incorporating hybridization among the emitter, optical field, and acoustic field captures these features. Guided by this model, we experimentally validate the condition for optimal cooling of acoustic phonons in an emitter-optomechanical system. These results reveal new regimes of strongly driven quantum nonlinear interactions.
Academic success still assumes uninterrupted careers
Letter to the Editor
Conditional means, vector pricings, amenability and fixed points in cones
arXiv:2512.13829v4 Announce Type: replace Abstract: We develop a generalization of conditional probability for arbitrary ordered vector spaces. A related problem is that of assigning a numerical value to one vector relative to another. We characterize the groups for which these generalized probabilities can be stationary, respectively invariant. Our results deviate from the setting of classical probability and lead to a new criterion for amenability and for fixed points in cones.
It's About Time: Temporal References in Emergent Communication
Emergent communication enables agents to develop bespoke languages that improve communication efficiency. Despite the known importance of temporal structure in natural language, there is no existing evidence of temporal references in emergent communication. This paper addresses this gap, by exploring how agents communicate about temporal relationships. We analyse three potential factors for the emergence of temporal references: environmental, external, and architectural. Our experiments demonstrate that altering the loss function is insufficient for temporal references to emerge; rather, architectural changes are necessary. A minimal change in agent architecture, using a different batching method, allows the emergence of temporal references. This modified design is compared with the standard architecture in a temporal referential games environment, which emphasises temporal relationships. The analysis shows that over 95% of the agents with the modified batching method develop temporal references, without changes to their loss function. We consider temporal referencing necessary for future improvements to the agents' communication efficiency, enabling future agents to use a closer to optimal coding as compared to purely compositional languages. These insights provide the basis for incorporation of temporal references into other emergent communication settings, and investigation of other aspects of language.
BeetleAtlas 2: An enhanced <i>Tribolium castaneum</i> web resource for tissue and developmental transcriptomics allowing refinement of gene predictions
by David P. Leader, Muhammad T. Naseem, Janina L. Rinke, Kenneth Veland Halberg BeetleAtlas is an online resource for tissue- and stage-specific transcriptomics in the red flour beetle, Tribolium castaneum. On updating from the original Tcas5.2 genome assembly to the more recent improved icTriCast1.1 genome assembly it became evident that there were major discrepancies between the gene models of the two genome annotations in use: the OGS3 and the NCBI gene sets. As neither was clearly superior we implemented a new design in BeetleAtlas 2 (beetleatlas.org) comprising two parallel ‘modes’ — one incorporating results using the NCBI gene models and a second incorporating those using the OGS3 gene models. This allows direct comparison where equivalent gene models exist: 50–57% of cases. To aid resolution of discrepancies between the two gene model sets and verification of results, gene models are linked to a custom visualization of RNA-seq read coverage of the genome in the UCSC Genome Browser. This displays reads from 22 tissues and life stages superimposed on the icTriCast1.1 genome assembly. Reference tracks show the NCBI gene models, the OGS3 gene models after translation of their coordinates from the Tcas5.2 assembly, and 1050 discontinued NCBI gene models from the previous assembly after a similar transfer of coordinates. We document various situations in which distinct patterns of expression of the tissues can be used to confirm and extend correlations between the two gene sets, resolve discrepancies between them, make corrections and identify putative genes or exons absent from the current gene sets. BeetleAtlas 2 allows those involved in Tribolium research to avoid the pitfalls inherent in incorrect gene models when planning experiments on specific genes and interpreting the results. It also demonstrates how BeetleAtlas 2 might play an important role in establishing a revised gene set for Tribolium castaneum in the future.
Instance-Aware Knowledge Distillation for Semi-Supervised Learning of an On-Board Multi-Task Dense Prediction Model for Collision Avoidance System
Collision avoidance systems have evolved toward camera-based deep learning approaches for driving scene understanding. However, deployment in edge environments such as country clubs is constrained by limited computational resources and unreliable communication infrastructure. Moreover, constructing large-scale datasets for the target domain involves substantial annotation cost. To address these limitations, we propose an instance-aware knowledge distillation framework for semi-supervised learning. Specifically, we generate pseudo labels that mitigate teacher bias by leveraging domain priors from the teacher and instance-centric knowledge from foundation models. The trained lightweight student is deployed in the proposed collision avoidance system and performs multiple dense prediction tasks in real-time. The system detects frontal obstacles and encodes their spatial information into controller area network messages for automated guided vehicle operation. To achieve this, we construct a large-scale country club dataset and perform field validation of the proposed system. Experimental results demonstrate that the student outperforms the large teacher in instance segmentation while mitigating performance degradation in monocular depth estimation. Compared with the teacher, the student reduces FLOPs by 22.68$\times$ and parameters by 14.33$\times$, achieving 6.46 FPS on a low-cost edge device.
Prevalence and Clinical Impact of Pathogenic Variants in Cardiomyopathy Genes Among Individuals with Cardiac Conduction Disorders
Importance: Cardiac conduction disorders have traditionally been regarded as a secondary manifestation of underlying structural heart diseases. However, isolated conduction disorders may precede the onset of heart failure (HF) suggesting shared mechanisms. Objective: To evaluate the prevalence and clinical significance of pathogenic/likely pathogenic (P/LP) rare variants in cardiomyopathy genes among individuals with conduction disorders. Design, Setting, and Participants: Biobank analysis of 192,834 participants with whole genome sequence data from Vanderbilt's BioVU and 353,092 participants from the All of Us Research Program (AoU). Participants with primary conduction disorder (left bundle branch block [LBBB], right bundle branch block [RBBB], high-grade atrioventricular block [AVB]) were identified after excluding secondary causes. Exposures: P/LP variants in cardiomyopathy genes. Main Outcomes and Measures: Primary outcome was P/LP carrier status by age and HF status. Secondary outcomes included incident HF and composite ventricular arrhythmias/sudden cardiac death/mortality (VA/SCD/mortality). Results: Among 16,959 participants with conduction disorders in BioVU and 13,442 in AoU, 432 (2.6%) and 206 (1.5%) were P/LP carriers, respectively. Conduction disorder was independently associated with carrier status (BioVU p