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Current and Emerging Treatment Options in Atrial Fibrillation
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Current and Emerging Treatment Options in Atrial Fibrillation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 2439

Special Issue Editor

Dr. Marco Valerio Mariani

E-Mail Website
Guest Editor
Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza Università di Roma, 00185 Rome, Italy
Interests: cardiology; arrhythmia; heart failure; coronary artery dissection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to provide a comprehensive overview of the current and emerging treatment options in the field of atrial fibrillation (AF). With the increasing prevalence of AF and the rapid advancements in therapeutic approaches, it is crucial to gather and disseminate the latest research findings to improve patients’ outcomes. This Special Issue will cover a wide range of topics related to the treatment of atrial fibrillation. These include, but are not limited to:

  1. Pharmacological interventions and antiarrhythmic drugs;
  2. Catheter ablation techniques and advancements;
  3. Novel surgical approaches for AF management;
  4. Non-pharmacological therapies, such as lifestyle modifications and alternative treatments;
  5. Device-based therapies, including pacemakers and implantable cardioverter-defibrillators (ICDs);
  6. Personalized medicine in AF treatment.

We invite original research articles, systematic reviews, meta-analyses, and clinical trials that contribute to our understanding and advancement of treatment options for atrial fibrillation. However, please note that mini-reviews and case reports will not be considered for this Special Issue.

This Special Issue aims to bring together cutting-edge research and expert perspectives to enhance our understanding and management of this prevalent cardiac condition. We look forward to receiving submissions that contribute to the advancement of treatment strategies in atrial fibrillation, and ultimately, improve patient care.

Dr. Marco Valerio Mariani
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • atrial fibrillation
  • left atrial appendage closure
  • ablation techniques
  • personalized medicine in AF treatment
  • cardioversion methods

Published Papers (4 papers)

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Research

12 pages, 558 KiB  
Article
Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More?
by Marco Valerio Mariani, Nicola Pierucci, Sara Trivigno, Pietro Cipollone, Agostino Piro, Cristina Chimenti, Domenico Giovanni Della Rocca, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle
J. Clin. Med. 2024, 13(5), 1470; https://doi.org/10.3390/jcm13051470 - 03 Mar 2024
Viewed by 473
Abstract
Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV [...] Read more.
Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h “wait-and-see” approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner. Full article
(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)
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10 pages, 3794 KiB  
Article
Early Clinical Outcomes and Advantages of a Novel-Size Adjustable Second-Generation Cryoballoon: A Proof-of-Concept Study
by Marco Schiavone, Gaetano Fassini, Massimo Moltrasio, Benedetta Majocchi, Fabrizio Tundo, Francesca Casati and Claudio Tondo
J. Clin. Med. 2024, 13(5), 1259; https://doi.org/10.3390/jcm13051259 - 22 Feb 2024
Viewed by 513
Abstract
(1) Background/Objective Balloon-guided catheter ablation (CA) has emerged as an alternative option for atrial fibrillation (AF) management. The recent introduction of a novel-size adjustable second-generation cryoballoon (CB) system offers innovations, but clinical outcomes remain unexplored. This study aims to assess the acute performance [...] Read more.
(1) Background/Objective Balloon-guided catheter ablation (CA) has emerged as an alternative option for atrial fibrillation (AF) management. The recent introduction of a novel-size adjustable second-generation cryoballoon (CB) system offers innovations, but clinical outcomes remain unexplored. This study aims to assess the acute performance of the POLARx FIT™ CB system in AFCA. (2) Methods: Consecutive patients undergoing AF ablation with the POLARx FIT™ CB system in our center were included. The primary outcome was the rate of 31 mm balloon-size utilization, with secondary outcomes including acute pulmonary vein isolation (PVI) rate, periprocedural complications, and in-hospital AF recurrences. (3) Results: Twenty-four patients with a mean age of 59.5 years, predominantly male (87.5%), and exhibiting paroxysmal AF (91.7%) were enrolled. Procedural characteristics demonstrated a high acute success rate (100% PV isolation) with a favorable safety profile. Notably, the 31 mm CB configuration was utilized in 51% of applications, showcasing its adaptability in challenging anatomies. No major complications occurred, with two patients experiencing in-hospital self-limiting AF recurrences. (4) Conclusions: This study represents the first comprehensive assessment of the POLARx FIT™ CB system in AF ablation. While acknowledging the study’s limitations, this novel CB emerges as a promising tool, warranting further exploration in larger studies with extended follow-up periods. Full article
(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)
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15 pages, 5664 KiB  
Article
Pulmonary Vein Isolation Followed by Biatrial Ablation of Rotational Activity in Patients with Persistent Atrial Fibrillation: Results of the Cryo-Vest Study
by Kay Felix Weipert, Julie Hutter, Malte Kuniss, Patrick Kahle, Joerg Yogarajah, Andreas Hain, Johannes Sperzel, Alexander Berkowitsch, Christian W. Hamm and Thomas Neumann
J. Clin. Med. 2024, 13(4), 1118; https://doi.org/10.3390/jcm13041118 - 16 Feb 2024
Viewed by 408
Abstract
Background and Aims: Noninvasive mapping allows the identification of patient-specific atrial rotational activity (RA) that might play a key role in the perpetuation of persistent atrial fibrillation (PsAF). So far, the impact of pulmonary vein isolation by cryoballoon (Cryo-PVI) on RA is [...] Read more.
Background and Aims: Noninvasive mapping allows the identification of patient-specific atrial rotational activity (RA) that might play a key role in the perpetuation of persistent atrial fibrillation (PsAF). So far, the impact of pulmonary vein isolation by cryoballoon (Cryo-PVI) on RA is unclear. Moreover, the long-term effect of periprocedural termination of AF during the ablation procedure is controversial. Methods: Noninvasive electrocardiographic mapping with a 252-electrode vest was performed in 42 patients with PsAF. After the first analysis, Cryo-PVI was performed. The RA was analyzed again and then targeted by radiofrequency catheter ablation. The primary clinical endpoint was periprocedural termination of AF. The secondary endpoint was freedom from any atrial arrhythmia >30 s during a 12-month follow-up. Results: In 33 patients (79%), right atrial RA was identified leading to biatrial ablation, and nine patients (21%) had left atrial RA only. Twelve patients (28.6%) converted from AF to sinus rhythm (SR) (Group A). Thirteen patients (30.9%) converted to atrial tachycardia (AT) (Group B). In 17 patients (40.5%), AF was not terminated by ablation (Group C). After a mean follow-up time of 13.8 months, 26 patients were free from AF and AT (61.9%). In terms of rhythm, control Group A (75%) and B (83.3%) showed higher success rates than Group C (33.3%) (p < 0.01). Cryo-PVI had no substantial impact on RA. Conclusions: The RA-based ablation approach showed acceptable success rates. Periprocedural termination of AF had a positive predictive impact on the outcome. No difference was observed between conversion to SR or to AT. Cryo-PVI had no impact on RA. Full article
(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)
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13 pages, 4895 KiB  
Article
Identification of Atrial Transmural Conduction Inhomogeneity Using Unipolar Electrogram Morphology
by Lu Zhang, Mathijs S. van Schie, Hongxian Xiang, Rongheng Liao, Jiahao Zheng, Paul Knops, Yannick J. H. J. Taverne and Natasja M. S. de Groot
J. Clin. Med. 2024, 13(4), 1015; https://doi.org/10.3390/jcm13041015 - 09 Feb 2024
Viewed by 697
Abstract
(1) Background: Structural remodeling plays an important role in the pathophysiology of atrial fibrillation (AF). It is likely that structural remodeling occurs transmurally, giving rise to electrical endo-epicardial asynchrony (EEA). Recent studies have suggested that areas of EEA may be suitable targets for [...] Read more.
(1) Background: Structural remodeling plays an important role in the pathophysiology of atrial fibrillation (AF). It is likely that structural remodeling occurs transmurally, giving rise to electrical endo-epicardial asynchrony (EEA). Recent studies have suggested that areas of EEA may be suitable targets for ablation therapy of AF. We hypothesized that the degree of EEA is more pronounced in areas of transmural conduction block (T-CB) than single-sided CB (SS-CB). This study examined the degree to which SS-CB and T-CB enhance EEA and which specific unipolar potential morphology parameters are predictive for SS-CB or T-CB. (2) Methods: Simultaneous endo-epicardial mapping in the human right atrium was performed in 86 patients. Potential morphology parameters included unipolar potential voltages, low-voltage areas, potential complexity (long double and fractionated potentials: LDPs and FPs), and the duration of fractionation. (3) Results: EEA was mostly affected by the presence of T-CB areas. Lower potential voltages and more LDPs and FPs were observed in T-CB areas compared to SS-CB areas. (4) Conclusion: Areas of T-CB could be most accurately predicted by combining epicardial unipolar potential morphology parameters, including voltages, fractionation, and fractionation duration (AUC = 0.91). If transmural areas of CB indeed play a pivotal role in the pathophysiology of AF, they could theoretically be used as target sites for ablation. Full article
(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)
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