Cardiac Electrophysiology: New Insights and Future Directions

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

Deadline for manuscript submissions: 31 August 2024 | Viewed by 519

Special Issue Editor


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Guest Editor
3rd Department of Cardiology, National and Kapodistrian University of Athens, 17674 Athens, Greece
Interests: cardiac electrophysiology; device therapy; atrial fibrillation; ventricular arrhythmias; sudden cardiac death; catheter ablation
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Special Issue Information

Dear Colleagues,

Amidst the worldwide COVID-19 pandemic, significant progress has been made over the previous years regarding our comprehension of arrhythmia processes and diagnostics, as well as the development of novel therapeutics.

Our knowledge of the risk factors and processes of atrial arrhythmias, as well as the ability to anticipate and treat them, has been enhanced by the application of machine learning and artificial intelligence. Recent advancements in the field of atrial fibrillation ablation have introduced novel technology and techniques, such as pulsed field ablation. Recent randomized trials in atrial fibrillation ablation have provided valuable information regarding rhythm control and long-term results. Significant progress has been made in comprehending the management of inherited disorders, such as catecholaminergic polymorphic ventricular tachycardia. We have acquired understanding regarding the reappearance of ventricular arrhythmias in the context of different illnesses, such as myocarditis and inherited syndromes. Advanced computational methods can be used to forecast the occurrence of ventricular arrhythmias and accurately identify the location of the arrhythmias in order to assist with ablation procedures. Our comprehension of noninvasive radiotherapy has made additional progress.

We have enhanced our comprehension of the role of His bundle pacing and left bundle branch area pacing in order to uphold simultaneous ventricular activation. Significant progress has also been made in the field of defibrillators, cardiac resynchronization therapy, remote monitoring and infection prevention. Moreover, significant progress has been made in comprehending the paths and mechanisms responsible for the development of atrial and ventricular arrhythmias.

In the current Special Issue, we focus on the latest advancements, developments and discoveries in the domain of identifying and managing rhythm disturbances. Furthermore, manuscripts summarizing the current state of knowledge, original articles on arrhythmias related to specific diseases or disciplines, and those highlighting potential gaps in our understanding are also welcome.

Dr. Michael Spartalis
Guest Editor

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Keywords

  • cardiac arrhythmias
  • atrial fibrillation
  • ventricular arrhythmias
  • remote monitoring
  • implantable cardioverter–defibrillators
  • cardiac resynchronization therapy
  • catheter ablation
  • channelopathies

Published Papers (1 paper)

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Research

13 pages, 1537 KiB  
Article
Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation
by Márton Boga, Gábor Orbán, Péter Perge, Zoltán Salló, Edit Tanai, Arnold Béla Ferencz, Patrik Tóth, Ferenc Komlósi, István Osztheimer, Klaudia Vivien Nagy, Béla Merkely, László Gellér and Nándor Szegedi
J. Clin. Med. 2024, 13(7), 1960; https://doi.org/10.3390/jcm13071960 - 28 Mar 2024
Viewed by 377
Abstract
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates [...] Read more.
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)
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