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Atrial Arrhythmias: Diagnosis, Management and Future Opportunities

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Dear Colleagues,

This is a formal invitation to be part of a new Special Issue of the Journal of Clinical Medicine. The title is self-explanatory: “Atrial Arrhythmias: Diagnosis, Management and Future Opportunities”. Due to the technological advancements in diagnostic tools and better clinical knowledge of pathophysiology, we are rethinking old concepts and facing new topics every single day. The consolidation and widespread use of newer and more advanced mapping as well as ablation technologies of atrial arrhythmias have substantially contributed to the growing interest in this field.

Among the several topics of interest, we would like to focus on the mapping and ablation of atrial arrhythmias, particularly focusing on post-AF ablation atrial arrhythmias’ mapping and ablation aspects.

Therefore, the aim of this Special Issue is to provide JCM readers with an update on the pathophysiology, diagnosis, and treatment of atrial arrhythmias.

Dr. Sergio Conti
Guest Editor

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Keywords

atrial fibrillation ablation
atrial tachycardia
atrial flutter
redo
repeat ablation
3D mapping
mapping technolo-gies and techniques

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10 pages, 1998 KiB

Open AccessArticle

CT-Assessment of Epicardial Fat Identifies Increased Inflammation at the Level of the Left Coronary Circulation in Patients with Atrial Fibrillation

by Renáta Gerculy, Imre Benedek, István Kovács, Nóra Rat, Vasile Bogdan Halațiu, Ioana Rodean, Lehel Bordi, Emanuel Blîndu, Aurelian Roșca, Botond-Barna Mátyás, Evelin Szabó, Zsolt Parajkó and Theodora Benedek

J. Clin. Med. 2024, 13(5), 1307; https://doi.org/10.3390/jcm13051307 - 26 Feb 2024

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Background: Atrial fibrillation (AF) can often be triggered by an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score have prognostic value for predicting future cardiovascular events. Our purpose was to investigate the correlation between pericoronary fat inflammation and the presence of AF among patients with coronary artery disease. Patients and methods: Eighty-one patients (mean age 64.75 ± 7.84 years) who underwent 128-slice CCTA were included in this study and divided into two groups: group 1 comprised thirty-six patients with documented AF and group 2 comprised forty-five patients without a known history of AF. Results: There were no significant differences in the absolute value of fat attenuation between the study groups (p > 0.05). However, the mean FAI Score was significantly higher in patients with AF (15.53 ± 10.29 vs. 11.09 ± 6.70, p < 0.05). Regional analysis of coronary inflammation indicated a higher level of this process, especially at the level of the left anterior descending artery (13.17 ± 7.91 in group 1 vs. 8.80 ± 4.75 in group 2, p = 0.008). Conclusions: Patients with AF present a higher level of perivascular inflammation, especially in the region of the left coronary circulation, and this seems to be associated with a higher risk of AF development. Full article

(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)

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15 pages, 1557 KiB

Open AccessArticle

Adverse Events and Clinical Correlates in Asian Patients with Atrial Fibrillation and Diabetes Mellitus: A Report from Asia Pacific Heart Rhythm Society Atrial Fibrillation Registry

by Tommaso Bucci, Katarzyna Nabrdalik, Alena Shantsila, Giulio Francesco Romiti, Wee-Siong Teo, Hyung-Wook Park, Wataru Shimizu, Hung-Fat Tse, Marco Proietti, Tze-Fan Chao, Gregory Y. H. Lip and Asia-Pacific Heart Rhythm Society Atrial Fibrillation Registry Investigators

J. Clin. Med. 2024, 13(5), 1274; https://doi.org/10.3390/jcm13051274 - 23 Feb 2024

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Abstract

Aims. To evaluate the adverse events (and its clinical correlates) in a large prospective cohort of Asian patients with atrial fibrillation (AF) and diabetes mellitus (DM). Material and Methods. We recruited patients with atrial fibrillation (AF) from the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry and included those for whom the diabetic mellitus (DM) status was known. We used Cox-regression analysis to assess the 1-year risk of all-cause death, thromboembolic events, acute coronary syndrome, heart failure and major bleeding. Results. Of 4058 patients (mean age 68.5 ± 11.8 years; 34.4% females) considered for this analysis, 999 (24.6%) had DM (age 71 ± 11 years, 36.4% females). Patients with DM had higher mean CHA₂DS₂-VASc (2.3 ± 1.6 vs. 4.0 ± 1.5, p < 0.001) and HAS-BLED (1.3 ± 1.0 vs. 1.7 ± 1.1, p < 0.001) risk scores and were less treated with rhythm control strategies compared to patients without DM (18.7% vs. 22.0%). After 1-year of follow-up, patients with DM had higher incidence of all-cause death (4.9% vs. 2.3%, p < 0.001), cardiovascular death (1.3% vs. 0.4%, p = 0.003), and major bleeding (1.8% vs. 0.9%, p = 0.002) compared to those without DM. On Cox regression analysis, adjusted for age, sex, heart failure, coronary and peripheral artery diseases and previous thromboembolic event, DM was independently associated with a higher risk of all-cause death (HR 1.48, 95% CI 1.00–2.19), cardiovascular death (HR 2.33, 95% CI 1.01–5.40), and major bleeding (HR 1.91, 95% 1.01–3.60). On interaction analysis, the impact of DM in determining the risk of all-cause death was greater in young than in older patients (p int = 0.010). Conclusions. Given the high rates of adverse outcomes in these Asian AF patients with DM, efforts to optimize the management approach of these high-risk patients in a holistic or integrated care approach are needed. Full article

(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)

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