Recent Advancement and Challenges in Cardiac Arrhythmias

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

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 7017

Special Issue Editors


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Guest Editor
Department of Cardiothoracic Medicine, Fondazione Toscana Gabriele Monasterio—CNR, 56124 Pisa, Italy
Interests: cardiac resynchronization therapy; implantable cardioverter defibrillator; sudden death; ablation
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E-Mail Website
Guest Editor
Department of Cardiology (UTIC), Università degli Studi dell’Aquila, 67100 L’Aquila, AQ, Italy
Interests: arrhythmias; electrophysiology; sudden death; sports cardiology; electrocardiography; heart failure; telemedicine
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli” – Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
Interests: atrial fibrillation; cardiovascular pharmacology; arrhythmic disorders; cardiac pacing; non-vitamin K oral anticoagulants; neuromuscular disorders; muscular dystrophies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Sudden death can be the first manifestation of a lot of pathological conditions. Novel algorithms for the identification of sudden cardiac death risk have been proposed, but more efforts are necessary to avoid this dramatic event. On the other hand, overtreatment, particularly in young patients, is not necessarily beneficial and must be avoided. A tailored and multidimensional approach, involving clinical, genetic and imaging findings, is required and represents our goal in the next few years.

This Special Issue of Journal of Clinical Medicine, “Recent Advancement and Challenges in Cardiac Arrhythmias”, will focus on recent improvements and findings in the field of risk stratification for sudden death. Furthermore, papers are welcome that summarize the current state of knowledge related to specific diseases, underlining potential gaps in our evidence. 

Dr. Martina Nesti
Dr. Luigi Sciarra
Prof. Dr. Vincenzo Russo
Guest Editors

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

  • sudden death
  • ventricular arrhythmias
  • risk stratification
  • electrophysiological study
  • ablation
  • implantable cardioverter defibrillator

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Published Papers (7 papers)

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Research

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20 pages, 15256 KiB  
Article
Twelve-Lead ECG, Holter Monitoring Parameters, and Genetic Testing in Brugada Syndrome: Insights from Analysis of Multigenerational Family with a History of Sudden Cardiac Arrest during Physical Activity
by Paweł T. Matusik, Piotr Bijak, Magdalena Kaźnica-Wiatr, Marek Karpiński, Patrycja S. Matusik, Andrzej Maziarz, Piotr Podolec and Jacek Lelakowski
J. Clin. Med. 2023, 12(20), 6581; https://doi.org/10.3390/jcm12206581 - 18 Oct 2023
Cited by 2 | Viewed by 1310
Abstract
Brugada syndrome (BrS) is an arrhythmogenic disorder increasing the risk of syncopal episodes and sudden cardiac death. BrS usually runs through families with reduced penetrance and variable expression. We analyzed the multigenerational family of a patient who died after sudden cardiac arrest with [...] Read more.
Brugada syndrome (BrS) is an arrhythmogenic disorder increasing the risk of syncopal episodes and sudden cardiac death. BrS usually runs through families with reduced penetrance and variable expression. We analyzed the multigenerational family of a patient who died after sudden cardiac arrest with post-mortem diagnosis of BrS. We analyzed clinical history, comprehensive arrhythmic risk, genetic findings, and additional tests, including electrocardiogram (ECG), detailed 24-hour Holter ECG results, and standard echocardiography findings, and followed up the patients in the ambulatory clinic. We analyzed a pedigree of 33 members of four generations of the family (19 male and 14 female patients). In this family, we identified 7 patients with BrS (median Modified Shanghai Score and Sieira model: 4.5 (4–6) and 1 (0–4) points, respectively), including both parents of the deceased patient, and 8 relatives with negative sodium channel blocker drug challenge test. Genetic testing revealed a novel mutation in sodium voltage-gated channel alpha subunit 5 (SCN5A) c.941A>G, (p.Tyr314Cys) inherited from the father of the proband. Patients with BrS were characterized by longer P-wave duration (120 (102–155) vs. 92.5 (88–110) ms, p = 0.013) and longer PR intervals (211.3 ±26.3 vs. 161.6 ± 18.9 ms, p = 0.001), along with more frequent positive aVR sign, but did not differ in terms of QRS duration or T-wave characteristics in resting ECGs. BrS patients were characterized by lower mean, minimal, and maximal (for all p ≤ 0.01) heart rates obtained from Holter ECG monitoring, while there was no difference in arrhythmias among investigated patients. Moreover, visual diurnal variability of ST segment changes and fragmented QRS complexes were observed in patients with BrS in Holter ECG monitoring. There were no major arrhythmic events during median follow-up of 68.7 months of alive BrS patients. These results suggest ECG features which may be associated with a diagnosis of BrS and indicate a novel SCN5A variant in BrS patients. Twelve-lead Holter ECG monitoring, with modified precordial leads placement, may be useful in BrS diagnostics and risk stratification in personalized medicine. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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Review

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16 pages, 1033 KiB  
Review
Coagulation Tests and Reversal Agents in Patients Treated with Oral Anticoagulants: The Challenging Scenarios of Life-Threatening Bleeding and Unplanned Invasive Procedures
by Andrea Pozzi, Fabiana Lucà, Sandro Gelsomino, Maurizio Giuseppe Abrignani, Simona Giubilato, Stefania Angela Di Fusco, Carmelo Massimiliano Rao, Stefano Cornara, Giorgio Caretta, Roberto Ceravolo, Iris Parrini, Giovanna Geraci, Carmine Riccio, Massimo Grimaldi, Furio Colivicchi, Fabrizio Oliva and Michele Massimo Gulizia
J. Clin. Med. 2024, 13(9), 2451; https://doi.org/10.3390/jcm13092451 - 23 Apr 2024
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Abstract
In clinical practice, the number of patients treated with direct oral anticoagulants (DOACs) has consistently increased over the years. Since anticoagulant therapy has been associated with an annual incidence of major bleeding (MB) events of approximately 2% to 3.5%, it is of paramount [...] Read more.
In clinical practice, the number of patients treated with direct oral anticoagulants (DOACs) has consistently increased over the years. Since anticoagulant therapy has been associated with an annual incidence of major bleeding (MB) events of approximately 2% to 3.5%, it is of paramount importance to understand how to manage anticoagulated patients with major or life-threatening bleeding. A considerable number of these patients’ conditions necessitate hospitalization, and the administration of reversal agents may be imperative to manage and control bleeding episodes effectively. Importantly, effective strategies for reversing the anticoagulant effects of DOACs have been well recognized. Specifically, idarucizumab has obtained regulatory approval for the reversal of dabigatran, and andexanet alfa has recently been approved for reversing the effects of apixaban or rivaroxaban in patients experiencing life-threatening or uncontrolled bleeding events. Moreover, continuous endeavors are being made to develop supplementary reversal agents. In emergency scenarios where specific reversal agents might not be accessible, non-specific hemostatic agents such as prothrombin complex concentrate can be utilized to neutralize the anticoagulant effects of DOACs. However, it is paramount to emphasize that specific reversal agents, characterized by their efficacy and safety, should be the preferred choice when suitable. Moreover, it is worth noting that adherence to the guidelines for the reversal agents is poor, and there is a notable gap between international recommendations and actual clinical practices in this regard. This narrative review aims to provide physicians with a practical approach to managing specific reversal agents. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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18 pages, 1585 KiB  
Review
Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives
by Adriana Argentiero, Maria Cristina Carella, Donato Mandunzio, Giulia Greco, Saima Mushtaq, Andrea Baggiano, Fabio Fazzari, Laura Fusini, Giuseppe Muscogiuri, Paolo Basile, Paola Siena, Nicolò Soldato, Gianluigi Napoli, Vincenzo Ezio Santobuono, Cinzia Forleo, Eduard Claver Garrido, Andrea Di Marco, Gianluca Pontone and Andrea Igoren Guaricci
J. Clin. Med. 2023, 12(24), 7752; https://doi.org/10.3390/jcm12247752 - 18 Dec 2023
Viewed by 990
Abstract
Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents [...] Read more.
Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) ≤ 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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10 pages, 485 KiB  
Review
Arrhythmias in Patients with Congenital Heart Disease: An Ongoing Morbidity
by Despoina Ntiloudi, Spyridon Rammos, Maria Karakosta, Alkistis Kalesi, Nearchos Kasinos and George Giannakoulas
J. Clin. Med. 2023, 12(22), 7020; https://doi.org/10.3390/jcm12227020 - 10 Nov 2023
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Abstract
With the aging of congenital heart disease (CHD) patients, the burden of arrhythmias is expanding. Atrial arrhythmias, especially intra-atrial reentrant tachycardia and atrial fibrillation, are the most prevalent forms of arrhythmia. Managing comorbidities, such as obesity, using pharmacotherapy, including antiarrhythmics and anticoagulants, and [...] Read more.
With the aging of congenital heart disease (CHD) patients, the burden of arrhythmias is expanding. Atrial arrhythmias, especially intra-atrial reentrant tachycardia and atrial fibrillation, are the most prevalent forms of arrhythmia. Managing comorbidities, such as obesity, using pharmacotherapy, including antiarrhythmics and anticoagulants, and ablation therapy has become the cornerstone of arrhythmia management. Ventricular tachycardias are also not rare; however, except for tetralogy of Fallot patients, recommendations for the use of implantable cardioverter defibrillators for primary prevention in other CHD patients are still not well established. Patients with CHD might also present with atrioventricular blockages because of their anatomy or following a surgical procedure. The scope of this article is to review the current knowledge and discuss the future directions regarding arrhythmia management in CHD patients. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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9 pages, 906 KiB  
Brief Report
Association of Prediabetes and Recurrent Stroke in Atrial Fibrillation Patients: A Population-Based Analysis of Hospitalizations and Outcomes
by Rupak Desai, Advait Vasavada, Bhavin A. Patel, Maharshi Raval, Avilash Mondal, Kshitij Mahajan, Nishanth Katukuri, Yash Varma, Akhil Jain and Geetha Krishnamoorthy
J. Clin. Med. 2024, 13(2), 573; https://doi.org/10.3390/jcm13020573 - 19 Jan 2024
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Abstract
Prediabetes is a risk factor for ischemic stroke in atrial fibrillation (AF) patients, yet, its impact on recurrent stroke in AF patients remains understudied. Using the 2018 National Inpatient Sample, we investigated the link between Prediabetes and recurrent stroke in AF patients with [...] Read more.
Prediabetes is a risk factor for ischemic stroke in atrial fibrillation (AF) patients, yet, its impact on recurrent stroke in AF patients remains understudied. Using the 2018 National Inpatient Sample, we investigated the link between Prediabetes and recurrent stroke in AF patients with prior stroke or transient ischemic attack (TIA). Among 18,905 non-diabetic AF patients, 480 (2.5%) had prediabetes. The prediabetic group, with a median age of 78, exhibited a two-fold higher risk of recurrent stroke compared to the non-prediabetic cohort (median age 82), as evidenced by both unadjusted (OR 2.14, 95% CI 1.72–2.66) and adjusted (adjusted for socio-demographics/comorbidities, OR 2.09, 95% CI 1.65–2.64, p < 0.001). The prediabetes cohort, comprising more male and Black patients, demonstrated associations with higher Medicaid enrollment, admissions from certain regions, and higher rates of hyperlipidemia, smoking, peripheral vascular disease, obesity, and chronic obstructive pulmonary disease (all p < 0.05). Despite higher rates of home health care and increased hospital costs in the prediabetes group, the adjusted odds of all-cause mortality were not statistically significant (OR 0.55, 95% CI 0.19–1.56, p = 0.260). The findings of this study suggest that clinicians should be vigilant in managing prediabetes in AF patients, and strategies to prevent recurrent stroke in this high-risk population should be considered. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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9 pages, 277 KiB  
Perspective
The Subcutaneous Implantable Cardioverter-Defibrillator: A Patient Perspective
by Martina Nesti, Vincenzo Russo, Zefferino Palamà, Luca Panchetti, Silvia Garibaldi, Umberto Startari, Gianluca Mirizzi, Marcello Piacenti, Andrea Rossi and Luigi Sciarra
J. Clin. Med. 2023, 12(20), 6675; https://doi.org/10.3390/jcm12206675 - 22 Oct 2023
Viewed by 679
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a new technology for the management of ICD patients. But what is the patients’ perspective? Previous studies on the transvenous ICD (TV-ICD) showed that device implantation is related not only to anxiety and depression because of the [...] Read more.
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a new technology for the management of ICD patients. But what is the patients’ perspective? Previous studies on the transvenous ICD (TV-ICD) showed that device implantation is related not only to anxiety and depression because of the fear of ICD shocks, but also to many biopsychosocial factors like body image changes, perceived reduction of socialization and limitation in professional and sports activities. Anxiety and distress are more evident in younger women because of aesthetic reasons. The scar size and the position of the S-ICD can help these patients and positively influence their social relationships. Moreover, the position of the S-ICD reduces possible complications from catheters due to stress injury and can improve patients’ professional life by avoiding some work activity limitations. An S-ICD can be also a good option for athletes in avoiding subclavian crash and reducing inappropriate shocks. However, some questions remain unsolved because an S-ICD is not suitable for patients with indications for pacing, cardiac resynchronization therapy or anti-tachycardia pacing. In conclusion, the use of an S-ICD can assist physicians in reducing the negative impact of implantation on the well-being of some groups of patients by helping them to avoid depression and anxiety as well as improving their noncompliance with their medical treatment. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
8 pages, 4971 KiB  
Case Report
Left Atrial Appendage Occlusion on a Beating Heart during Minimally Invasive Valve Surgery Using an Aortic Endoclamp: A Case Report
by Mathieu N. Suleiman, Ann-Sophie Kaemmerer, Jörg Fechner, Ehab Nooh, Michael Weyand and Christian Heim
J. Clin. Med. 2023, 12(19), 6325; https://doi.org/10.3390/jcm12196325 - 30 Sep 2023
Viewed by 900
Abstract
Concomitant LAA occlusion has been shown to be an effective and safe treatment for patients with atrial fibrillation during cardiac surgery to prevent embolic stroke. Minimally invasive procedures are challenging due to restricted access to and visibility of the surgical site. Also, aortic [...] Read more.
Concomitant LAA occlusion has been shown to be an effective and safe treatment for patients with atrial fibrillation during cardiac surgery to prevent embolic stroke. Minimally invasive procedures are challenging due to restricted access to and visibility of the surgical site. Also, aortic endoclamping has been developed as an alternative surgical approach to exoclamping. The aim of this article is to demonstrate the method of beating heart LAA occlusion with the Atriclip® (AtriCure, Mason, OH, USA) device during minimally invasive mitral valve surgery while using the endoclamping alternative for aortic cross-clamping. Full article
(This article belongs to the Special Issue Recent Advancement and Challenges in Cardiac Arrhythmias)
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