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Atrial Fibrillation: Advances in Diagnosis and Contemporary Management Strategies
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Atrial Fibrillation: Advances in Diagnosis and Contemporary Management Strategies

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

Deadline for manuscript submissions: closed (20 April 2024) | Viewed by 3198

Special Issue Editor

Dr. Guy Rozen

E-Mail Website
Guest Editor
Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA 02111, USA
Interests: clinical cardiac electrophysiology; atrial fibrillation; novel catheter ablation techniques; left atrial occlusion; physiologic pacing

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) is being increasingly recognized as the cardiovascular epidemic of the 21st century, impacting millions globally. The clinical and economic burden of AF is anticipated to increase with the ongoing population aging and rise in prevalence of risk factors such as obesity, hypertension, sleep apnea and others. Given its association with an increased risk of stroke, heart failure and mortality, an early diagnosis and effective management of AF are paramount. Over the past decade, significant advancements have been achieved in the field of AF, from innovative diagnostic tools that facilitate early detection, to changes in the paradigm of AF management, favoring patient-tailored rhythm control management to improve patient outcomes. In parallel, cutting-edge technologies that revolutionized AF management procedures, including novel electro-anatomical mapping systems, advanced ablation catheters and techniques and left atrial appendage occlusion devices, have been transforming patient care in the last two decades. This Special Issue aims to explore the most recent advancements in the diagnosis and treatment of atrial fibrillation. Researchers in the field of atrial fibrillation are encouraged to submit original articles or reviews to this Special Issue. With contributions from leading experts, this Special Issue intends to provide a valuable resource for clinical researchers and doctors involved in atrial fibrillation care, paving the way for improved outcomes for patients with this challenging arrhythmia.

Dr. Guy Rozen
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
  • ablation therapy
  • cardiac electrophysiology
  • interventional electrophysiology
  • cardiac arrhythmias
  • cardiac resynchronization therapy

Published Papers (3 papers)

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Research

11 pages, 1201 KiB  
Article
New Score for Predicting Results after Catheter Ablation for Atrial Fibrillation: VAT-DHF
by Alexandrina Nastasă, Ștefan Bogdan, Corneliu Iorgulescu, Andrei Dan Radu, Luminița Craițoiu-Nirlu and Radu Gabriel Vătășescu
J. Clin. Med. 2024, 13(1), 61; https://doi.org/10.3390/jcm13010061 - 22 Dec 2023
Viewed by 633
Abstract
Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required [...] Read more.
Introduction: Catheter ablation (CA) for atrial fibrillation (AF) has been proven to have the highest efficacy in maintaining sinus rhythm. Several studies have proposed different scores for predicting post-procedural success, but most have not been validated in prospective cohorts. Further research is required to determine the optimal formulae. Purpose: This study aimed to identify independent predictors of AF recurrence after CA and develop a composite score. Methods: Consecutive patients with persistent and paroxysmal AF who underwent CA were retrospectively analyzed. The independent predictors of recurrence were used to create a new predictive score. Results: The cohort included 263 patients with a follow-up of 37.6 ± 23.4 months. Persistent AF, f-waves < 0.1 mV, indexed left atrium volume, the presence of type 2 diabetes, and smaller height were independent predictors of recurrence and were used to create a new scoring model, VAT-DHF (V = Volume, AT = AF Type, D = Diabetes, H = Height, F = f waves). The ROC curve for this new score showed an AUC of 0.869, p < 0.0001, 95% CI [0.802–0.936], while those for APPLE and CHA2DS2-VASc showed an AUC of 0.765, 95% CI [0.637–0.893] and an AUC of 0.655, 95% CI [0.580–0.730], respectively. Patients who had a VAT-DHF score between 0 and 3.25, 3.25 and 6, and ≥6, had success rates of 95.7%, 76.3%, and 25% (p < 0.0001), respectively. Conclusions: The novel VAT-DHF score is easy to calculate and may be a useful clinical tool for identifying patients with a low, intermediate, or high risk of AF recurrence after CA. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Advances in Diagnosis and Contemporary Management Strategies)
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12 pages, 1086 KiB  
Article
Discontinuation of Oral Anticoagulants in Atrial Fibrillation Patients: Impact of Treatment Strategy and on Patients’ Health Status
by Ryo Nakamaru, Nobuhiro Ikemura, Takehiro Kimura, Yoshinori Katsumata, Charles F. Sherrod, Hiroshi Miyama, Yasuyuki Shiraishi, Hideaki Kanki, Koji Negishi, Ikuko Ueda, Keiichi Fukuda, Seiji Takatsuki and Shun Kohsaka
J. Clin. Med. 2023, 12(24), 7712; https://doi.org/10.3390/jcm12247712 - 15 Dec 2023
Viewed by 857
Abstract
Aims: The discontinuation of oral anticoagulants (OACs) remains as a significant concern in the management of atrial fibrillation (AF). The discontinuation rate may vary depending on management strategy, and physicians may also discontinue OACs due to concerns about patient satisfaction with their care. [...] Read more.
Aims: The discontinuation of oral anticoagulants (OACs) remains as a significant concern in the management of atrial fibrillation (AF). The discontinuation rate may vary depending on management strategy, and physicians may also discontinue OACs due to concerns about patient satisfaction with their care. We aimed to assess the incidence of OAC discontinuation and its relationship to patients’ health in an outpatient AF registry. Methods and Results: From a multicenter registry for newly recognized AF patients (n = 3313), we extracted 1647 (49.7%) patients with OACs and a CHA2DS2-Vasc score of ≥2. Discontinuation was defined as sustained cessation of OACs within a 1-year follow-up. We examined predictors associated with discontinuation and its relations to health status defined by the AFEQT questionnaire. Of the 1647 patients, 385 (23.6%) discontinued OACs after 1 year, with discontinuation rates varying across treatment strategies (15.3% for catheter ablation, 4.9% for rhythm control with antiarrhythmic drugs, and 3.0% for rate control). Successful rhythm control was associated with discontinuation in the catheter ablation (OR 6.61, 95% CI 3.00–14.6, p < 0.001) and antiarrhythmic drugs (OR 6.47, 95% CI 2.62–15.9, p < 0.001) groups, whereas the incidence of bleeding events within 1 year was associated with discontinuation in the rate control group. One-year AFEQT scores did not significantly differ between patients who discontinued OACs and those who did not in each treatment strategy group. Conclusions: OAC discontinuation was common among AF patients with significant stroke risk but varied depending on the chosen treatment strategy. This study also found no significant association between OAC discontinuation and patients’ health status. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Advances in Diagnosis and Contemporary Management Strategies)
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11 pages, 1007 KiB  
Article
Anticoagulants versus Left Atrial Appendage Occlusion in Patients with Atrial Fibrillation and Co-Morbid Thrombocytopenia
by Wiktoria Kowalska, Katarzyna Mitręga, Anna Olma, Tomasz Podolecki, Zbigniew Kalarus and Witold Streb
J. Clin. Med. 2023, 12(24), 7637; https://doi.org/10.3390/jcm12247637 - 12 Dec 2023
Viewed by 770
Abstract
Left atrial appendage closure (LAAC) is an alternative approach to anticoagulants. Nonetheless, data regarding the outcomes of LAAC procedures in patients with thrombocytopenia remain lacking. The primary objective was to determine the incidence of the composite endpoint comprising ischemic stroke, intracranial hemorrhage, major [...] Read more.
Left atrial appendage closure (LAAC) is an alternative approach to anticoagulants. Nonetheless, data regarding the outcomes of LAAC procedures in patients with thrombocytopenia remain lacking. The primary objective was to determine the incidence of the composite endpoint comprising ischemic stroke, intracranial hemorrhage, major bleeding, and cardiac cause of death among patients with atrial fibrillation (AF) and thrombocytopenia who were either undergoing LAAC or receiving oral anticoagulants. The secondary endpoint was the determination of total mortality. Data from a prospective, single-center registry of patients undergoing LAAC procedures were analyzed. A subset of 50 consecutive patients with thrombocytopenia were selected. Thrombocytopenia was defined as a thrombocyte count below 150,000. Subsequently, from patients hospitalized with AF receiving oral anticoagulants, 50 patients were further chosen based on propensity score matching, ensuring comparability with the study group. The primary endpoint occurred in 2% of patients in the LAAC group and 10% of patients in the non-LAAC group (p = 0.097). Additionally, a significant difference was noted in the occurrence of the secondary endpoint, which was observed in 0% of patients in the LAAC group and 10% of patients in the non-LAAC group (p = 0.025). In patients with thrombocytopenia the LAAC procedure improves prognosis compared with continued anticoagulant treatment. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Advances in Diagnosis and Contemporary Management Strategies)
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