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

Deadline for manuscript submissions: closed (25 June 2022) | Viewed by 21184

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Prof. Dr. Katarzyna Mizia-Stec

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First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 47 Ziolowa St., 40-635 Katowice, Poland
Interests: cardiac arrhythmias; heart failure; pulmonary hypertension; valular heart disease; imaging modalities; endothelial dysfunction
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Dear colleagues,

Current medicine is rapidly growing. Advances in our knowledge of the scientific and clinical aspects of atrial fibrillation (AF) have enabled progress in AF treatment. This fact is of particularimportance because AF constitutes the most common arrhythmia; its prevalence has risen to epidemic levels worldwide and will grow over the next decades. The public health dimension of AF underlines the recognition of AF risk factors as well as AF prediction and management.

The scientfic and clinical aspects of AF involve both targeted prevention programs and the current developments in diagnosis, monitoring and treatment, including current technological and methodological advances.

Novel diagnostic tools offer insight into AF diagnosis, AF burden, atrial cardiomyopathy and thromboembolic risk. Rhythm control or rate control and stroke prophylaxis are the cornerstones of AF therapy; however, all these strategies have been constantly improved evolution. Because of the limited efficacy of antiarrhythmic drugs for risk factors’ modification, “up-stream” therapy and AF ablation have become primary therapeutic strategies. Pulmonary vein isolation is the main but not only form of AF ablation. Several new ablation techniques and technologies and stroke prophylaxes are being explored. New conceptional and technological evolution (e.g., eHealth and artificial inteligence) promises an exciting future in the development of complex AF approaches.

In this Special Issue, we invite researchers to submit high-quality original papers on new insights into the prevalence, pathophysiology, diagnosis, monitoring, risk prediction, prophylaxis and treatment options of AF.

Prof. Dr. Katarzyna Mizia-Stec
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
Pathogenesis
Monitoring
Imaging modalities
Risk prediction
Anticoagulation
Antiarrhythmic drugs
Up-stream therapy
Ablation

Published Papers (10 papers)

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Research

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14 pages, 3068 KiB

Open AccessArticle

Fibrillatory Wave Amplitude Evolution during Persistent Atrial Fibrillation Ablation: Implications for Atrial Substrate and Fibrillation Complexity Assessment

by Fabien Squara, Didier Scarlatti, Sok-Sithikun Bun, Pamela Moceri, Emile Ferrari, Olivier Meste and Vicente Zarzoso

J. Clin. Med. 2022, 11(15), 4519; https://doi.org/10.3390/jcm11154519 - 3 Aug 2022

Cited by 2 | Viewed by 1350

Abstract

Background. Fibrillatory Wave Amplitude (FWA) has been described as a non-invasive marker of atrial fibrillation (AF) complexity, and it predicts catheter ablation outcome. However, the actual determinants of FWA remain incompletely understood. Objective. To assess the respective implications of anatomical atrial substrate and AF spectral characteristics for FWA. Methods. Persistent AF patients undergoing radiofrequency catheter ablation were included. FWA was measured on 1-min ECG by TQ concatenation in Lead I, V1, V2, and V5 at baseline and immediately before AF termination. FWA evolution during ablation was compared to that of AF dominant frequency (DF) measured by Independent Component Analysis on 12-lead ECG. FWA was compared to the extent of endocardial low-voltage areas (LVA I < 10%; II 10–20%; III 20–30%; IV > 30%), to the surface of healthy left atrial tissue, and to P-wave amplitude in sinus rhythm. The predictive value of FWA for AF recurrence during follow-up was assessed. Results. We included 29 patients. FWA remained stable along ablation procedure with comparable values at baseline and before AF termination (Lead I p = 0.54; V1 p = 0.858; V2 p = 0.215; V5 p = 0.14), whereas DF significantly decreased (5.67 ± 0.68 vs. 4.95 ± 0.58 Hz, p < 0.001). FWA was higher in LVA-I than in LVA-II, -III, and -IV in Lead I and V5 (p = 0.02 and p = 0.01). FWA in V5 was strongly correlated with the surface of healthy left atrial tissue (R = 0.786; p < 0.001). FWA showed moderate to strong correlation to P-wave amplitude in all leads. Finally, FWA did not predict AF recurrence after a follow-up of 23.3 ± 9.8 months. Conclusions. These findings suggest that FWA is unrelated to AF complexity but is mainly determined by the amount of viable atrial myocytes. Therefore, FWA should only be referred as a marker of atrial tissue pathology. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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10 pages, 1335 KiB

Open AccessArticle

by Do Young Kim, Yun Gi Kim, Ha Young Choi, Yun Young Choi, Ki Yung Boo, Kwang-No Lee, Seung-Young Roh, Jaemin Shim, Jong-Il Choi and Young-Hoon Kim

J. Clin. Med. 2022, 11(11), 3111; https://doi.org/10.3390/jcm11113111 - 31 May 2022

Cited by 2 | Viewed by 1359

Abstract

(1) Background: We hypothesized that female sex would have a differential impact on left atrial (LA) low-voltage areas (LVAs) according to CHA₂DS₂-VA scores. (2) Methods: This study included 553 patients who underwent radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). LVAs were defined as regions with bipolar peak-to-peak voltages of <0.5 mV. The proportion of LVAs was calculated by dividing the total LVA by the LA surface area. (3) Results: There was no sex-related difference in LA LVAs among patients with a CHA₂DS₂-VA scores ≤ 2. The proportion of LVAs was significantly higher in females among patients with CHA₂DS₂-VA scores of 3 or 4 (10.1 (4.7–15.1)% vs. 15.8 (9.2–32.1)%; p = 0.027). Female sex was significantly associated with extensive LVAs (LVA proportion ≥ 30%). Females had odd ratios of 27.82 (95% confidence interval (CI) 3.33–756.8, p = 0.01), and 1.53 (95% CI 0.81–2.83, p = 0.184) for extensive LAVs in patients with CHA₂DS₂-VA scores ≥ 3 and CHA₂DS₂-VA scores < 3, respectively. In the multiple regression model, female patients with a CHA₂DS₂-VA ≥3 were significantly associated with a higher proportion of LVAs (β = 8.52, p = 0.039). (4) Conclusions: Female sex was significantly associated with extensive LVAs, particularly when their CHA₂DS₂-VA scores were ≥3. This result suggests that female sex has a differential effect on the extent of LVAs based on the presence of additional risk factors. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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9 pages, 1068 KiB

Open AccessArticle

ABO Blood Type Is Associated with Thrombotic Risk in Patients with Nonvalvular Atrial Fibrillation

by Albert Youngwoo Jang, Jeongduk Seo, Yae Min Park, Yong Hoon Shin, Joonpyo Lee, Pyung Chun Oh, Woong Chol Kang, Wook-Jin Chung and Jeonggeun Moon

J. Clin. Med. 2022, 11(11), 3064; https://doi.org/10.3390/jcm11113064 - 29 May 2022

Cited by 2 | Viewed by 2036

Abstract

Blood type is reportedly correlated with the occurrence of cardiovascular diseases, presumably because of its effect on thrombogenicity. However, the relationship between blood type and thrombotic complications in atrial fibrillation (AF) remains unclear. This retrospective study analyzed the blood types of 1170 AF patients (mean age, 70 years; 58% men) who were followed up for up to 4 years. Patients with greater than mild mitral stenosis or prosthetic valves were excluded. The cohort included 305 (26%) type O, 413 (35%) type A, 333 (28%) type B, and 119 (10%) type AB patients. The primary endpoint of major adverse cerebrovascular events (MACE) occurred in 52 (4.4%) patients. When longitudinal outcomes were plotted, AB blood type patients had worse prognosis than non-AB blood type patients (p = 0.039), particularly type O blood patients (p = 0.049). Multivariate Cox regression analysis revealed that AB blood type was associated with higher MACE rates (adjusted hazard ratio, 2.01; 95% confidence interval, 1.01–4.00; p = 0.048) than non-AB blood types independent of anticoagulation therapy duration or CHA2DS2-VASc score. These indicate that AF patients with AB blood type are at an increased risk of MACE compared to those with non-AB blood type independent of the duration of anticoagulation or the CHA₂DS₂-VASc score. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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10 pages, 761 KiB

Open AccessArticle

Efficacy of Electrical Cardioversion in Relation to Occurrence and Type of Functional Mitral Regurgitation in Patients with Atrial Fibrillation

by Konrad Klocek, Katarzyna Klimek, Michał Tworek, Karolina Wrona-Kolasa, Małgorzata Cichoń, Maciej Wybraniec and Katarzyna Mizia-Stec

J. Clin. Med. 2022, 11(8), 2069; https://doi.org/10.3390/jcm11082069 - 7 Apr 2022

Cited by 1 | Viewed by 1411

Abstract

Background: Recent studies have changed the perception of rhythm control in the treatment of atrial fibrillation (AF). Functional mitral regurgitation (fMR) can be both a cause and a consequence of AF and may influence rhythm restoration procedures. Materials and methods: A retrospective analysis included 182 consecutive patients with AF on optimal medical therapy (OMT) undergoing electrical cardioversion (CVE). Based on transthoracic echocardiography, the study group was divided into 20 (11%) patients without mitral regurgitation (MR) and 132 (82%) with fMR 77 (58%) with atrial fMR (afMR; left ventricle ejection fraction (LVEF) ≥ 50%, left atrial (LA) dilatation) and 55 (42%) and with ventricular fMR (vfMR; LVEF < 50%). Patients with severe and organic MR were excluded from the study. Results: vfMR patients had a greater incidence of kidney failure (p = 0.01) and coronary heart disease (p = 0.02); more frequent use of diuretics during hospitalization (p < 0.01); greater LA diameter and area (p < 0.01; p < 0.01) than afMR patients. CVE efficiency was high in all four groups (84–95%). The presence and type of fMR did not affect the efficacy of CVE (p = 0.2; p = 0.9) and did not require the use of more energy (p = 0.4; p = 0.8). The independent predictor of successful CVE was the amount of white blood cells (OR 0.74, p < 0.05). Conclusions: Efficacy of CVE is high among AF patients on OMT regardless of the incidence and type of fMR. Subclinical inflammation should be excluded before elective CVE because it may decrease its efficacy. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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13 pages, 1899 KiB

Open AccessArticle

AF Inducibility Is Related to Conduction Abnormalities at Bachmann’s Bundle

by Lianne N. van Staveren, Willemijn F. B. van der Does, Annejet Heida, Yannick J. H. J. Taverne, Ad J. J. C. Bogers and Natasja M. S. de Groot

J. Clin. Med. 2021, 10(23), 5536; https://doi.org/10.3390/jcm10235536 - 26 Nov 2021

Cited by 4 | Viewed by 1609

Abstract

We investigated whether patterns of activation at Bachmann’s bundle are related to AF inducibility. Epicardial mapping of Bachmann’s bundle during sinus rhythm was performed prior to cardiac surgery (192 electrodes, interelectrode distances: 2 mm). Compared to non-inducible patients (N = 20), patients with inducible AF (N = 34) had longer lines of conduction block (18(2–164) mm vs. 6(2–28) mm, p = 0.048), prolonged total activation time (55(28–143) ms vs. 46(24–73) ms, p = 0.012), multiple wavefronts entering Bachmann’s bundle more frequently (64% vs. 37%, p = 0.046) and more often areas of simultaneous activation (conduction velocity > 1.7 m/s, 45% vs. 16%, p = 0.038). These observations further support a relation between conduction abnormalities at Bachmann’s bundle and AF inducibility. The next step is to examine whether Bachmann’s bundle activation patterns can also be used to identify patients who will develop AF after cardiac surgery during both short- and long-term follow-up. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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9 pages, 799 KiB

Open AccessArticle

Vascular Protective Effects of New Oral Anticoagulants in Patients with Atrial Fibrillation

by Gyeong-Won Jang, Jung Myung Lee, Seung Woo Choi, Joan Kim, Young Shin Lee, Hyung Oh Kim, Hyemoon Chung, Jong Shin Woo, Jin Bae Kim, Woo-Shik Kim and Weon Kim

J. Clin. Med. 2021, 10(19), 4332; https://doi.org/10.3390/jcm10194332 - 23 Sep 2021

Cited by 1 | Viewed by 1653

Abstract

This study was designed to determine the efficacy of a new oral anticoagulant (NOAC) therapy for the prevention of endothelial dysfunction and atherosclerosis progression in patients with atrial fibrillation (AF). Sixty-five AF patients with a CHA2DS2-VASc score ≥2 without previous history of cardiovascular disease were registered and randomly assigned to either an NOAC group (dabigatran or rivaroxaban) or the warfarin group. Reactive hyperemia peripheral arterial tonometry (RH-PAT) measurements reflecting endothelial function were taken using Endo-PAT2000. Carotid intima–media thickness (IMT) was measured at baseline, 12 months, and 24 months, and several biomarkers were also analyzed. For the primary end point, the reactive hyperemia index (RHI) for the NOAC group was 1.5 ± 0.4 and that for the warfarin group was 1.6 ± 0.5. The left and right carotid IMT was 0.7 mm in the NOAC groups and 0.8 mm in the warfarin group. At 12 months, RHI was 1.6 ± 0.3 for the dabigatran group, 1.6 ± 0.5 for the rivaroxaban group, and 1.6 ± 0.3 for the warfarin group. The three groups did not differ statistically with respect to change in left and right carotid IMT at 12 and 24 months, respectively. The biomarkers for endothelial function and atherosclerosis were not significantly different. There was a trend of reduced P-selectin levels in the NOAC group compared to the warfarin group. In patients with AF, there were no significant differences in the prevention of endothelial dysfunction and atherosclerosis progression between the NOAC and warfarin groups. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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11 pages, 850 KiB

Open AccessArticle

Relative Importance of Heart Failure Events Compared to Stroke and Bleeding in AF Patients

by Sandro Ninni, Gilles Lemesle, Thibaud Meurice, Olivier Tricot, Nicolas Lamblin and Christophe Bauters

J. Clin. Med. 2021, 10(5), 923; https://doi.org/10.3390/jcm10050923 - 28 Feb 2021

Cited by 4 | Viewed by 1552

Abstract

Introduction: Incident heart failure (HF), ischemic stroke and systemic embolism (IS/SE), and major bleeding related to anticoagulation therapy are still the most frequent events occurring in patients with atrial fibrillation (AF). The aim of this study was to assess the 3-year incidence, predictors, and related mortality of IS/SE, major bleeding, and HF in a large cohort of AF outpatients. Methods and results: We studied 4973 outpatients with prevalent AF included in the CARDIONOR registry. The mean age was 72.9 ± 11.2 years, 24.1% had diabetes mellitus and 78.9% had anticoagulant therapy at baseline. The mean CHA₂DS₂Vasc score was 3.4 ± 1.7. After a median follow-up of 3.2 years (IQR: 2.8 to 3.5), incident HF, IS/SE and major bleeding occurred in 10.5%, 3.3% and 2.1% of patients, respectively. When analyzed as time-dependent variables, IS/SE, major bleeding and hospitalization for decompensated HF were all strongly associated with mortality. The independent predictors of incident HF were age, women, hypertension, diabetes mellitus, coronary artery disease and a previous history of HF. A sensitivity analysis in patients without history of HF at inclusion revealed that incident HF remained the most frequent adverse event, occurring in 5.3% of patients, compared to IS/SE (1.7%) and major bleeding (2.5%). Conclusion: HF is a common residual cardiovascular adverse event occurring in AF outpatients and is associated with a very high mortality. Since modifiable risk factors are associated with incident HF, upstream intensive management of these risk factors would be of interest. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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14 pages, 264 KiB

Open AccessArticle

Hyperintense Brain Lesions in Asymptomatic Low Risk Patients with Paroxysmal Atrial Fibrillation Undergoing Radiofrequency Pulmonary Vein Isolation

by Joanna Wieczorek, Katarzyna Mizia-Stec, Anetta Lasek-Bal, Piotr Wieczorek, Iwona Woźniak-Skowerska, Anna M. Wnuk-Wojnar and Krzysztof Szydło

J. Clin. Med. 2021, 10(4), 565; https://doi.org/10.3390/jcm10040565 - 3 Feb 2021

Viewed by 1787

Abstract

Background: The aim was to determine the occurrence, consequences and risk factors for brain white matter hyperintensities (WMH) assessed in magnetic resonance imaging (MRI) in low-risk patients with paroxysmal atrial fibrillation (AF) undergoing radiofrequency pulmonary vein isolation (PVI-RF). Methods: 74 patients with AF (median 58.5 years (IQR 50–63), 45 male) were included. Before and after a minimum of 6 months after PVI-RF, a brain MRI and a mini-mental state examination (MMSE) were performed. Results: Baseline WMH lesions were found in 55 (74.3%) patients and in 48 from 62 (77.4%) patients after PVI-RF. The WMH lesions were more frequent among older patients, with a higher CHA2DS2-Vasc (C—Congestive heart failure/LV dysfunction, H—Hypertension, A—Age, D—Diabetes mellitus, S—Stroke, V—Vascular Disease, Sc—Sex category). Factors affecting the severity of the WMH were: older age, the co-existence of the PFO and coronary artery disease (CAD). After a follow-up period, the factors predisposing to brain WMH lesions occurrence (age, higher BMI and CHA2DS2-Vasc score) and to the more advanced changes (age, higher CHA2DS2-Vasc score, CAD, PFO) were obtained. Conclusions: The presence and severity of cerebral microembolism are associated with age, higher CHA2DS2-Vasc score and the coexistence of PFO and CAD. PVI-RF procedure and its efficacy does not influence on MRI lesions. In this population, cerebral microembolism is not related to cognitive impairment. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

9 pages, 3631 KiB

Open AccessArticle

Left Atrial Appendage Morphology and Left Atrial Wall Thickness Are Associated with Cardio-Embolic Stroke

by Agne Adukauskaite, Fabian Barbieri, Thomas Senoner, Fabian Plank, Michael Knoflach, Christian Boehme, Florian Hintringer, Silvana Mueller, Axel Bauer, Gudrun Feuchtner and Wolfgang Dichtl

J. Clin. Med. 2020, 9(12), 3944; https://doi.org/10.3390/jcm9123944 - 5 Dec 2020

Cited by 8 | Viewed by 3737

Abstract

Background. New markers for stroke risk stratification in patients with atrial fibrillation (AF) are on demand. Hence, we aimed to investigate the association of left atrial appendage (LAA) and left atrium (LA) morphological parameters in patients with cardio-embolic (CE) stroke due to AF in comparison to controls without stroke. Methods: A retrospective analysis of cardiac computed tomography angiography (CTA) examinations performed between 2006 and 2017 for clinical indications in 158 patients (median age 65 (54–73) years, 48.7% females) was conducted: 56 patients with CE stroke were compared to 102 controls not differing in gender, body mass index (BMI) and CHA₂DS₂-VASc score. Results: On multivariable regression analysis adjusted for CHA₂DS₂-VASc score and LA diameter CE stroke was independently associated with the following parameters: windsock LAA type (OR 2.55; CI: 1.04–6.26, p = 0.041), a greater lobe number (OR 1.54; CI: 1.13–2.10, p = 0.006), a greater LAA ostium area (OR 1.88; CI: 1.38–2.55, p < 0.001) and a greater left atrium wall thickness (LAWT) in the middle and right part, measured along the anterior LA wall in the axial plane (respectively, OR 1.94; CI: 1.26–3.0, p = 0.003 and OR 1.57; CI: 1.07–2.31, p = 0.021). Conclusions: The windsock LAA type, a greater LAA lobe number, a larger LAA ostium and a greater LAWT are associated with CE stroke. These CTA parameters could improve risk stratification for thromboembolic stroke. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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Review

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16 pages, 877 KiB

Open AccessReview

Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation

by Silvia Garibaldi, Michela Chianca, Iacopo Fabiani, Michele Emdin, Marcello Piacenti, Claudio Passino, Alberto Aimo, Antonella Fedele, Carlo Maria Cipolla and Daniela Maria Cardinale

J. Clin. Med. 2022, 11(15), 4452; https://doi.org/10.3390/jcm11154452 - 30 Jul 2022

Cited by 5 | Viewed by 3368

Abstract

Longer life expectancy along with advancements in cancer and atrial fibrillation (AF) therapies and treatment strategies have led to an increase in the number of individuals with both diseases. As a result, the complicated management of these patients has become crucial, necessitating individualised treatment that considers the bi-directional relationship between these two diseases. On the one hand, giving appropriate pharmaceutical therapy is exceptionally difficult, considering the recognised thromboembolic risk posed by AF and malignancy, as well as the haemorrhagic risk posed by cancer. The alternative pulmonary vein isolation (PVI) ablation, on the other hand, has been inadequately explored in the cancer patient population; there is yet inadequate data to allow the clinician to unambiguously select patients that can undertake this therapeutic intervention. The goal of this review is to compile the most valuable data and supporting evidence about the characteristics, care, and therapy of cancer patients with AF. Specifically, we will evaluate the pharmaceutical options for a proper anticoagulant therapy, as well as the feasibility and safety of PVI in this population. Full article

(This article belongs to the Special Issue New Insights into Atrial Fibrillation)

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