Submit to Medicina Review for Medicina Propose a Special Issue

Journal Menu

Journal Browser

► Journal Browser

Atrial Fibrillation Management

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 December 2020) | Viewed by 14178

Share This Special Issue

Special Issue Editors

Dr. Dalia Giedrimienė

E-Mail Website
Guest Editor

University of Saint Joseph, West. Hartford, CT, USA Cardiology Department, Hartford Hospital, Hartford, CT, USA
Interests: cardiovascular physiology; cardiac arrhythmias; antiarrhythmics; atrial fibrillation management; gender differences in cardiovascular disease; sudden death; ventricular arrhythmias and implantable devices; oral anticoagulants; integration of cardiac care

Dr. Jae-Sun Uhm

E-Mail Website
Guest Editor

Department of Cardiology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeongi-do, Korea
Interests: arrhythmia; atrial fibrillation; congenital heart disease; sudden cardiac death; ventricular arrhythmia

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AFib) remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world. Despite good progress in the management of AFib, the number of patients with this arrhythmia is predicted to increase steeply in the upcoming years. The estimated number of people with AFib worldwide in 2020 was 20.9 million. It has been noticed that one in four middle-aged adults in US and Europe will develop AFib. By 2030, more than 15 million AFib patients are anticipated in the European Union, with a possible 215,000 newly diagnosed cases per year. There is a greater prevalence of AFib in older persons and in patients with pre-existing conditions such as hypertension, heart failure, coronary artery disease, valvular heart disease, diabetes, obesity, and chronic kidney disease. The higher prevalence of AFib is associated with better detection of silent AFib and increasing age of populations predisposed to AFib conditions worldwide. AFib is directly related to an increased risk of all-cause mortality, especially death due to stroke and heart failure. Multiple studies have shown that ~25% of patients with an ischemic stroke have an AFib diagnosis before, during, or after the initial event. Almost a third of patients with AFib require hospitalization, and treatment cost is increasing dramatically despite new preventive and surgical management options.

Despite advances in the management of AFib with oral anticoagulation by using vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) which reduce stroke and mortality, the morbidity due to AFib remains high. Other interventions, such as rhythm control and rate control, improve AFib-related symptoms and help to preserve cardiac function, but they do not demonstrate a significant reduction in morbidity or mortality.

The understanding of electrophysiological issues surrounding atrial fibrillation has been translated into therapeutic advances. The electrophysiological mechanisms responsible for the onset of atrial fibrillation help to identify the best option for treatment and the maintenance of normal sinus rhythm. The recognition of pathophysiological and genetic aspects and the assessment of the remodeling of atrial structure and ion channel function help to guide the management of AFib by improving the screening, detection, and timely administration of treatment.

The integrated management of patients with AFib is very important, and is necessary for the consistent, guideline-adherent management of patients with the goal of improving outcomes. This approach is consistent with the Innovative Care for Chronic Conditions Framework proposed by the WHO. The integrated care of patients with newly diagnosed AFib should help to improve AFib management, such as the underuse of anticoagulation, access to rate and rhythm control therapy, selecting approaches to cardiovascular risk reduction, and the timely use of advanced non-pharmacological methods such as catheter or surgical interventions (ablation, LAA occlusion, AF surgery, etc.). Integrative AFib care requires the cooperation of primary care physicians, cardiologists, cardio surgeons, and AFib and stroke specialists.

The purpose of this Special Issue is to present and discuss the clinical matters associated with AFib and its management, with a focus on pharmacological and non-pharmacological approaches and with the inclusion of evidence-guided therapy into the integrative care of patients with AFib.

Dr. Dalia Giedrimienė
Dr. Jae-Sun Uhm
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. Medicina is an international peer-reviewed open access monthly 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 1800 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 epidemiology
pathophysiology of atrial fibrillation
atrial fibrillation management
rate and rhythm control
stroke prevention
anticoagulation therapy
antiarrhythmics
non-pharmacologic therapies for atrial fibrillation
atrial fibrillation education
health promotion
integrative services

Published Papers (7 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Other

11 pages, 784 KiB

Open AccessArticle

A Higher Polygenic Risk Score Is Associated with a Higher Recurrence Rate of Atrial Fibrillation in Direct Current Cardioversion-Treated Patients

by Simon Vogel, Irina Rudaka, Dmitrijs Rots, Jekaterīna Isakova, Oskars Kalējs, Kristīne Vīksne and Linda Gailīte

Medicina 2021, 57(11), 1263; https://doi.org/10.3390/medicina57111263 - 18 Nov 2021

Cited by 4 | Viewed by 1983

Abstract

Background and Objectives: Recurrence of atrial fibrillation (AF) within six months after sinus rhythm restoration with direct current cardioversion (DCC) is a significant treatment challenge. Currently, the factors influencing outcome are mostly unknown. Studies have found a link between genetics and the risk of AF and efficacy of rhythm control. The aim of this study was to examine the association between eight single-nucleotide variants (SNVs) and the risk of AF development and recurrence after DCC. Materials and Methods: Regarding the occurrence of AF, 259 AF cases and 108 controls were studied. Genotypes for the eight SNVs located in the genes CAV1, MYH7, SOX5, KCNN3, ZFHX3, KCNJ5 and PITX2 were determined using high-resolution melting analysis and confirmed with Sanger sequencing. Six months after DCC, a telephone interview was conducted to determine whether AF had recurred. A polygenic risk score (PRS) was calculated as the unweighted sum of risk alleles. Multivariate regression analyses were performed to assess SNV and PRS association with AF occurrence and recurrence after DCC. Results: The risk allele of rs2200733 (PITX2) was significantly associated with the development of AF (p = 0.012, OR = 2.31, 95% CI = 1.206–4.423). AF recurred in 60% of patients and the allele generally associated with a decreased risk of AF of rs11047543 (SOX5) was associated with a greater risk of AF recurrence (p = 0.014, OR = 0.223, 95% CI = 0.067–0.738). A PRS of greater than 7 was significantly associated (p = 0.008) with a higher likelihood of developing AF after DCC (OR = 4.174, 95% CI = 1.454–11.980). Conclusions: A higher PRS is associated with increased odds of AF recurrence after treatment with DCC. PITX2 (rs2200733) is significantly associated with an increased risk of AF. The protective allele of rs11047543 (SOX5) is associated with a greater risk of AF recurrence. Further studies are needed to predict the success of rhythm control and guide patient selection towards the most efficacious treatment. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

15 pages, 1637 KiB

Open AccessArticle

Predictors of Atrial Fibrillation Recurrences after a First Radiofrequency Catheter Ablation Intervention for Paroxysmal Atrial Fibrillation—Experience of a Low Volume Ablation Centre

by Lavinia-Lucia Matei, Călin Siliște, Sebastian Stoica, Gabriel-Cristian Bejan, Liviu-Nicolae Ghilencea and Dragoș Vinereanu

Medicina 2021, 57(11), 1139; https://doi.org/10.3390/medicina57111139 - 20 Oct 2021

Viewed by 1917

Abstract

Background and Objectives: Atrial fibrillation recurrences (AFR) after radiofrequency catheter ablation (RFCA) are not uncommon, up to 65% of patients having relapses in the first year. However, current data are based mainly on studies from centres with a large volume of ablations, as they include technically inhomogeneous interventions, and populations with different types of AF. The aim of our study was to assess and stratify the risk at 6 and 12 months for AFR after a single RFCA, in patients with paroxysmal AF, in a centre with low volume activity. Materials and Methods: We enrolled 40 patients who underwent an initial RFCA, followed by continuous 48 h ECG monitoring at 1, 3, 6, and 12 months. Patients self-monitored their cardiac activity by random daily radial pulse palpation or in the presence of palpitations. Results: Ten independent predictors for late AFR were identified, and a 6-month risk score was computed using three of them: AFR duration in the first month, number of AFR between 1 and 3 months, and supraventricular ectopics per 24 h at 6 months. The score can explain 59% of the AFR (p = 0.001). A further 12-month assessment identified three independent predictors. The presence of AFR between 6–12 months is the most important of them (OR = 23.11, 95% CI = 3.87–137.83, p = 0.001), explaining 45% of AFR over 1 year. The risk scores at 6 and 12 months were internally validated. Conclusions: The 6-month score proved to be a useful tool in guiding further strategy for patients with a low risk, while a longer follow-up to 12 months may avoid unnecessary early reinterventions. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

12 pages, 2002 KiB

Open AccessArticle

Radiofrequency vs. Cryoballoon vs. Thoracoscopic Surgical Ablation for Atrial Fibrillation: A Single-Center Experience

by Hee-Jin Kwon, Ji Hoon Choi, Hye Ree Kim, Seung-Jung Park, Dong Seop Jeong, Young Keun On, June Soo Kim and Kyoung-Min Park

Medicina 2021, 57(10), 1023; https://doi.org/10.3390/medicina57101023 - 26 Sep 2021

Cited by 4 | Viewed by 1846

Abstract

Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

11 pages, 618 KiB

Open AccessArticle

Functional Mitral Regurgitation in Patients with Preserved Ejection Fraction Qualified for Pulmonary Vein Isolation: A Negative Prognostic Factor for Catheter Ablation Efficacy

by Małgorzata Cichoń, Maciej Wybraniec, Magdalena Mizia-Szubryt and Katarzyna Mizia-Stec

Medicina 2021, 57(8), 798; https://doi.org/10.3390/medicina57080798 - 03 Aug 2021

Cited by 2 | Viewed by 1594

Abstract

Background and Objectives: Functional mitral regurgitation (F-MR) observed in patients with atrial fibrillation could affect the effectiveness of the sinus rhythm restoring procedures. The aim of the study was to evaluate the impact of F-MR on pulmonary vein isolation (PVI) efficacy in patient with preserved ejection fraction (EF). Materials and Methods: One hundred and thirty-six patients with EF ≥ 50% (65.4% males; mean age 56 ± 11 years) with symptomatic paroxysmal or persistent AF qualified for PVI were enrolled into the study. F-MR assessment was performed in transthoracic (TTE) and transesophageal (TEE) echocardiography before the PVI procedure. PVI efficacy was evaluated in three-month and long-term follow-up. Results: F-MR was diagnosed in 74.3% patient in transthoracic echocardiography (TTE) (trace: 26.5%, mild: 43.4%, moderate: 3.7%, severe 0.7%) and 94.9% in transesophageal echocardiography (TEE) (trace: 17.6%, mild: 59.6%, moderate: 16.2%, severe: 1.5%). The PVI three-month efficacy was 75.7% in the three-month and 64% in the long-term observation. Severe F-MR in TEE at baseline was associated with lower three-month PVI efficacy (p = 0.012), while moderate to severe F-MR in TEE was related to inefficient PVI assessed in long-term follow-up (p = 0.041). Conclusions: Significant F-MR confirmed by TEE predicts three-month as well as long-term PVI efficacy. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

9 pages, 644 KiB

Open AccessArticle

Are Three Weeks of Oral Anticoagulation Sufficient for Safe Cardioversion in Atrial Fibrillation?

by Stefan Naydenov, Nikolay Runev and Emil Manov

Medicina 2021, 57(6), 554; https://doi.org/10.3390/medicina57060554 - 31 May 2021

Cited by 6 | Viewed by 2020

Abstract

Background and Objectives: Patients with atrial fibrillation (AF), lasting >48 h, considered for cardioversion, are recommended ≥3 weeks of oral anticoagulation before sinus rhythm restoration because of high risk of development of left atrial thrombosis (LAT) and stroke. However, the optimal duration of anticoagulation in the presence of overt LAT is unknown. Materials and Methods: An open-label study aimed to investigate the prevalence of spontaneous echo contrast (SEC) and LAT before and after 3 weeks of direct oral anticoagulant (DOAC) treatment. We included 51 consecutive patients (50.9% males), mean age 69.3 ± 7.4 years with paroxysmal/unknown duration of AF, considered for cardioversion, who agreed to have transesophageal echocardiography at enrollment and 3 weeks later. Results: At baseline SEC was present in 26 (50.9%) and LAT in 10 (19.6%) of 51 patients. After 3 weeks on DOAC, SEC persisted in 12 (25.0%) and LAT in 7 (14.5%) of 48 patients, p < 0.05 vs. baseline. Factors, associated most strongly with persistence of SEC/LAT, were left atrial appendage (LAA) emptying velocity <20 cm/s (OR = 2.82), LAA lobes >2 (OR = 1.84), and indexed left atrial volume ≥34 mL/m² (OR = 1.37). Conclusions: In our study the incidence of SEC/LAT, particularly in AF with unknown duration, was not as low as we expected. The prevalence of SEC/LAT seemed to be dependent on factors not routinely evaluated in AF patients planned for cardioversion (indexed LA volume, LAA morphology and number of lobules, LAA emptying velocity, etc.). Our data suggested an individualized approach for DOAC duration in AF patients before an attempt for restoration of sinus rhythm is made, taking into consideration the LAA morphology and function. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

12 pages, 2501 KiB

Open AccessArticle

Circadian Pattern of Acute Myocardial Infarction and Atrial Fibrillation in a Mediterranean Country: A study in Diabetic Patients

by Stylianos Daios, Christos Savopoulos, Ilias Kanellos, Christos Argyrios Goudis, Ifigeneia Nakou, Stergiani Petalloti, Nicolas Hadjidimitriou, Dimitrios Pilalas, Antonios Ziakas and Georgia Kaiafa

Medicina 2021, 57(1), 41; https://doi.org/10.3390/medicina57010041 - 06 Jan 2021

Cited by 4 | Viewed by 2282

Abstract

Background and objectives: The circadian pattern seems to play a crucial role in cardiovascular events and arrhythmias. Diabetes mellitus is a complex metabolic disorder associated with autonomic nervous system alterations and increased risk of microvascular and macrovascular disease. We sought to determine whether acute myocardial infarction (AMI) and atrial fibrillation (AF) follow a circadian pattern in diabetic patients in a Mediterranean country. Materials and Methods: This retrospective study included 178 diabetic patients (mean age: 67.7) with AMI or AF who were admitted to the coronary care unit. The circadian pattern of AMI and AF was identified in the 24-h period (divided in 3-h and 1-h intervals). Patients were also divided in 3 groups according to age; 40–65 years, 66–79 years and patients older than 80 years. A chi-square goodness-of-fit test was used for the statistical analysis. Results: AMI seems to occur more often in the midnight hours (21:00–23:59) (p < 0.001). Regarding age distribution, patients between 40 and 65 years were more likely to experience an AMI compared to other age groups (p < 0.001). Autonomic alterations, working habits, and social reasons might contribute to this phenomenon. AF in diabetic patients occurs more frequently at noon (12:00–14:59) (p = 0.019). Conclusions: Diabetic patients with AMI and AF seem to follow a specific circadian pattern in a Mediterranean country, with AMI occurring most often at midnight hours and AF mostly at noon. Autonomic dysfunction, glycemic fluctuations, intense anti-diabetic treatment before lunch, and patterns of insulin secretion and resistance may explain this pattern. More studies are needed to elucidate the circadian pattern of AMI and AF in diabetic patients to contribute to the development of new therapeutic approaches in this setting. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Figure 1

Other

Jump to: Research

6 pages, 11991 KiB

Open AccessCase Report

Erysipelas Complicated with Acute Exudative Pericarditis

by Akvilė Gečaitė, Aušra Vainalavičiūtė, Daiva Emilija Rekienė, Laima Jankauskienė and Albinas Naudžiūnas

Medicina 2020, 56(11), 571; https://doi.org/10.3390/medicina56110571 - 29 Oct 2020

Viewed by 1709

Abstract

Erysipelas is a common skin infection of the upper dermis. Its most common complications are local; these include abscess formation, skin necrosis, etc. In the present article, we introduce a case of a 75-year-old patient with erysipelas of the face complicated with acute exudative pericarditis. The patient came to Kaunas Clinical Hospital complaining of extreme fatigue and fever, oedema of the left side of the face, and erythema typical for erysipelas. The patient also felt sternum and epigastric pain, especially during breathing, and dyspnoea. Heart work was rhythmic 100 bpm; blood pressure was 142/70 mmHg. Pericardial friction rub was heard over the left sternal border. There were no alterations in other systems. In the electrocardiogram, concave ST segment elevation in leads II, III, and aVF was identified. In addition, during hospitalisation, the patient experienced atrial fibrillation paroxysm, which was treated with amiodarone intravenously. The blood test showed C-reactive protein: 286 mg/L; white blood cells: 20 × 10⁹/L; troponin I was within the normal range. During echocardiography, pericardial fluid in pericardial cavity was identified. As no changes in troponin I were observed, according to the ST segment elevation, the woman was diagnosed with erysipelas of the left side of the face complicated with acute exudative pericarditis. Antibacterial treatment of cephalosporins was administered. After the treatment, C-reactive protein decreased to 27.8 mg/L; whereas, in the electrocardiogram, the return of the ST segment to the isoline was observed, and pericardial fluid resorbed from the pericardial cavity. To the best of the authors’ knowledge, this case is a rare combination of erysipelas complicated with acute exudative pericarditis. Full article

(This article belongs to the Special Issue Atrial Fibrillation Management)

► Show Figures

Journal Menu

Journal Browser

Atrial Fibrillation Management

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (7 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI