Atrial Fibrillation and Related Complications: Pathogenetic, Diagnostic and Therapeutic Perspectives

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 1358

Special Issue Editor


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Guest Editor
National Taiwan University Hospital, Taipei, Taiwan
Interests: atrial fibrillation; LAAO; genetics; ablation; arrhythmia

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) remains the most prevalent form of arrhythmia and affects millions of people worldwide. The prevalence of atrial fibrillation rises with age and increases annually. AF has serious consequences, such as heart failure, embolic stroke, and patient discomfort. The ectopic activity of pulmonary veins is the best-studied cause of atrial fibrillation. Electrical disturbances due to structural or electrical remodeling lead to its more facile induction and support the maintenance of arrhythmia. Transcriptional changes in atrial ion channels or impaired calcium homeostasis play a key role in the  development of chronic atrial fibrillation. However, the pathogenesis described above remains preliminary. Further studies are needed to help understand the genetic, metabolic, and ionic changes implicated in the development of AF. The diagnosis of AF is straightforward using ECG. However, some controversial issues remain to be elucidated, such as the monitoring of AF for asymptomatic patients, atrial high-rate episodes, and the utilization of modern electronic devices that enable physicians to detect AF in a timely manner. These fields also warrant further investigation. The treatment modalities applicable to AF include rate/rhythm control, stroke prevention and ablation. However, some advances in the treatment of AF have been made; these include the development of novel anti-arrhythmic drugs or the treatment of ionic channelopathy. These therapeutics methods are rapidly advancing and we are expecting further innovations.

This Research Topic welcomes basic, translational, clinical, and applied research that enhances our understanding of atrial fibrillation. Potential areas of interest include, but are not limited to, the following:

  • The pathogenesis of atrial fibrillation, from genetic, ionic channel to atrial tissue and structural changes;
  • The diagnosis of atrial fibrillation;
  • Therapeutic approaches to AF, including novel anti-arrhythmic drugs, genetic therapy and ablation (newer target by newer algorithms), etc.

We welcome the submission of reviews and original research papers.

Dr. Jien Jiun Chen
Guest Editor

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Keywords

  • atrial fibrillation
  • complication
  • genetics
  • pathogenesis
  • ablation
  • stroke prevention

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Published Papers (1 paper)

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Research

13 pages, 2121 KiB  
Article
The Electroanatomic Volume of the Left Atrium as a Determinant of Recurrences in Patients with Atrial Fibrillation After Pulmonary Vein Isolation: A Prospective Study
by Amaia Martínez León, David Testa Alonso, María Salgado, Ruth Álvarez Velasco, Minel Soroa, Daniel Gracia Iglesias and David Calvo
Biomedicines 2025, 13(1), 7; https://doi.org/10.3390/biomedicines13010007 - 24 Dec 2024
Viewed by 620
Abstract
Background/Objectives: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence [...] Read more.
Background/Objectives: Catheter ablation for atrial fibrillation (AF) is a well-established therapeutic approach for maintaining sinus rhythm, though its efficacy remains suboptimal in certain patients. The left atrium (LA) volume, commonly assessed through transthoracic echocardiography (TTE), is a recognized predictor of AF recurrence after pulmonary vein isolation (PVI). However, the complex three-dimensional structure of the LA makes precise measurement challenging with traditional TTE techniques. Electroanatomic mapping (EAM) offers a more accurate evaluation of LA geometry and volume, which may enhance the prediction of ablation outcomes. Methods: This prospective study included 197 patients with AF who were referred for PVI to our center (Hospital Universitario Central de Asturias, Spain) between 2016 and 2020. All participants underwent pre-ablation TTE and EAM to assess the electric active volume (EAV) of the LA. Clinical follow-up included regular Holter monitoring and electrocardiograms to detect AF recurrences. Results: The mean age was 56.3 ± 9.67 years, and 34% had persistent AF. The mean LA volumes measured by TTE and the EAV by EAM were 62.86 ± 15.58 mL and 126.75 ± 43.35 mL, respectively, with a moderate positive correlation (r = 0.49, p < 0.001). AF recurrences were observed in 51.27% of patients over a 36 ± 15-month follow-up period. Cox regression analyses (univariate and multivariate), Kaplan–Meier curves and log-rank tests were used to illustrate freedom from atrial arrhythmia during follow-up. Both EAV by EAM and TTE volumes were significant predictors of AF recurrence in the univariate analysis (HR 1.002 [1.001–1.003], p = 0.033 and HR 1.001 [1.006–1.012], p < 0.01, respectively). Among clinical variables, persistent AF was significantly associated with a higher risk of recurrence (HR 1.17 [1.096–1.268], p = 0.02). Conclusions: EAV of the LA assessment by EAM demonstrates a significant correlation with TTE measurements and is a predictor of AF post-ablation recurrence. In patients selected for catheter ablation, EAV by EAM provides additional insights that could contribute to therapeutic decision-making and risk stratification of AF recurrences. Full article
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