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New Developments in Clinical Cardiac Pacing and Electrophysiology
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New Developments in Clinical Cardiac Pacing and Electrophysiology

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

Deadline for manuscript submissions: closed (30 December 2024) | Viewed by 5890

Special Issue Editors

Prof. Dr. Vidal Essebag

E-Mail Website
Guest Editor
1. Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
2. Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
Interests: cardiac electrophysiology; atrial fibrillation; cardiac implantable device; cardiac defibrillator
Dr. Ahmed AlTurki

E-Mail Website
Guest Editor
Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
Interests: atrial fibrillation; cardiac electrophysiology; cardiac implantable device

Special Issue Information

Dear Colleagues,

Cardiac pacing and electrophysiology focuses on the study, diagnosis, and treatment of heart rhythm disorders. This field is rapidly progressing, with significant advances in both device implantation and catheter ablation. Advanced technologies, such as remote monitoring, leadless pacing systems, and catheter-based interventions, have greatly improved patient outcomes and reduced complications. Key aspects of cardiac pacing and electrophysiology include arrhythmia management, device programming, lead extraction, and risk stratification. With ongoing research and advancements in this field, the development of innovative therapies and improved patient care remains a priority.

This Special Issue aims to collect original articles and reviews that improve knowledge in the field of cardiac pacing and electrophysiology. We look forward to receiving your contributions to this Special Issue.

Prof. Dr. Vidal Essebag
Dr. Ahmed AlTurki
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

  • catheter ablation
  • atrial fibrillation
  • cardiac pacing
  • electrophysiology
  • pacemakers
  • heart rhythm disorders
  • implantable cardioverter-defibrillators (ICDS)
  • cardiac resynchronization therapy (CRT)
  • remote monitoring

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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10 pages, 201 KiB  
Article
Renal Artery Denervation Combined with Pulmonary Vein Isolation in Patients with Heart Failure and Atrial Fibrillation: Pilot Study: Renal Artery Denervation in Treatment of Atrial Fibrillation and Heart Failure
by Tomasz Skowerski, Mariusz Skowerski, Iwona Wozniak-Skowerska, Andrzej Hoffmann, Andrzej Kułach, Andrzej Ochała, Katarzyna Mizia-Stec, Zbigniew Gasior and Grzegorz Smolka
J. Clin. Med. 2025, 14(5), 1727; https://doi.org/10.3390/jcm14051727 - 4 Mar 2025
Viewed by 568
Abstract
Background: Heart failure (HF) is a progressive condition associated with reduced life expectancy and quality of life. Atrial fibrillation (AF), the most common arrhythmia in HF patients, significantly worsens symptoms and outcomes. The coexistence of HF and AF is linked to higher morbidity [...] Read more.
Background: Heart failure (HF) is a progressive condition associated with reduced life expectancy and quality of life. Atrial fibrillation (AF), the most common arrhythmia in HF patients, significantly worsens symptoms and outcomes. The coexistence of HF and AF is linked to higher morbidity and mortality rates, with a bidirectional relationship exacerbating both conditions. The recent evidence has suggested that combining pulmonary vein isolation (PVI) with renal denervation (RDN) may offer a promising strategy for reducing AF burden and enhancing patient outcomes. Methods: This prospective interventional clinical trial aimed to assess the safety and effectiveness of a combined RDN and PVI approach compared to PVI alone. Eighteen patients, aged 18 to 80 years, with paroxysmal or persistent AF and HF (left ventricular ejection fraction [LVEF] < 50%) were enrolled. RDN was performed under general anesthesia using the four-electrode Symplicity Spyral catheter and Symplicity G3 radiofrequency generator (Medtronic). Patients were randomized to the RDN+PVI group (n = 7) or the PVI-only group (n = 11). The groups were similar in age (59 ± 8.4 years vs. 62.5 ± 11.08 years, p = NS) and baseline characteristics, including hypertension, obesity, and impaired left ventricular function (LVEF 35.86% vs. 38.54%, RDN+PVI vs. PVI only; p = NS). Results: Over a mean follow-up of 24 months, one patient died, ten were hospitalized, six underwent repeat PVI, and eight achieved AF freedom. Patients in the RDN+PVI group were significantly more likely to remain AF-free (n = 6 vs. 2; p = 0.0063). The need for repeat ablation was higher in the PVI-only group (54.5% vs. 0%), though this did not reach statistical significance. Hospitalization rates and changes in ejection fraction were similar between groups. Importantly, no procedural complications were observed. Conclusions: Combining RDN with PVI is a safe hybrid approach for AF management in HF patients, showing promising efficacy in reducing AF recurrence. Larger randomized studies are needed to confirm these findings and further explore this novel therapeutic strategy. Full article
(This article belongs to the Special Issue New Developments in Clinical Cardiac Pacing and Electrophysiology)
17 pages, 2325 KiB  
Article
The Suboptimal QLV Ratio May Indicate the Need for a Left Bundle Branch Area Pacing-Optimized Cardiac Resynchronization Therapy Upgrade
by Péter Ezer, Kitti Szűcs, Réka Lukács, Tamás Bisztray, Gábor Vilmányi, István Szokodi, András Komócsi and Attila Kónyi
J. Clin. Med. 2024, 13(19), 5742; https://doi.org/10.3390/jcm13195742 - 26 Sep 2024
Cited by 1 | Viewed by 1293
Abstract
Background: The QLV ratio (QLV/baseline QRS width) is an established intraoperative-measurable parameter during cardiac resynchronization therapy (CRT) device implantation, potentially predicting the efficacy of electrical resynchronization. Methods: Left bundle branch area pacing-optimized CRT (LOT-CRT) is a novel approach with the potential [...] Read more.
Background: The QLV ratio (QLV/baseline QRS width) is an established intraoperative-measurable parameter during cardiac resynchronization therapy (CRT) device implantation, potentially predicting the efficacy of electrical resynchronization. Methods: Left bundle branch area pacing-optimized CRT (LOT-CRT) is a novel approach with the potential to improve both responder rate and responder level in the CRT candidate patient group, even when an optimal electro-anatomical left ventricular lead position is not achievable. In our observational study, 72 CRT-defibrillator candidate patients with a QRS duration of 160 ± 12 ms were consecutively implanted. Using a QLV-ratio-based implant strategy, 40 patients received a biventricular CRT device (Biv-CRT) with an optimal QLV ratio (≥70%). Twenty-eight patients with a suboptimal QLV ratio (<70%) were upgraded intraoperatively to a LOT-CRT system. Patients were followed for 12 months. Results: The postoperative results showed a significantly greater reduction in QRS width in the LOT-CRT patient group compared to the Biv-CRT patients (40.4 ± 14 ms vs. 32 ± 13 ms; p = 0.024). At 12 months, the LOT-CRT group also demonstrated a significantly greater improvement in left ventricular ejection fraction (14.9 ± 8% vs. 10.3 ± 7.4%; p = 0.001), and New York Heart Association functional class (1.2 ± 0.5 vs. 0.8 ± 0.4; p = 0.031), and a significant decrease in NT-pro-BNP levels (1863± 380 pg/mL vs. 1238 ± 412 pg/mL; p = 0.012). Notably, the LOT-CRT patients showed results comparable to Biv-CRT patients with a super-optimal QLV ratio (>80%) in terms of QRS width reduction and LVEF improvement. Conclusions: Our single-center study demonstrated the feasibility of a QLV-ratio-based implantation strategy during CRT implantation. Patients with a LOT-CRT system showed significant improvements, whereas Biv-CRT patients with a super-optimal QLV ratio may not be expected to benefit from an additional LOT-CRT upgrade. Full article
(This article belongs to the Special Issue New Developments in Clinical Cardiac Pacing and Electrophysiology)
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14 pages, 1674 KiB  
Article
His Bundle Pacing: Predicting Mortality and Major Complications in Mid-Term Follow-Up
by Piotr Kulesza, Rafał Gardas, Krzysztof S. Gołba, Tomasz Soral, Rafał Sznajder, Grzegorz Jarosiński, Kamil Zub and Danuta Łoboda
J. Clin. Med. 2024, 13(6), 1802; https://doi.org/10.3390/jcm13061802 - 21 Mar 2024
Cited by 2 | Viewed by 1470
Abstract
Introduction: His bundle pacing (HBP) is suitable for 80% of patients with any indication for permanent pacemaker implantation, with a clinical benefit compared to right ventricular pacing (RVP). Although complications and mortality related to RVP are widely reported in the literature, data [...] Read more.
Introduction: His bundle pacing (HBP) is suitable for 80% of patients with any indication for permanent pacemaker implantation, with a clinical benefit compared to right ventricular pacing (RVP). Although complications and mortality related to RVP are widely reported in the literature, data on HBP are limited. This study aimed to analyze HBP complications and outcomes in the short-term (up to 30 days) and long-term (up to the following 24 months) follow-up (F/U). Materials and Methods: The study includes 373 patients aged ≥ 18, enrolled from October 2015 to May 2019 in a single-center HBP prospective registry conducted in the Department of Electrocardiology, Upper Silesian Medical Centre of the Medical University of Silesia in Katowice, Poland. Mortality and HBP complications were used as end-points: during hospitalization and up to 30 days (short-term F/U), and for each F/U point—six months, 12 months, and 24 months after the procedure (long-term F/U). Results: Successful HBP was achieved in 252 patients (68%), with an increasing success rate during consecutive years: 57% in 2015–2016 and 73% in 2017–2019. Complications were found in 8.4% of patients (21/252) in short-term F/U and 5.8% (13/224), 5.5% (11/201), and 6.9% (12/174) at six months, 12 months, and 24 months, respectively. There were no deaths during the first 30 days. However, 26 patients (10.3%) died within 24 months. A left ventricular ejection fraction (LVEF) ≤ 34% was the only independent predictor of all-cause mortality or any major complication in the 24-month F/U. Conclusions: This single-center study reported a low risk of mortality and complications associated with HBP at the short-term F/U. However, during the long-term F/U, we observed a higher but acceptable risk of major complications, with a lower LVEF being an independent predictor of the composite end-point of all-cause mortality or any major complication. Full article
(This article belongs to the Special Issue New Developments in Clinical Cardiac Pacing and Electrophysiology)
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8 pages, 1124 KiB  
Article
The Influence of Different Multipolar Mapping Catheter Types on Procedural Outcomes in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation
by Kristof-Ferenc Janosi, Dorottya Debreceni, Botond Bocz, Dalma Torma, Mark Keseru, Tamas Simor and Peter Kupo
J. Clin. Med. 2024, 13(4), 1029; https://doi.org/10.3390/jcm13041029 - 11 Feb 2024
Viewed by 1445
Abstract
(1) Background: During pulmonary vein isolation (PVI) for atrial fibrillation (AF), multipolar mapping catheters (MMC) are often used. We aimed to compare the procedural outcomes of two MMCs, specifically a circular-shaped and a five-spline-shaped MMC. (2) Methods: We enrolled 70 consecutive patients in [...] Read more.
(1) Background: During pulmonary vein isolation (PVI) for atrial fibrillation (AF), multipolar mapping catheters (MMC) are often used. We aimed to compare the procedural outcomes of two MMCs, specifically a circular-shaped and a five-spline-shaped MMC. (2) Methods: We enrolled 70 consecutive patients in our prospective, observational trial undergoing PVI procedures for paroxysmal AF. The initial 35 patients underwent PVI procedures with circular-shaped MMC guidance (Lasso Group), and the procedures for the latter 35 cases were performed using five-spline-shaped MMC (PentaRay Group). (3) Results: No significant differences were identified between the two groups in total procedure time (80.2 ± 17.7 min vs. 75.7 ± 14.8 min, p = 0.13), time from femoral vein puncture to the initiation of the mapping (31.2 ± 7 min vs. 28.9 ± 6.8, p = 0.80), mapping time (8 (6; 13) min vs. 9 (6.5; 10.5) min, p = 0.73), duration between the first and last ablation (32 (30; 36) min vs. 33 (26; 40) min, p = 0.52), validation time (3 (2; 4) min vs. 3 (1; 5) min, p = 0.46), first pass success rates (89% vs. 91%, p = 0.71), left atrial dwelling time (46 (37; 53) min vs. 45 (36.5; 53) min, p = 0.56), fluoroscopy data (time: 150 ± 71 s vs. 143 ± 56 s, p = 0.14; dose: 6.7 ± 4 mGy vs. 7.4 ± 4.4 mGy, p = 0.90), total ablation time (1187 (1063; 1534) s vs. 1150.5 (1053; 1393.5) s, p = 0.49), the number of ablations (78 (73; 93) vs. 83 (71.3; 92.8), p = 0.60), and total ablation energy (52,300 (47,265; 66,804) J vs. 49,666 (46,395; 56,502) J, p = 0.35). (4) Conclusions: This study finds comparable procedural outcomes bet-ween circular-shaped and five-spline-shaped MMCs for PVI in paroxysmal AF, supporting their interchangeability in clinical practice for anatomical mapping. Full article
(This article belongs to the Special Issue New Developments in Clinical Cardiac Pacing and Electrophysiology)
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Review

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12 pages, 875 KiB  
Review
Atrial Fibrillation Ablation: Impact on Burden and Cardiovascular Outcomes
by Ahmed AlTurki and Vidal Essebag
J. Clin. Med. 2025, 14(8), 2648; https://doi.org/10.3390/jcm14082648 - 12 Apr 2025
Viewed by 329
Abstract
Atrial fibrillation [AF] is the most common sustained arrhythmia observed in clinical practice with considerable cardiovascular morbidity and mortality. AF burden provides a quantitative measurement of AF and is now more readily achievable utilizing wearable and implantable cardiac monitoring devices. This review summarizes [...] Read more.
Atrial fibrillation [AF] is the most common sustained arrhythmia observed in clinical practice with considerable cardiovascular morbidity and mortality. AF burden provides a quantitative measurement of AF and is now more readily achievable utilizing wearable and implantable cardiac monitoring devices. This review summarizes the current literature on AF burden and cardiovascular outcomes and outlines the effect and role of catheter ablation in ameliorating AF burden. Full article
(This article belongs to the Special Issue New Developments in Clinical Cardiac Pacing and Electrophysiology)
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