Catheter Ablation of Cardiac Arrhythmias: Current Updates and Perspectives

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

Deadline for manuscript submissions: 15 February 2025 | Viewed by 11113

Special Issue Editor


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Guest Editor
Director of Clinical Cardiac Electrophysiology, University Medicine Greifswald, Fleischmann Straße 8, 17475 Greifswald, Germany
Interests: general cardiology; arrhythmias/electrophysiology/catheter ablation; hypertension; heart failure; stroke
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Special Issue Information

Dear Colleagues,

Catheter ablation is an effective treatment option for cardiac arrhythmia. For decades, there have been remarkable advancements in mapping and ablation techniques and technology, helping clinicians further understand the mechanism of arrhythmias, in order to facilitate procedures, and to improve the safety of ablation and patients’ clinical outcomes. The aim and scope of this Special Issue mainly focus on, but are not limited to, the following: current mapping and ablation techniques for arrhythmias, procedural endpoints and outcomes, procedural complications, and prevention strategies. We welcome original research, systematic reviews, state-of-the-art reviews, challenging/informative case series, challenging/informative images in mapping and ablation, new technologies, etc.

Dr. Shaojie Chen
Guest Editor

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Keywords

  • ablation
  • arrhythmia
  • electrophysiology
  • atrial fibrillation
  • atrial flutter
  • atrial tachycardia
  • mapping
  • supraventricular tachycardia
  • ventricular arrhythmia

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Published Papers (8 papers)

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Research

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11 pages, 1929 KiB  
Article
Pulmonary Vein Isolation for Atrial Fibrillation: Comparison of a Very High-Power Very Short-Duration (vHPvSD) Ablation Protocol versus a Hybrid Ablation Approach—Procedural and Mid-Term Outcome Data
by Alexander Baumgartner, Martin Martinek, Michael Derndorfer, Georgios Kollias, Peter Ammann, Helmut Pürerfellner and Sebastian Seidl
J. Clin. Med. 2024, 13(10), 2879; https://doi.org/10.3390/jcm13102879 - 13 May 2024
Viewed by 783
Abstract
Background: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is a standard-of-care treatment in the rhythm control strategy of symptomatic atrial fibrillation (AF). Ablation protocols, varying in the power and duration of energy delivery, have changed rapidly in recent years. Very high-power very [...] Read more.
Background: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is a standard-of-care treatment in the rhythm control strategy of symptomatic atrial fibrillation (AF). Ablation protocols, varying in the power and duration of energy delivery, have changed rapidly in recent years. Very high-power very short-duration ablation (vHPvSD) is expected to shorten procedural times compared to conventional ablation approaches. However, the existing data suggest that this might come at the cost of lower first-pass isolation rates, a predictor of poor ablation long-term outcomes. This study aims to compare a vHPvSD protocol to a hybrid strategy, in which the power and duration of the energy transfer are adapted depending on the anatomical location. Methods: We retrospectively analyzed procedural and outcome data from 93 patients (55 vHPvSD vs. 38 hybrid) scheduled for de novo pulmonary vein isolation. A vHPvSD ablation protocol (90 Watt (W), 4 s) was compared to a hybrid protocol using vHPvSD on the posterior wall and 50 W HPSD (high-power short-duration) ablation guided by the Ablation Index along the remaining spots. Results: Ablation times were significantly shorter in the vHPvSD cohort (5.4 min. vs. 14.2 min, p < 0.001), thus resulting in a significant reduction in the overall procedural duration (91 min vs. 106 min, p = 0.003). The non-significant slightly higher first-pass isolation rates in the vHPvSD cohort (85% vs. 76%, p = 0.262) did not affect freedom from AF 6 months after the procedure (83% vs. 87%, p = 0.622). Conclusions: vHPvSD helps in shortening the PVI procedural duration, thus neither affecting first-pass isolation rates nor freedom from atrial tachyarrhythmia recurrence at 6 months after the index procedure. Full article
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Review

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14 pages, 8345 KiB  
Review
Overcoming Access Challenges to Treat Arrhythmias in Patients with Congenital Heart Disease Using Robotic Magnetic-Guided Catheter Ablation
by Paul Khairy, Katia Dyrda, Blandine Mondésert, Martin Aguilar, Marc Dubuc, Julia Cadrin-Tourigny, Peter G. Guerra, Alexandre Raymond-Paquin, Léna Rivard, Rafik Tadros, Mario Talajic, Bernard Thibault, Laurent Macle and Denis Roy
J. Clin. Med. 2024, 13(18), 5432; https://doi.org/10.3390/jcm13185432 - 13 Sep 2024
Abstract
The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly [...] Read more.
The prevalence of congenital heart disease (CHD) has surged in recent decades, owing to a substantial reduction in mortality. As individuals with CHD age, they become increasingly susceptible to late complications including arrhythmias. These arrhythmias often arise decades after surgical intervention and significantly impact quality of life, hospitalizations, and mortality. Catheter ablation has gained widespread acceptance as a critical intervention for managing arrhythmias in patients with CHD. However, anatomical and physiological features unique to this population pose challenges to standard manual ablation procedures, potentially impacting safety and efficacy. Robotic magnetic-guided navigation (RMN) has emerged as a technological solution to address these challenges. By utilizing soft and flexible catheters equipped with magnets at their tips, RMN enables robotic steering and orientation of catheters in three-dimensional space. This technology overcomes obstacles such as distorted vascular pathways and complex post-surgical reconstructions to facilitate access to target chambers and improve maneuverability within the heart. In this review, we present an overview of the safety and efficacy evidence for RMN-guided catheter ablation in CHD patients and highlight potential advantages. Additionally, we provide a detailed case presentation illustrating the practical application of RMN technology in this population. Although the literature on RMN-guided ablation in patients with CHD remains limited, it has shown promise in achieving successful outcomes, particularly in cases where manual ablation failed or was deemed non-feasible. Further validation through large-scale prospective studies is necessary to fully ascertain the benefits of RMN technology in this patient population. Full article
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13 pages, 625 KiB  
Review
Management of Arrhythmias and Conduction Disorders in Amyloid Cardiomyopathy
by Katarzyna Holcman, Andrzej Ząbek, Krzysztof Boczar, Piotr Podolec and Magdalena Kostkiewicz
J. Clin. Med. 2024, 13(11), 3088; https://doi.org/10.3390/jcm13113088 - 24 May 2024
Viewed by 786
Abstract
Cardiac amyloidosis, a condition characterized by abnormal protein deposition in the heart, leads to restrictive cardiomyopathy and is notably associated with an increased risk of arrhythmias and conduction disorders. This article reviews the current understanding and management strategies for these cardiac complications, with [...] Read more.
Cardiac amyloidosis, a condition characterized by abnormal protein deposition in the heart, leads to restrictive cardiomyopathy and is notably associated with an increased risk of arrhythmias and conduction disorders. This article reviews the current understanding and management strategies for these cardiac complications, with a focus on recent advancements and clinical challenges. The prevalence and impact of atrial arrhythmias, particularly atrial fibrillation, are examined, along with considerations for stroke risk and anticoagulation therapy. The article also addresses the complexities of managing rate and rhythm control, outlining the utility and limitations of pharmacological agents and interventions such as catheter ablation. Furthermore, it reviews the challenges in the treatment of ventricular arrhythmias, including the contentious use of implantable cardioverter-defibrillators for primary and secondary prevention. Individualized approaches, considering the unique characteristics of cardiac amyloidosis, are paramount. Continuous research and clinical exploration are essential to refine treatment strategies and improve outcomes in this challenging patient population. Full article
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13 pages, 298 KiB  
Review
Catheter Ablation for Channelopathies: When Is Less More?
by Adhya Mehta, Rishi Chandiramani, Binita Ghosh, Babken Asatryan, Adrija Hajra and Andreas S. Barth
J. Clin. Med. 2024, 13(8), 2384; https://doi.org/10.3390/jcm13082384 - 19 Apr 2024
Viewed by 912
Abstract
Ventricular fibrillation (VF) is a common cause of sudden cardiac death in patients with channelopathies, particularly in the young population. Although pharmacological treatment, cardiac sympathectomy, and implantable cardioverter defibrillators (ICD) have been the mainstay in the management of VF in patients with channelopathies, [...] Read more.
Ventricular fibrillation (VF) is a common cause of sudden cardiac death in patients with channelopathies, particularly in the young population. Although pharmacological treatment, cardiac sympathectomy, and implantable cardioverter defibrillators (ICD) have been the mainstay in the management of VF in patients with channelopathies, they are associated with significant adverse effects and complications, leading to poor quality of life. Given these drawbacks, catheter ablation has been proposed as a therapeutic option for patients with channelopathies. Advances in imaging techniques and modern mapping technologies have enabled increased precision in identifying arrhythmia triggers and substrate modification. This has aided our understanding of the underlying pathophysiology of ventricular arrhythmias in channelopathies, highlighting the roles of the Purkinje network and the epicardial right ventricular outflow tract in arrhythmogenesis. This review explores the role of catheter ablation in managing the most common channelopathies (Brugada syndrome, congenital long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). While the initial results for ablation in Brugada syndrome are promising, the long-term efficacy and durability of ablation in different channelopathies require further investigation. Given the genetic and phenotypic heterogeneity of channelopathies, future studies are needed to show whether catheter ablation in patients with channelopathies is associated with a reduction in VF, and psychological distress stemming from recurrent ICD shocks, particularly relative to other available therapeutic options (e.g., quinidine in high-risk Brugada patients). Full article
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18 pages, 3260 KiB  
Review
Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control
by Shaojie Chen, Yuehui Yin, Zhiyu Ling, Christian Meyer, Helmut Pürerfellner, Martin Martinek, Márcio Galindo Kiuchi, Piotr Futyma, Lin Zhu, Alexandra Schratter, Jiazhi Wang, Willem-Jan Acou, Philipp Sommer, Feifan Ouyang, Shaowen Liu, Julian K. R. Chun and Boris Schmidt
J. Clin. Med. 2022, 11(22), 6871; https://doi.org/10.3390/jcm11226871 - 21 Nov 2022
Cited by 8 | Viewed by 2723
Abstract
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, [...] Read more.
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, the time of Diagnosis-to-Intervention appears crucial. Recent evidence shows that earlier rhythm control is associated with a lower risk of adverse cardiovascular outcomes in patients with early AF. Particularly, CA as an initial first line rhythm control strategy is associated with significant reduction of arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA is shown to significantly lower the risk of progression from paroxysmal AF to persistent AF. When treating persistent AF, the overall clinical success after ablation remains unsatisfactory, however the ablation outcome in patients with “early” persistent AF appears better than those with “late” persistent AF. “Adjunctive” ablation on top of pulmonary vein isolation (PVI), e.g., ablation of atrial low voltage area, left atrial posterior wall, vein of Marshall, left atrial appendage, etc., may further reduce arrhythmia recurrence in selected patient group. New ablation concepts or new ablation technologies have been developing to optimize therapeutic effects or safety profile and may ultimately improve the clinical outcome. Full article
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Other

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8 pages, 3193 KiB  
Case Report
Long QT Syndrome and WPW Syndrome: A Very Rare Association between Two Causes of Sudden Cardiac Death in a Young Patient
by Radu Gabriel Vătășescu, Silvia Deaconu, Corneliu Nicolae Iorgulescu, Gabriela Marascu, Bogdan Oprita and Alexandru Deaconu
J. Clin. Med. 2024, 13(3), 804; https://doi.org/10.3390/jcm13030804 - 30 Jan 2024
Cited by 1 | Viewed by 1167
Abstract
Long QT syndrome (LQT) and WPW syndrome are causes of sudden cardiac death (SCD) in the young, and their association has been rarely reported. A 26-year-old woman presented with recurrent syncope. Her ECG showed a short PR interval, wide QRS (150 ms) due [...] Read more.
Long QT syndrome (LQT) and WPW syndrome are causes of sudden cardiac death (SCD) in the young, and their association has been rarely reported. A 26-year-old woman presented with recurrent syncope. Her ECG showed a short PR interval, wide QRS (150 ms) due to a delta wave, and QT prolongation (QT 580 ms, QTc 648 ms). ECG monitoring documented recurrent salvos of a self-terminating wide QRS tachycardia, generally slightly polymorphic, sometimes with “torsade des pointes” (TdP) appearance, which were linked to the syncopal/presyncope episodes. Electrophysiologic monitoring diagnosed a right para-hisian accessory pathway with a very short ERP (240 ms baseline, <200 ms after isoproterenol). The pathway was ablated successfully. Despite QRS narrowing (80 ms), QT prolongation persisted after ablation (QT 620 ms, QTc 654 ms), with short runs of TdP, despite beta-blocker treatment, which was increased to the maximal dosage. A dual-chamber implantable cardioverter defibrillator (ICD) was implanted. To our knowledge, this is the first case report of an association between LQT and WPW syndrome in which both conditions are associated with an increased risk of SCD. Full article
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13 pages, 1348 KiB  
Systematic Review
Epicardial Adipose Tissue and Atrial Fibrillation Recurrence following Catheter Ablation: A Systematic Review and Meta-Analysis
by Ioannis Anagnostopoulos, Maria Kousta, Charalampos Kossyvakis, Nikolaos Taxiarchis Paraskevaidis, Dimitrios Vrachatis, Spyridon Deftereos and Georgios Giannopoulos
J. Clin. Med. 2023, 12(19), 6369; https://doi.org/10.3390/jcm12196369 - 5 Oct 2023
Cited by 3 | Viewed by 1237
Abstract
(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship [...] Read more.
(1)Introduction: Catheter ablation has become a cornerstone for the management of patients with atrial fibrillation (AF). Nevertheless, recurrence rates remain high. Epicardial adipose tissue (EAT) has been associated with AF pathogenesis and maintenance. However, the literature has provided equivocal results regarding the relationship between EAT and post-ablation recurrence.(2) Purpose: to investigate the relationship between total and peri-left atrium (peri-LA) EAT with post-ablation AF recurrence. (3) Methods: major electronic databases were searched for articles assessing the relationship between EAT, quantified using computed tomography, and the recurrence of AF following catheter ablation procedures. (4) Results: Twelve studies (2179 patients) assessed total EAT and another twelve (2879 patients) peri-LA EAT. Almost 60% of the included patients had paroxysmal AF and recurrence was documented in 34%. Those who maintained sinus rhythm had a significantly lower volume of peri-LA EAT (SMD: −0.37, 95%; CI: −0.58–0.16, I2: 68%). On the contrary, no significant difference was documented for total EAT (SMD: −0.32, 95%; CI: −0.65–0.01; I2: 92%). No differences were revealed between radiofrequency and cryoenergy pulmonary venous isolation. No publication bias was identified. (5) Conclusions: Only peri-LA EAT seems to be predictive of post-ablation AF recurrence. These findings may reflect different pathophysiological roles of EAT depending on its location. Whether peri-LA EAT can be used as a predictor and target to prevent recurrence is a matter of further research. Full article
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7 pages, 2534 KiB  
Case Report
Not Just a One-Way: Mahaim Accessory Pathway Concomitantly Supporting Orthodromic Atrioventricular Re-Entrant Tachycardia
by Alexandru Deaconu, Viviana Gondos and Radu Vatasescu
J. Clin. Med. 2023, 12(1), 159; https://doi.org/10.3390/jcm12010159 - 25 Dec 2022
Cited by 1 | Viewed by 1640
Abstract
Introduction: We report the case of a 41-year-old female with documented narrow QRS tachycardia. During electrophysiological study, both orthodromic and antidromic atrioventricular reentry tachycardia (AVRT) were demonstrated as well as short episodes of pre-excited atrial fibrillation. Programmed atrial stimulation resulted in decremental anterograde [...] Read more.
Introduction: We report the case of a 41-year-old female with documented narrow QRS tachycardia. During electrophysiological study, both orthodromic and antidromic atrioventricular reentry tachycardia (AVRT) were demonstrated as well as short episodes of pre-excited atrial fibrillation. Programmed atrial stimulation resulted in decremental anterograde conduction on the AP, thus confirming an unexpected Mahaim accessory pathway (AP) diagnosis. Discussion: Limited 3D activation maps of the right atrium during orthoAVRT, respectively, and the right ventricle (RV) during antiAVRT were constructed and helped accurately describe the atrial and ventricular insertion points, which were superposed on the tricuspid ring, confirming the existence of a single short atrio-ventricular right free wall AP. Short atrioventricular APs with anterograde Mahaim-type conduction concomitantly sustaining orthodromic AVRT are extremely rare. Conclusions: Electroanatomical 3D mapping may help both to clarify the diagnosis and increase the success rate by accurately describing the insertion points of complex accessory pathways. Full article
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