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Advances in the Diagnosis and Treatment of Cardiac Arrhythmias

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

Deadline for manuscript submissions: closed (18 June 2024) | Viewed by 7194

Special Issue Editors


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Guest Editor
Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Interests: arrhythmias; transcatheter cardiac ablation; neuromodulation and radiotherapy of cardiac arrhythmias

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Guest Editor
1. Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
2. Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Interests: out-of-hospital cardiac arrest; cardiopulmonary resuscitation; arrhythmias
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Special Issue Information

Dear Colleagues,

Cardiac arrhythmias include a great variety of clinical conditions, from the most benign, such as isolated extra beats, to the most life-threatening conditions that can lead to ventricular fibrillation and sudden cardiac death. Our knowledge about the mechanisms of the genesis and perpetuation of cardiac arrhythmias has evolved dramatically in recent years. In parallel, the clinical portfolio for the treatment of cardiac arrhythmias has been enriched significantly, and cardiologists today have different potential “weapons” to help patients with cardiac arrhythmias. Anti-arrhythmic drugs, transcatheter cardiac ablation, pacemakers, and defibrillators are established and effective treatments that are extensively used worldwide in everyday clinical practice. Nonetheless, the results, especially for the treatment of the most prevalent arrhythmias, such as atrial fibrillation and ventricular arrhythmias, are still suboptimal. Personalized therapy, neuromodulation and radiotherapy of cardiac arrhythmias are among the most promising new potential treatments that have recently emerged. These new frontiers may significantly change the clinical approach to cardiac arrhythmias in the near future.

The aim of this Special Issue is to host original and review contributions on the diagnosis and treatment of cardiac arrhythmias. This issue should provide readers with a comprehensive overview of established therapies but also help to take the first steps into the future in the fascinating and complex world of cardiac arrhythmias.

Dr. Roberto Rordorf
Dr. Enrico Baldi
Guest Editors

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Keywords

  • atrial fibrillation
  • arrhythmia surgery
  • CIED therapy
  • neuromodulation
  • radiotherapy of cardiac arrhythmias
  • cardiac ablation
  • ventricular arrhythmias
  • anti-arrhythmic drugs
  • pacemakers
  • defibrillators

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Published Papers (3 papers)

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Research

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11 pages, 616 KiB  
Article
Clinical Characteristics of Atrial Flutter and Its Response to Pharmacological Cardioversion with Amiodarone in Comparison to Atrial Fibrillation
by Maciej T. Wybraniec, Kamil Górny, Kamil Jabłoński, Julia Jung, Kiryl Rabtsevich, Przemysław Szyszka, Fabian Wesołek, Karolina Bula, Małgorzata Cichoń, Wojciech Wróbel and Katarzyna Mizia-Stec
J. Clin. Med. 2023, 12(13), 4262; https://doi.org/10.3390/jcm12134262 - 25 Jun 2023
Cited by 3 | Viewed by 2205
Abstract
Background: Unlike atrial fibrillation (AF), atrial flutter (AFl) is thought to be relatively refractory to pharmacological cardioversion (PC), but the evidence is scarce. The aim of this study was to evaluate the clinical characteristics and efficacy of the PC of AFl with amiodarone [...] Read more.
Background: Unlike atrial fibrillation (AF), atrial flutter (AFl) is thought to be relatively refractory to pharmacological cardioversion (PC), but the evidence is scarce. The aim of this study was to evaluate the clinical characteristics and efficacy of the PC of AFl with amiodarone in comparison to AF. Materials and methods: This retrospective study covered 727 patients with urgent consult for AF/AFl in a high-volume emergency department between 2015 and 2018. AFl was diagnosed in 222 (30.5%; median age: 68 (62; 75) years; 65.3% men). In a nested case-control study, 59 control patients with AF, matched in terms of age and sex with 60 AFl patients, were subject to PC with amiodarone. The primary endpoint was return of sinus rhythm confirmed using a 12-lead ECG. Results: The AFl population had a median CHA2DS2-VASc score of 3 (2; 4) and episode duration of 72 h (16; 120). In the AFl cohort, 36% of patients were initially subject to PC, 33.3% to electrical cardioversion (EC) and 40.5% to catheter ablation. In comparison to the AF group, the AFl patients required a longer hospitalization time, had a higher rate of EC (p < 0.001) and less frequent use of PC (p < 0.001) and, lower left ventricular ejection fraction (p < 0.001) and more pronounced cardiovascular risk factors. The efficacy of PC with amiodarone was significantly lower in AFl than AF group (39% vs. 65%, relative risk (RR) 0.60, p = 0.007). Conclusions: AFl patients shared a greater burden of comorbidities than AF patients, while the efficacy of PC in AFl was low. Patients should be initially managed with primary electrical cardioversion. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Cardiac Arrhythmias)
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Review

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17 pages, 949 KiB  
Review
Association between Inflammation and New-Onset Atrial Fibrillation in Acute Coronary Syndromes
by Ruxandra-Maria Băghină, Simina Crișan, Silvia Luca, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Alina Gabriela Negru, Constantin-Tudor Luca and Dan Gaiță
J. Clin. Med. 2024, 13(17), 5088; https://doi.org/10.3390/jcm13175088 - 27 Aug 2024
Cited by 2 | Viewed by 2245
Abstract
Acute coronary syndrome (ACS) is a complex clinical syndrome that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Its underlying mechanism refers to coronary plaque disruption, with consequent platelet aggregation and thrombosis. Inflammation plays an important role in the progression of atherosclerosis [...] Read more.
Acute coronary syndrome (ACS) is a complex clinical syndrome that encompasses acute myocardial infarction (AMI) and unstable angina (UA). Its underlying mechanism refers to coronary plaque disruption, with consequent platelet aggregation and thrombosis. Inflammation plays an important role in the progression of atherosclerosis by mediating the removal of necrotic tissue following myocardial infarction and shaping the repair processes that are essential for the recovery process after ACS. As a chronic inflammatory disorder, atherosclerosis is characterized by dysfunctional immune inflammation involving interactions between immune (macrophages, T lymphocytes, and monocytes) and vascular cells (endothelial cells and smooth muscle cells). New-onset atrial fibrillation (NOAF) is one of the most common arrhythmic complications in the setting of acute coronary syndromes, especially in the early stages, when the myocardial inflammatory reaction is at its maximum. The main changes in the atrial substrate are due to atrial ischemia and acute infarcts that can be attributed to neurohormonal factors. The high incidence of atrial fibrillation (AF) post-myocardial infarction may be secondary to inflammation. Inflammatory response and immune system cells have been involved in the initiation and development of atrial fibrillation. Several inflammatory indexes, such as C-reactive protein and interleukins, have been demonstrated to be predictive of prognosis in patients with ACS. The cell signaling activation patterns associated with fibrosis, apoptosis, and hypertrophy are forms of cardiac remodeling that occur at the atrial level, predisposing to AF. According to a recent study, the presence of fibrosis and lymphomononuclear infiltration in the atrial tissue was associated with a prior history of AF. However, inflammation may contribute to both the occurrence/maintenance of AF and its thromboembolic complications. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Cardiac Arrhythmias)
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30 pages, 2542 KiB  
Review
Multidisciplinary Approach in Atrial Fibrillation: As Good as Gold
by Fabiana Lucà, Maurizio Giuseppe Abrignani, Fabrizio Oliva, Maria Laura Canale, Iris Parrini, Adriano Murrone, Carmelo Massimiliano Rao, Martina Nesti, Stefano Cornara, Irene Di Matteo, Michela Barisone, Simona Giubilato, Roberto Ceravolo, Carlo Pignalberi, Giovanna Geraci, Carmine Riccio, Sandro Gelsomino, Furio Colivicchi, Massimo Grimaldi and Michele Massimo Gulizia
J. Clin. Med. 2024, 13(16), 4621; https://doi.org/10.3390/jcm13164621 - 7 Aug 2024
Cited by 3 | Viewed by 2006
Abstract
Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential [...] Read more.
Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential exacerbating conditions, a multidisciplinary team (MDT) should manage AF patients by cooperating with a cardiologist. Effective management of AF patients necessitates the implementation of a well-coordinated and tailored care pathway aimed at delivering optimized treatment through collaboration among various healthcare professionals. Management of AF should be carefully evaluated and mutually agreed upon in consultation with healthcare providers. It is crucial to recognize that treatment may evolve due to the emergence of new risk factors, symptoms, disease progression, and advancements in treatment modalities. In the context of multidisciplinary AF teams, a coordinated approach involves assembling a diverse team tailored to meet individual patients’ unique needs based on local services’ availability. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Cardiac Arrhythmias)
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