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Current and Emerging Treatment Options in Atrial Fibrillation

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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 November 2024) | Viewed by 10120

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Dr. Marco Valerio Mariani

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Department of Cardiovascular Sciences, Policlinico Umberto I, Sapienza Università di Roma, 00185 Rome, Italy
Interests: cardiology; arrhythmia; heart failure; coronary artery dissection
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Special Issue Information

Dear Colleagues,

This Special Issue aims to provide a comprehensive overview of the current and emerging treatment options in the field of atrial fibrillation (AF). With the increasing prevalence of AF and the rapid advancements in therapeutic approaches, it is crucial to gather and disseminate the latest research findings to improve patients’ outcomes. This Special Issue will cover a wide range of topics related to the treatment of atrial fibrillation. These include, but are not limited to:

Pharmacological interventions and antiarrhythmic drugs;
Catheter ablation techniques and advancements;
Novel surgical approaches for AF management;
Non-pharmacological therapies, such as lifestyle modifications and alternative treatments;
Device-based therapies, including pacemakers and implantable cardioverter-defibrillators (ICDs);
Personalized medicine in AF treatment.

We invite original research articles, systematic reviews, meta-analyses, and clinical trials that contribute to our understanding and advancement of treatment options for atrial fibrillation. However, please note that mini-reviews and case reports will not be considered for this Special Issue.

This Special Issue aims to bring together cutting-edge research and expert perspectives to enhance our understanding and management of this prevalent cardiac condition. We look forward to receiving submissions that contribute to the advancement of treatment strategies in atrial fibrillation, and ultimately, improve patient care.

Dr. Marco Valerio Mariani
Guest Editor

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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

atrial fibrillation
left atrial appendage closure
ablation techniques
personalized medicine in AF treatment
cardioversion methods

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Published Papers (8 papers)

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Research

11 pages, 870 KiB

Open AccessArticle

Mind the Gap: Recurrence of Sex-Related Differences in Patients with Acute Atrial Fibrillation in the Emergency Department—A Retrospective Cohort Study

by Sophie Gupta, Martin Lutnik, Filippo Cacioppo, Julia Oppenauer, Teresa Lindmayr, Nikola Schütz, Elvis Tumnitz, Hans Domanovits, Michael Schwameis and Jan Niederdöckl

J. Clin. Med. 2025, 14(4), 1250; https://doi.org/10.3390/jcm14041250 - 13 Feb 2025

Viewed by 556

Abstract

Background/Objectives: In recent years, awareness of sex disparities in atrial fibrillation (AF) and atrial flutter (AFL) has grown, resulting in significant advancements in sex-specific treatment strategies. As these treatment approaches continue to evolve, it is essential to remain attentive to sex-related issues to ensure equitable care for all patients, a point first emphasised by the 2016 AF guidelines. Our objective was the long-term evaluation of sex-specific treatment standards for acute AF/AFL. Methods: This cohort study included cases of acute AF/AFL treated in the emergency department of the Medical University of Vienna, Austria, between 2012 and 2022. The Kaplan–Meier method was used to analyse time-to-event data. The effect of sex on the time to restoration of sinus rhythm was assessed using the log-rank test for unadjusted models and the likelihood ratio test for adjusted models. The groups were categorised based on cases occurring before and after 2016. Results: A total of 3661 cases (55.7% male) were analysed. Before 2016, sinus rhythm was achieved in 70.8% of males and 71.2% of females; after 2016, these rates were 71.8% and 68.6%, respectively. The adjusted model showed a significant effect of sex on the time to restoration of sinus rhythm after 2016 (p = 0.013) but not before (p = 0.865). A subgroup analysis indicated similar results for pharmacologic rhythm control (p = 0.035 vs. p = 0.193). A sensitivity analysis confirmed robustness, with similar effects in both models. The success rate of pharmacological cardioversion was lower in women than in men but was used more frequently in women after 2016. Conclusions: The re-emergence of a sex gap in success rates and time to restoration of sinus rhythm in emergency treatment for acute AF/AFL is concerning and necessitates a re-evaluation of treatment protocols, improved decision-making processes, and further research to ensure equitable, effective, and safe emergency care for all patients. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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14 pages, 3332 KiB

Open AccessArticle

Preoperative Non-Invasive Mapping for Targeted Concomitant Surgical Ablation of Non-Paroxysmal Atrial Fibrillation (PreMap Study)

by David Santer, Brigitta Gahl, Ali Dogan, Florian Bruehlmeier, Ulisse Camponovo, Rory Maguire, Larissa Goldiger, Vanessa Boss, Nicole Weber, Lena Schmuelling, Stefan Gherca, Jens Bremerich, Nadine Cueni, Luca Koechlin, Michael Kühne, Jules Miazza, Oliver Reuthebuch, Alexa Hollinger, Martin Siegemund, Christian Sticherling, Friedrich Eckstein and Simon A. Amacher Show full author list Hide full author list

J. Clin. Med. 2025, 14(2), 481; https://doi.org/10.3390/jcm14020481 - 14 Jan 2025

Viewed by 942

Abstract

Background/Objectives: The present study introduces our targeted approach for concomitant surgical ablation (CSA) using non-invasive phase mapping (NIPM) and describes its effectiveness regarding freedom from atrial fibrillation (AF). Methods: This retrospective study included cardiac surgical patients undergoing preoperative NIPM for CSA guidance. The primary outcome was freedom from AF six months after surgery. Key secondary outcomes were freedom from AF at hospital discharge and three months, frequency of biatrial ablation, feasibility and safety, the rate of CSA, complications, and levels of biomarkers. The control group consisted of patients undergoing CSA without NIPM. Results: Forty-four patients (Control: n = 31/NIPM: n = 13) were included. The NIPM group was younger (64 vs. 71 years [p = 0.044]), had a lower EuroSCORE II (2.6 vs. 3.4 [p = 0.041]), and a smaller left atrial size (46 mm vs. 54 mm [p = 0.025]). Surgery duration was longer in the NIPM group (285 vs. 230 min [p = 0.037]) with similar aortic cross-clamp times. Preoperative NIPM resulted in an effective frequency of CSA of 93%. CSA was more extensive in the NIPM group, with biatrial ablation performed in 54% vs. 26% of patients (p = 0.09). Conclusions: Routine preoperative NIPM in patients with non-paroxysmal atrial fibrillation might aid in increasing the number of patients receiving concomitant surgical ablation and developing a personalized CSA approach for every patient. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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11 pages, 1104 KiB

Open AccessArticle

Assessing Key Factors Influencing Successful Resuscitation Outcomes in Out-of-Hospital Cardiac Arrest (OHCA)

by Cristian Ichim, Vlad Pavel, Patricia Mester, Stephan Schmid, Samuel Bogdan Todor, Oana Stoia, Paula Anderco, Arne Kandulski, Martina Müller, Philipp Heumann and Adrian Boicean

J. Clin. Med. 2024, 13(23), 7399; https://doi.org/10.3390/jcm13237399 - 4 Dec 2024

Cited by 5 | Viewed by 1188

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a critical health issue with survival influenced by multiple factors. This study analyzed resuscitation outcomes at the County Clinical Emergency Hospital of Sibiu, Romania, during pre-COVID-19 and pandemic periods. Methods: A retrospective analysis of 508 OHCA patients (2017–2020) assessed the return of spontaneous circulation (ROSC) as the primary endpoint. Statistical methods included decision tree analysis, logistic regression and ROC curve analysis to evaluate the predictive value of adrenaline dose and patient factors. Results: The mortality rate was 68.7%, with non-shockable rhythms predominant among fatalities. Rural patients, though younger, had lower ROSC rates than urban counterparts. Logistic regression showed that lower adrenaline doses (≤4 mg, OR 11.835 [95% CI: 6.726–20.27]; 4–6 mg, OR 2.990 [95% CI: 1.773–5.042]) were associated with better ROSC outcomes. Conclusions: A multivariable model (AUC = 0.773) incorporating demographics and pandemic status outperformed adrenaline dose alone (AUC = 0.711). Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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8 pages, 968 KiB

Open AccessArticle

Comparison of Conventionally Performed and Intracardiac Echocardiography Guided Catheter Ablation of Atrioventricular Node in Patients with Permanent Atrial Fibrillation—A Retrospective Single-Center Study

by Dorottya Debreceni, Maja Mandel, Kristof-Ferenc Janosi, Botond Bocz, Dalma Torma, Tamas Simor and Peter Kupo

J. Clin. Med. 2024, 13(15), 4565; https://doi.org/10.3390/jcm13154565 - 5 Aug 2024

Viewed by 1005

Abstract

Background: Atrioventricular node (AVN) ablation is an effective treatment for atrial fibrillation (AF) with uncontrolled ventricular rates despite maximal pharmacological treatment. Intracardiac echocardiography (ICE) can help with visualizing structures, positioning catheters, and guiding the ablation procedure. We compared only fluoroscopy-guided and ICE-guided AVN ablation regarding patients with permanent AF. Methods: Sixty-two consecutive patients underwent AVN ablation were enrolled in our retrospective single-center study (ICE group: 28 patients, Standard group: 34 patients). Procedural data, acute and long-term success rate, and complications were analyzed. Results: ICE guidance for AVN ablation significantly reduced fluoroscopy time (0.30 [0.06; 0.85] min vs. 7.95 [3.23; 6.59] min, p < 0.01), first-to-last ablation time (4 [2; 16.3] min vs. 26.5 [2.3; 72.5] min, p = 0.02), and in-procedure time (40 [34; 55] min vs. 60 [45; 110], p = 0.02). There was no difference in either the total ablation time (199 [91; 436] s vs. 294 [110; 659] s, p = 0.22) or in total ablation energy (8272 [4004; 14,651] J vs. 6065 [2708; 16,406] J, p = 0.28). The acute success rate was similar (ICE: 100% vs. Standard: 94%, p = 0.49) between the groups. Conclusions: In our retrospective trial, ICE-guided AVN ablation reduced fluoroscopy time, procedure time, and first-to-last ablation time. There was no difference in ablation time, total ablation energy, acute and long-term success, and complication rate. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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12 pages, 558 KiB

Open AccessEditor’s ChoiceArticle

Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More?

by Marco Valerio Mariani, Nicola Pierucci, Sara Trivigno, Pietro Cipollone, Agostino Piro, Cristina Chimenti, Domenico Giovanni Della Rocca, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle

J. Clin. Med. 2024, 13(5), 1470; https://doi.org/10.3390/jcm13051470 - 3 Mar 2024

Cited by 17 | Viewed by 1742

Abstract

Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h “wait-and-see” approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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10 pages, 3794 KiB

Open AccessArticle

Early Clinical Outcomes and Advantages of a Novel-Size Adjustable Second-Generation Cryoballoon: A Proof-of-Concept Study

by Marco Schiavone, Gaetano Fassini, Massimo Moltrasio, Benedetta Majocchi, Fabrizio Tundo, Francesca Casati and Claudio Tondo

J. Clin. Med. 2024, 13(5), 1259; https://doi.org/10.3390/jcm13051259 - 22 Feb 2024

Cited by 3 | Viewed by 1345

Abstract

(1) Background/Objective Balloon-guided catheter ablation (CA) has emerged as an alternative option for atrial fibrillation (AF) management. The recent introduction of a novel-size adjustable second-generation cryoballoon (CB) system offers innovations, but clinical outcomes remain unexplored. This study aims to assess the acute performance of the POLARx FIT™ CB system in AFCA. (2) Methods: Consecutive patients undergoing AF ablation with the POLARx FIT™ CB system in our center were included. The primary outcome was the rate of 31 mm balloon-size utilization, with secondary outcomes including acute pulmonary vein isolation (PVI) rate, periprocedural complications, and in-hospital AF recurrences. (3) Results: Twenty-four patients with a mean age of 59.5 years, predominantly male (87.5%), and exhibiting paroxysmal AF (91.7%) were enrolled. Procedural characteristics demonstrated a high acute success rate (100% PV isolation) with a favorable safety profile. Notably, the 31 mm CB configuration was utilized in 51% of applications, showcasing its adaptability in challenging anatomies. No major complications occurred, with two patients experiencing in-hospital self-limiting AF recurrences. (4) Conclusions: This study represents the first comprehensive assessment of the POLARx FIT™ CB system in AF ablation. While acknowledging the study’s limitations, this novel CB emerges as a promising tool, warranting further exploration in larger studies with extended follow-up periods. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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15 pages, 5664 KiB

Open AccessArticle

Pulmonary Vein Isolation Followed by Biatrial Ablation of Rotational Activity in Patients with Persistent Atrial Fibrillation: Results of the Cryo-Vest Study

by Kay Felix Weipert, Julie Hutter, Malte Kuniss, Patrick Kahle, Joerg Yogarajah, Andreas Hain, Johannes Sperzel, Alexander Berkowitsch, Christian W. Hamm and Thomas Neumann

J. Clin. Med. 2024, 13(4), 1118; https://doi.org/10.3390/jcm13041118 - 16 Feb 2024

Viewed by 1161

Abstract

Background and Aims: Noninvasive mapping allows the identification of patient-specific atrial rotational activity (RA) that might play a key role in the perpetuation of persistent atrial fibrillation (PsAF). So far, the impact of pulmonary vein isolation by cryoballoon (Cryo-PVI) on RA is unclear. Moreover, the long-term effect of periprocedural termination of AF during the ablation procedure is controversial. Methods: Noninvasive electrocardiographic mapping with a 252-electrode vest was performed in 42 patients with PsAF. After the first analysis, Cryo-PVI was performed. The RA was analyzed again and then targeted by radiofrequency catheter ablation. The primary clinical endpoint was periprocedural termination of AF. The secondary endpoint was freedom from any atrial arrhythmia >30 s during a 12-month follow-up. Results: In 33 patients (79%), right atrial RA was identified leading to biatrial ablation, and nine patients (21%) had left atrial RA only. Twelve patients (28.6%) converted from AF to sinus rhythm (SR) (Group A). Thirteen patients (30.9%) converted to atrial tachycardia (AT) (Group B). In 17 patients (40.5%), AF was not terminated by ablation (Group C). After a mean follow-up time of 13.8 months, 26 patients were free from AF and AT (61.9%). In terms of rhythm, control Group A (75%) and B (83.3%) showed higher success rates than Group C (33.3%) (p < 0.01). Cryo-PVI had no substantial impact on RA. Conclusions: The RA-based ablation approach showed acceptable success rates. Periprocedural termination of AF had a positive predictive impact on the outcome. No difference was observed between conversion to SR or to AT. Cryo-PVI had no impact on RA. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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12 pages, 4895 KiB

Open AccessArticle

Identification of Atrial Transmural Conduction Inhomogeneity Using Unipolar Electrogram Morphology

by Lu Zhang, Mathijs S. van Schie, Hongxian Xiang, Rongheng Liao, Jiahao Zheng, Paul Knops, Yannick J. H. J. Taverne and Natasja M. S. de Groot

J. Clin. Med. 2024, 13(4), 1015; https://doi.org/10.3390/jcm13041015 - 9 Feb 2024

Cited by 1 | Viewed by 1388

Abstract

(1) Background: Structural remodeling plays an important role in the pathophysiology of atrial fibrillation (AF). It is likely that structural remodeling occurs transmurally, giving rise to electrical endo-epicardial asynchrony (EEA). Recent studies have suggested that areas of EEA may be suitable targets for ablation therapy of AF. We hypothesized that the degree of EEA is more pronounced in areas of transmural conduction block (T-CB) than single-sided CB (SS-CB). This study examined the degree to which SS-CB and T-CB enhance EEA and which specific unipolar potential morphology parameters are predictive for SS-CB or T-CB. (2) Methods: Simultaneous endo-epicardial mapping in the human right atrium was performed in 86 patients. Potential morphology parameters included unipolar potential voltages, low-voltage areas, potential complexity (long double and fractionated potentials: LDPs and FPs), and the duration of fractionation. (3) Results: EEA was mostly affected by the presence of T-CB areas. Lower potential voltages and more LDPs and FPs were observed in T-CB areas compared to SS-CB areas. (4) Conclusion: Areas of T-CB could be most accurately predicted by combining epicardial unipolar potential morphology parameters, including voltages, fractionation, and fractionation duration (AUC = 0.91). If transmural areas of CB indeed play a pivotal role in the pathophysiology of AF, they could theoretically be used as target sites for ablation. Full article

(This article belongs to the Special Issue Current and Emerging Treatment Options in Atrial Fibrillation)

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