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Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation
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Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation

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

Deadline for manuscript submissions: 31 July 2025 | Viewed by 2106

Special Issue Editors

Prof. Dr. Nikolaos K. Fragakis

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Guest Editor
Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
Interests: arrhythmias; supraventricular tachycardia; syncope; bradycardia; ventricular arrhythmias; sudden cardiac death (SCD); atrial fibrillation; heart failure
Special Issues, Collections and Topics in MDPI journals
Dr. Paschalis Karakasis

E-Mail Website
Guest Editor
2nd Cardiology Department, Hippokration General Hospital, Aristotle University Medical School, Κonstantinoupoleos 49, PK 54642 Thessaloniki, Greece
Interests: cardiology; statistics; diabetes; heart failure; atrial fibrillation; atherosclerosis; SGLT-2 inhibitors; GLP-1 receptor agonists; myocardial infarction; ablation; arrhythmias
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cardiac ablation has revolutionized the management of arrhythmias, offering a minimally invasive alternative to pharmacological therapy. Despite its success, challenges remain in terms of optimizing procedural efficacy, safety, and long-term outcomes. This Special Issue will focus on advancements in technology, techniques, and patient care aimed at enhancing outcomes for patients undergoing cardiac ablation. Possible topics include novel mapping systems for precision ablation, the use of artificial intelligence to predict arrhythmia recurrence, and innovations in catheter technology such as high-power, short-duration energy delivery. It will also explore patient-specific strategies, including pre-procedural imaging, anticoagulation optimization, and post-procedure care pathways to reduce arrhythmia recurrence. Contributions addressing disparities in access to ablation therapy and its outcomes are particularly encouraged. By integrating cutting-edge research, clinical insights, and multidisciplinary approaches, this Special Issue will provide a comprehensive resource for clinicians and researchers committed to advancing the science and practice of cardiac ablation.

Prof. Dr. Nikolaos K. Fragakis
Dr. Paschalis Karakasis
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

  • arrhythmias
  • cardiac ablation
  • catheter technology
  • imaging
  • anticoagulation optimization
  • post-procedure care

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Published Papers (3 papers)

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Research

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13 pages, 2547 KiB  
Article
Left Atrial Substrate Modification for Long-Standing Persistent Atrial Fibrillation and Left Atrial Macro- or Micro-Reentrant Tachycardia Using a Single-Shot Pulsed Field Ablation System—A Case Series
by Paul Lustig, Jonghui Lee, Michael Sponder, Günter Stix, Christian Hengstenberg, Robert Schönbauer and Stefan Stojkovic
J. Clin. Med. 2025, 14(6), 1891; https://doi.org/10.3390/jcm14061891 - 11 Mar 2025
Viewed by 696
Abstract
Background: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, [...] Read more.
Background: Pulsed field ablation [PFA] is a novel ablation technique for pulmonary vein isolation [PVI] in patients with paroxysmal and persistent atrial fibrillation. However, data for the efficacy and safety of PFA for left atrial substrate modification using a single shot PFA system, in patients with long-standing persistent atrial fibrillation [AF] and left atrial macro- as well as micro-reentrant atrial tachycardia [LAMRT], are scarce. Here, we provide a small, single-center case series regarding the efficacy and safety of left atrial substrate modification using a single-shot PFA system. Methods: Nine patients with long-standing persistent AF and LAMRT underwent redo-PVI and left atrial substrate modification using a single-shot PFA system. Patients were subsequently followed up for 1 year. Results: The median age was 64 years [IQR 55.5–75], with 44% of the participants being female. The median time since the first diagnosis of AF was 7 years [IQR 4–15.5]. After re-PVI, posterior wall isolation was performed in five patients, roof isolation in six patients, and anterior wall ablation between the superior mitral annulus and the right superior pulmonary vein [RSPV] in five patients. In two patients, cavotricuspid isthmus ablation was additionally performed to treat typical atrial flutter. The acute procedural success rate was 100%, with all LAMRTs and typical flutters successfully terminating by ablation. At 1-year follow-up, four patients [44%] experienced a recurrence of any atrial arrhythmia. Median time to recurrence was 164 days [138–212.8]. Importantly, no acute or chronic complications were observed. Conclusions: In this small, single-center case series, left atrial substrate modification for long-standing persistent AF and AT using a single-shot PFA system was safe and showed an excellent acute success rate. Full article
(This article belongs to the Special Issue Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation)
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Review

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16 pages, 790 KiB  
Review
Artificial Intelligence in Atrial Fibrillation: From Early Detection to Precision Therapy
by Paschalis Karakasis, Panagiotis Theofilis, Marios Sagris, Konstantinos Pamporis, Panagiotis Stachteas, Georgios Sidiropoulos, Panayotis K. Vlachakis, Dimitrios Patoulias, Antonios P. Antoniadis and Nikolaos Fragakis
J. Clin. Med. 2025, 14(8), 2627; https://doi.org/10.3390/jcm14082627 - 11 Apr 2025
Viewed by 650
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, associated with significant morbidity, mortality, and healthcare burden. Despite advances in AF management, challenges persist in early detection, risk stratification, and treatment optimization, necessitating innovative solutions. Artificial intelligence (AI) has emerged as a transformative [...] Read more.
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, associated with significant morbidity, mortality, and healthcare burden. Despite advances in AF management, challenges persist in early detection, risk stratification, and treatment optimization, necessitating innovative solutions. Artificial intelligence (AI) has emerged as a transformative tool in AF care, leveraging machine learning and deep learning algorithms to enhance diagnostic accuracy, improve risk prediction, and guide therapeutic interventions. AI-powered electrocardiographic screening has demonstrated the ability to detect asymptomatic AF, while wearable photoplethysmography-based technologies have expanded real-time rhythm monitoring beyond clinical settings. AI-driven predictive models integrate electronic health records and multimodal physiological data to refine AF risk stratification, stroke prediction, and anticoagulation decision making. In the realm of treatment, AI is revolutionizing individualized therapy and optimizing anticoagulation management and catheter ablation strategies. Notably, AI-enhanced electroanatomic mapping and real-time procedural guidance hold promise for improving ablation success rates and reducing AF recurrence. Despite these advancements, the clinical integration of AI in AF management remains an evolving field. Future research should focus on large-scale validation, model interpretability, and regulatory frameworks to ensure widespread adoption. This review explores the current and emerging applications of AI in AF, highlighting its potential to enhance precision medicine and patient outcomes. Full article
(This article belongs to the Special Issue Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation)
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13 pages, 2397 KiB  
Review
Thermal and Non-Thermal Energies for Atrial Fibrillation Ablation
by Francesco M. Brasca, Emanuele Curti and Giovanni B. Perego
J. Clin. Med. 2025, 14(6), 2071; https://doi.org/10.3390/jcm14062071 - 18 Mar 2025
Viewed by 553
Abstract
The cornerstone of ablative therapy for atrial fibrillation (AF) is pulmonary vein isolation (PVI). Whether PVI should be added with additional lesions in persistent atrial fibrillation (PerAF) or for any post-ablative recurrent AF is a matter of debate. Whatever the ablative strategy, it [...] Read more.
The cornerstone of ablative therapy for atrial fibrillation (AF) is pulmonary vein isolation (PVI). Whether PVI should be added with additional lesions in persistent atrial fibrillation (PerAF) or for any post-ablative recurrent AF is a matter of debate. Whatever the ablative strategy, it must determine the choice of energy source to achieve the most durable lesion sets with the least likelihood of complications. Radiofrequency (RF) is the most studied thermal ablation technique. It can be combined with high-density electroanatomic mapping and can be used for both pulmonary and extrapulmonary atrial ablation. Cryoenergy is at least as effective as radiofrequency for PVI; it is rapid, relatively safe, and has a steep learning curve. Therefore, it has been proposed as a first-line approach for PVI-only procedures. More recently, a non-thermal technique based on the application of pulsed direct current (Pulsed Field Ablation—PFA) has been introduced. PFA causes cell death by opening cell membrane pores (electroporation) without a significant increase in tissue temperature. It is fast and does not alter the extracellular matrix as thermal techniques do, although it ends up causing long-lasting, transmural lesions. Most importantly, it is relatively selective on cardiac myocytes and therefore potentially safer than thermal techniques. Some PFA systems can be combined with electroanatomic mapping systems. However, as of now, it appears that these ablation technologies should be considered complementary rather than alternative for a number of practical and theoretical reasons. Full article
(This article belongs to the Special Issue Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation)
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