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Catheter Ablation of Atrial Fibrillation: Current Progress and New Challenges
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Catheter Ablation of Atrial Fibrillation: Current Progress and New Challenges

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

Deadline for manuscript submissions: 25 April 2026 | Viewed by 2705

Special Issue Editors

Dr. Sorin Stefan Popescu

E-Mail Website
Guest Editor
Department of Rhythmology, University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
Interests: catheter ablation; atrial fibrillation; ventricular arrhythmias; cardiovascular implantable electronic devices
Prof. Dr. Roland Richard Tilz

E-Mail Website
Guest Editor
Department of Rhythmology, University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
Interests: catheter ablation; atrial fibrillation; ventricular arrhythmias; cardiovascular implantable electronic devices
Prof. Dr. Karl-Heinz Kuck

E-Mail Website
Guest Editor
Department of Rhythmology, University Heart Centre Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
Interests: catheter ablation; atrial fibrillation; ventricular arrhythmias; cardiovascular implantable electronic devices

Special Issue Information

Dear Colleagues,

Atrial fibrillation is the most common arrhythmia seen in adults, affecting over 59 million people worldwide as of 2019. Its prevalence is expected to rise significantly in the coming years, placing an increasing burden on healthcare systems across the world. Atrial fibrillation is associated with substantial morbidity, including stroke and heart failure, as well as reduced quality of life and increased mortality.

Catheter ablation has become the cornerstone of interventional treatments for atrial fibrillation and is now performed across the world. In recent years, numerous clinical in recent years have demonstrated the safety and efficacy of catheter ablation. Additionally, novel technologies and treatment strategies have been introduced into clinical practice, aiming to further reduce complication rates, enhance efficacy, and alleviate the strain on healthcare systems.

Among these advancements, pulsed field ablation has been developed to minimize the incidence of thermal complications, such as oesophageal fistulas and phrenic nerve palsy, while also improving the durability of pulmonary vein isolation and, consequently, the long-term success of catheter ablation. Furthermore, innovative strategies, such as same-day discharge following catheter ablation, seek to optimize healthcare resource utilization while enhancing patient comfort and satisfaction.

This Special Issue explores the impact of emerging ablation technologies and catheter ablation strategies on atrial fibrillation, with a focus on safety, efficacy, and sustainability. It also addresses the new challenges arising in the interventional management of atrial fibrillation.

Dr. Sorin Stefan Popescu
Prof. Dr. Roland Richard Tilz
Prof. Dr. Karl-Heinz Kuck
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 250 words) can be sent to the Editorial Office for assessment.

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
  • novel technologies
  • pulmonary vein isolation
  • same-day discharge
  • pulsed field ablation
  • cryo-ablation
  • radiofrequency
  • safety
  • efficacy
  • sustainability

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Published Papers (2 papers)

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25 pages, 1308 KB  
Review
Targeting the Substrate: Mechanism-Based Ablation Strategies for Persistent Atrial Fibrillation
by Gabriela-Elena Marascu, Alexandru Ioan Deaconu, Raluca-Elena Mitran, Laura Adina Stanciulescu and Radu Gabriel Vatasescu
J. Clin. Med. 2025, 14(14), 5147; https://doi.org/10.3390/jcm14145147 - 20 Jul 2025
Viewed by 1746
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, especially effective in patients with paroxysmal AF, where the pulmonary veins (PVs) are the primary triggers. More complex arrhythmogenic mechanisms are involved in persistent AF (PsAF), and PVI alone may not [...] Read more.
Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, especially effective in patients with paroxysmal AF, where the pulmonary veins (PVs) are the primary triggers. More complex arrhythmogenic mechanisms are involved in persistent AF (PsAF), and PVI alone may not be sufficient. Personalized, substrate-based ablation strategies are increasingly used and can significantly enhance outcomes in PsAF patients. While radiofrequency ablation remains the gold standard, cryoablation provides effective PVI, and pulsed field ablation is emerging as a safer, promising alternative. Advanced mapping techniques may better target scar areas responsible for arrhythmogenesis, optimizing procedural results. While still in development, artificial intelligence and machine learning enable more personalized and precise ablation strategies and may improve long-term outcomes. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Current Progress and New Challenges)
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28 pages, 3721 KB  
Systematic Review
Effects of Sodium Glucose Co-Transporter 2 Inhibitors on Atrial Fibrillation Recurrences After Catheter Ablation in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis
by Saketh Parsi, Kunal Sonavane, Usha Ravi, Pallavi D. Shirsat, Venkata S. Chamarthi, Mohamed Gabr, Harikrishna Choudary Ponnam, Salim Surani, Vikas Bansal and Rahul Kashyap
J. Clin. Med. 2025, 14(22), 8001; https://doi.org/10.3390/jcm14228001 - 11 Nov 2025
Viewed by 526
Abstract
Background/Objectives: Sodium glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated a reduction in heart failure (HF) hospitalizations in HF patients and decreased recurrence of atrial fibrillation (AF), including in those who have undergone catheter ablation (CA). The effects of SGLT2i are likely due to [...] Read more.
Background/Objectives: Sodium glucose co-transporter 2 inhibitors (SGLT2is) have demonstrated a reduction in heart failure (HF) hospitalizations in HF patients and decreased recurrence of atrial fibrillation (AF), including in those who have undergone catheter ablation (CA). The effects of SGLT2i are likely due to suppression of the renin–angiotensin–aldosterone system, reduction in oxidative stress with subsequent improvement in myocardial efficiency, and attenuation of cardiac remodeling. We aim to present the effects of SGLT2i on AF recurrence in patients who have undergone CA for AF. Methods: This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and retrospective studies evaluating the effect of SGLT2i on AF recurrence following CA compared with non-SGLT2i. The primary outcome was the recurrence of AF by the final follow-up reported in each study. Secondary outcomes include AF recurrence by the first follow-up within 12 to 24 months and follow-up intervals (6, 12, 18, 24, and 36 to 42 months) post-ablation, multivariate risk of AF recurrence, and the effect on left atrial diameter (LAD) (less than 45 mm vs. greater than or equal to 45 mm). For risk of bias (ROB) analysis, the NIH ROB and Cochrane ROB2 tool were used. All statistical, heterogeneity, and sensitivity analyses were conducted using Cochrane Review Manager. A random-effect model was employed for all pooled statistical analyses. Results: A total of nine studies, two RCTs and seven retrospective studies, were included (N = 6874) for the primary outcome. Compared to non-SGLT2i (N = 3693), SGLT2i (N = 3181) significantly decreased AF recurrence by the final follow-up (OR = 0.62; 95% CI: 0.45–0.85; p = 0.008). For secondary outcomes, SGLT2i significantly reduced AF recurrence by the first follow-up within 12 to 24 months post-ablation (OR = 0.58; p = 0.0001) and by the different follow-up periods, 6-month (OR = 0.53; p = 0.02), 12-month (OR = 0.56; p = 0.0001), 18-month (OR = 0.55; p = 0.01), and 24-month (OR = 0.60; p = 0.12) follow-up periods. On the other hand, by 36 to 42 months, SGLT2i was associated with increased risk of AF recurrence (OR = 1.41; p = 0.004). Conclusions: We conclude that SGLT2i demonstrated a reduction in AF recurrence following CA, particularly by 12 to 18 months post-ablation. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Current Progress and New Challenges)
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