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Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders
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Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders

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

Deadline for manuscript submissions: 25 June 2026 | Viewed by 5109

Special Issue Editors

Dr. Piotr Bienias

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Guest Editor
Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland
Interests: electrocardiography; ambulatory electrocardiography monitoring; arrhythmias non invasive assessment; cardiac involvement and arrhythmias in rare and genetic disorders
Dr. Jakub Baran

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Guest Editor
1. Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland
2. Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland
Interests: invasive arrhythmia assessment and treatment; catheter ablation; ventricular arrhythmia; sudden cardiac death risk stratification

Special Issue Information

Dear Colleagues,

Issues related to cardiac arrhythmias constitute an inherent problem in modern cardiology and internal medicine in general. In everyday clinical practice, we encounter cases that are seemingly easy but actually extremely difficult. Expanding our knowledge on various aspects of arrhythmology is extremely important for every cardiologist. We are currently focusing on the development of knowledge in this area, acquiring more and more experience with modern therapeutic technologies.

It is extremely important that our own research and observation results be presented to the international cardiology community. Only in this way can we exchange experiences and scientific progress moving forward. This is the purpose of the current Special Issue of the Journal of Clinical Medicine, entitled “Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders”.

Therefore, researchers in the field of cardiac arrhythmias are encouraged to submit their findings to this Special Issue in the form of original articles or reviews. We are excited to invite you to contribute to this Special Issue.

Dr. Piotr Bienias
Dr. Jakub Baran
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

  • non-invasive arrhythmia assessment
  • electrocardiography
  • invasive arrhythmia assessment
  • invasive electrophysiology
  • catheter ablation
  • implantable devices
  • rare diseases and arrhythmias
  • arrhythmia risk stratification
  • genetics aspects of arrhythmogenesis
  • channelopathy

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Published Papers (6 papers)

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Research

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8 pages, 207 KB  
Article
Patent Foramen Ovale Does Not Affect Left Atrial Pressure in Atrial Fibrillation Ablation Patients
by Marek Kiliszek, Marcin Wańczuk, Beata Uziębło-Życzkowska, Krystian Krzyżanowski and Paweł Krzesiński
J. Clin. Med. 2026, 15(3), 1299; https://doi.org/10.3390/jcm15031299 - 6 Feb 2026
Viewed by 463
Abstract
Background: Elevated left atrial pressure is often a consequence of left ventricular diastolic dysfunction. Patent foramen ovale (PFO) with left-to-right shunt could serve as a left atrium unloading factor. The aim of the study was to test whether PFO in patients with atrial [...] Read more.
Background: Elevated left atrial pressure is often a consequence of left ventricular diastolic dysfunction. Patent foramen ovale (PFO) with left-to-right shunt could serve as a left atrium unloading factor. The aim of the study was to test whether PFO in patients with atrial fibrillation (AF) is linked to lower left atrial pressure (LAP). Methods: A retrospective analysis was performed on consecutive patients undergoing AF ablation from 2019 to 2023. The presence of PFO was assessed with standard transesophageal echocardiography, performed in all patients before ablation. LAP was measured directly in the left atrium just after transseptal puncture. Mean LAP was analyzed. Results: A total of 409 patients were included in the analysis, 85 of whom had PFO (20.8%). There were no significant differences between the groups in baseline characteristics such as age, sex, and comorbidities. Overall, 34.4% of patients had a history of heart failure, independent of the presence of a patent foramen ovale (PFO). Mean LAP was not significantly different between patients with and without PFO (p = 0.36). Conclusions: In patients undergoing AF ablation, more than 20% of patients have PFO. The presence of PFO does not significantly influence LAP, measured directly in the left atrium. The presence of PFO is not linked to a lower prevalence of heart failure. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
14 pages, 631 KB  
Article
The Impact of Obesity on the Left Atrium and Arrhythmia Recurrence in Patients with Atrial Fibrillation Undergoing Ablation
by Beata Uziębło-Życzkowska, Marek Kiliszek, Krystian Krzyżanowski and Paweł Krzesiński
J. Clin. Med. 2025, 14(19), 7043; https://doi.org/10.3390/jcm14197043 - 5 Oct 2025
Cited by 2 | Viewed by 1427
Abstract
Objectives: Obesity and atrial fibrillation (AF) are strongly linked and are both associated with significant left atrial (LA) pathology. This study aimed to assess differences in LA size and function between obese and non-obese AF patients and to evaluate AF recurrence in [...] Read more.
Objectives: Obesity and atrial fibrillation (AF) are strongly linked and are both associated with significant left atrial (LA) pathology. This study aimed to assess differences in LA size and function between obese and non-obese AF patients and to evaluate AF recurrence in both groups. Materials and Methods: We retrospectively analyzed patients undergoing first-time ablation for AF. Obesity was defined as body mass index ≥30 kg/m2, and patients were divided accordingly into obese and non-obese groups. Results: Among 672 patients (median age of 66 years; 39.1% women), 308 (45.8%) were obese. Obese patients had significantly larger LA dimensions (LA area, LA volume, and LAVI indexed to height2 (but not that indexed to body surface area (BSA)); p < 0.001), as well as higher LA-pressure-related parameters (LA stiffness index (p = 0.004), E-wave velocity (p = 0.002), and E/e′ ratio (p < 0.001)) and invasively measured mean LA pressure (p < 0.0001). However, there were no significant differences in parameters directly reflecting LA function, such as LA emptying fraction, LA reservoir strain, or LA appendage velocity. These findings remained consistent in the sinus rhythm subgroup (n = 374). The 1-year AF recurrence rate did not differ between obese and non-obese groups (data available for 73.8% (496) patients; p = 0.40), regardless of baseline rhythm. Conclusions: In AF patients undergoing their first ablation, obesity was associated with a larger LA size and higher LA pressure. In obese individuals, indexing LA dimensions to height2 seems to better reflect LA enlargement than indexing to BSA. LA function and AF recurrence rates after a 1-year follow-up period were similar between obese and non-obese patients. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
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15 pages, 651 KB  
Article
The Impact of Comorbidities on Pulmonary Function Measured by Spirometry in Patients After Percutaneous Cryoballoon Pulmonary Vein Isolation Due to Atrial Fibrillation
by Monika Różycka-Kosmalska, Marcin Kosmalski, Michał Panek, Alicja Majos, Izabela Szymczak-Pajor, Agnieszka Śliwińska, Jacek Kasznicki, Jerzy Krzysztof Wranicz and Krzysztof Kaczmarek
J. Clin. Med. 2025, 14(15), 5431; https://doi.org/10.3390/jcm14155431 - 1 Aug 2025
Viewed by 1048
Abstract
Background/Objectives: Pulmonary vein isolation (PVI) via cryoballoon ablation (CBA) is a recommended therapeutic strategy for patients with symptomatic paroxysmal and persistent atrial fibrillation (AF) who are refractory to antiarrhythmic drugs. Although PVI has demonstrated efficacy in reducing AF recurrence and improving patients’ quality [...] Read more.
Background/Objectives: Pulmonary vein isolation (PVI) via cryoballoon ablation (CBA) is a recommended therapeutic strategy for patients with symptomatic paroxysmal and persistent atrial fibrillation (AF) who are refractory to antiarrhythmic drugs. Although PVI has demonstrated efficacy in reducing AF recurrence and improving patients’ quality of life, its impact on respiratory function is not well understood, particularly in patients with comorbid conditions. The aim of the study was to search for functional predictors of the respiratory system in the process of evaluating the efficiency of clinical assessment of CBA in patients with AF. Methods: We conducted a prospective study on 42 patients with symptomatic AF who underwent CBA, assessing their respiratory function through spirometry before and 30 days after the procedure. Exclusion criteria included pre-existing lung disease and cardiac insufficiency. The impact of variables such as body mass index (BMI), coronary artery disease (CAD) and heart failure (HF) on spirometry parameters was analyzed using statistical tests. Results: No significant changes were observed in overall post-PVI spirometry parameters for the full cohort. However, post hoc analyses revealed a significant decline in ΔMEF75 in patients with CAD and BMI ≥ 30 kg/m2, whereas ΔFEV1/FVCex was significantly increased in patients with HF, as well as in patients with ejection fraction (EF) < 50%. Conclusions: CBA for AF does not universally affect respiratory function in the short term, but specific subgroups, including patients with CAD and a higher BMI, may require post-procedure respiratory monitoring. In addition, PVI may improve lung function in patients with HF and reduced EF. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
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Review

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23 pages, 4737 KB  
Review
The History of the Precordial Early Repolarization and Sudden Death Syndrome, Lately Named Brugada Syndrome
by Bortolo Martini
J. Clin. Med. 2026, 15(10), 3903; https://doi.org/10.3390/jcm15103903 - 19 May 2026
Abstract
This paper intends to go through the medical history of a new syndrome, beginning from its incidental observation to the nowadays ongoing reports quickly approaching 7000 published papers. This large number makes it difficult for the researcher to correctly quote the previous significant [...] Read more.
This paper intends to go through the medical history of a new syndrome, beginning from its incidental observation to the nowadays ongoing reports quickly approaching 7000 published papers. This large number makes it difficult for the researcher to correctly quote the previous significant published data, and the usual strategy is to copy and paste the last articles references. This review is mainly detailed historical research of the step-by-step journey mainly of the first three decades, with less attention to the ongoing and late scientific controversies that are indeed quoted. The new syndrome was early named “precordial early repolarization (PER) syndrome” but became popular after being renamed “Brugada syndrome” (BS). Nowadays it is classified as one of the “J wave syndromes” (JWSs). The main characteristic of this new entity was an unusual astonishing precordial coved ST segment elevation that gave rise since its first descriptions to two different pathophysiological theories, one organic and the second functional. The first theory ascribed the ST elevation to an unusual pattern of depolarization at the right ventricular outflow tract (RVOT), while the second favored an abnormal dynamic repolarization pattern. Both phenomena were sometimes linked to an ion channel genetic abnormality. In the following decades, many eminent scientists and also some excellent humble cardiologists made significant observations regarding epidemiology, laboratory, diagnostic techniques, genetic, clinical findings, histology, embryology, therapeutic approaches, and risk stratification. This rush “to be the first who” has created more confusion than certainty, and only in this last decade a more scientific and less emotional approach has led to a common acceptance of an underlying organic background that causes a strange conduction delay mainly at the epicardial level of the RVOT. “Next generation” cardiologists are in charge of further elucidating the genetic, the structural, and electrical pathophysiology, and the correct risk stratification needed to correctly identify the true patients who need a therapy and avoid unusual and dangerous treatments to healthy people with a benign strange ECG. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
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21 pages, 1059 KB  
Review
Predictors for Device-Detected Subclinical Atrial Fibrillation: An Up-to-Date Narrative Review
by Traian Chiuariu, Larisa Anghel, Delia Melania Popa, Gavril-Silviu Bîrgoan, Șerban Daniel Fechet, Răzvan-Liviu Zanfirescu, Mircea Ovanez Balasanian, Radu Andy Sascău and Cristian Stătescu
J. Clin. Med. 2026, 15(2), 578; https://doi.org/10.3390/jcm15020578 - 11 Jan 2026
Cited by 1 | Viewed by 863
Abstract
Background: Device-detected subclinical atrial fibrillation (SCAF) and atrial high-rate episodes (AHRE) are increasingly recognized in patients with cardiac implantable electronic devices and through long-term rhythm monitoring. Although often asymptomatic, these episodes are associated with a higher risk of clinical atrial fibrillation (AF), [...] Read more.
Background: Device-detected subclinical atrial fibrillation (SCAF) and atrial high-rate episodes (AHRE) are increasingly recognized in patients with cardiac implantable electronic devices and through long-term rhythm monitoring. Although often asymptomatic, these episodes are associated with a higher risk of clinical atrial fibrillation (AF), stroke, and heart failure. Aims: This narrative review summarizes clinical, electrocardiographic, echocardiographic, and circulating biomarkers associated with the development and progression of device-detected SCAF/AHRE. Methods: We performed a comprehensive search of PubMed, Embase, and Scopus using combinations of the terms “subclinical atrial fibrillation”, “atrial high-rate episodes”, “device-detected AF”, “predictive factors”, “P-wave morphology”, “echocardiographic parameters”, “left atrial strain”, and “biological markers”. We included English-language-only studies of patients with cardiac implantable electronic devices or long-term monitoring and reporting incident SCAF/AHRE or AF as outcomes, published in the last 10 years. Results: Older age, high body mass index, heart failure, obstructive sleep apnea, and C2HEST score are consistently associated with SCAF. On-surface electrocardiogram (ECG) and device electrograms, prolonged and dispersed P-wave indices, low atrial sensing amplitude, and specific pacing configurations, particularly right ventricular apical pacing with wide QRS, predict incident and longer-lasting AHRE. Echocardiographic markers of atrial cardiomyopathy, including increased left atrial volume and impaired atrial strain, together with indices of left ventricular diastolic dysfunction, further refine risk. Among circulating biomarkers, galectin-3 and high-sensitivity C-reactive protein show the most reproducible associations with incident AHRE. Conclusions: A multiparametric approach combining clinical profile, ECG features, advanced echocardiography, and selected biomarkers may improve identification of patients at risk for device-detected SCAF. Further prospective studies are needed to define risk thresholds that justify intensified rhythm surveillance and early initiation of anticoagulation or rhythm control strategies, especially in AHRE shorter than 24 h. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
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Other

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12 pages, 10732 KB  
Case Report
One Shot, One Rhythm: Termination of Refractory Persistent Atrial Fibrillation in a Young Patient via Single Pulmonary Vein Application: A Case Report
by Jonasz Kozielski, Alicja Dąbrowska-Kugacka, Ludmiła Daniłowicz-Szymanowicz and Marek Szołkiewicz
J. Clin. Med. 2025, 14(20), 7297; https://doi.org/10.3390/jcm14207297 - 16 Oct 2025
Viewed by 747
Abstract
Background/Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia, with catheter ablation outcomes differing significantly between paroxysmal and persistent forms. While pulmo-nary vein isolation (PVI) remains the cornerstone of ablation, persistent AF is often associ-ated with atrial remodeling and non-pulmonary vein triggers, [...] Read more.
Background/Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia, with catheter ablation outcomes differing significantly between paroxysmal and persistent forms. While pulmo-nary vein isolation (PVI) remains the cornerstone of ablation, persistent AF is often associ-ated with atrial remodeling and non-pulmonary vein triggers, reducing procedural success rates and necessitating repeat interventions. However, in selected patients with minimal atrial substrate, a single PVI may achieve durable rhythm control. This case report illus-trates such a scenario in a young patient with persistent AF and tachyarrhythmia-induced cardiomyopathy (TIC). Methods: A 42-year-old previously healthy male presented with newly diagnosed persistent AF complicated by TIC and heart fail-ure (left ventricular ejection fraction [LVEF] 25%). Despite rate control, anticoagulation, guideline-directed heart failure therapy, amiodarone pretreatment, and two failed electrical cardioversions, the patient remained symptomatic. Elec-troanatomic mapping was performed to assess atrial substrate prior to radiofrequency ablation. Results: Mapping revealed no extensive low-voltage zones, indicating absence of significant atrial fibrosis. During ablation, si-nus rhythm was restored spontaneously with a single application targeting the infero-posterior aspect of the right infe-rior pulmonary vein. No additional arrhythmogenic substrate was identified. The patient maintained sinus rhythm throughout 14 months of follow-up, with marked clinical improvement, normalization of LVEF (55%), regression of atrial and ventricular enlargement, and resolution of heart failure symptoms. Quality of life, assessed by the ASTA question-naire, improved from 24 to 0 points. Conclusions: This case highlights that even in therapy-resistant persistent AF with severe structural and functional cardiac impairment, arrhythmia may be driven by discrete pulmonary vein-dependent mechanisms. Careful patient selection, particu-larly in younger individuals without advanced atrial remodeling, can identify those in whom PVI alone achieves durable rhythm control and reverse cardiac remodeling. Full article
(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)
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