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Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions
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Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions

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

Deadline for manuscript submissions: 28 December 2025 | Viewed by 1429

Special Issue Editors

Dr. Roberto Scacciavillani

E-Mail Website
Guest Editor
Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
Interests: cardiac electrophysiology; catheter ablation; atrial fibrillation; heart failure; device therapy
Dr. Gemma Pelargonio

E-Mail Website
Guest Editor
Department of Cardiovascular & Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
Interests: cardiac electrophysiology; catheter ablation

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) is the most common type of supraventricular arrhythmia, with a worldwide growing incidence and prevalence. This condition is associated with increased morbidity and mortality, and clinicians often face multiple challenges in the management of AF.

There are multiple therapeutic options, both pharmacological and interventional, but we are still far away from the solution of this complicated conundrum.

This Special Issue will cover multiple topics related to the treatment of atrial fibrillation, with a focus especially, but not only, on rhythm control. We invite you to submit research articles, reviews, and clinical trials that will deal with, but are not limited to, the following aspects:

  • Novelties in pharmacological strategies for rhythm control;
  • AF catheter ablation technologies, including radiofrequency, cryoablation, and the emerging role of pulsed field ablation;
  • The role of surgical and hybrid AF ablation;
  • The autonomic nervous system, its link with AF, and the benefits of neuromodulation and cardioneuroablation in the setting of AF ablation;
  • Strategies to reduce the thromboembolic risk, from oral anticoagulation to left atrial appendage occlusion;
  • Device-based therapies, including ablate and pace strategies, left bundle branch area pacing, and leadless systems.

The objective of this Special Issue of the Journal of Clinical Medicine is to offer readers a thorough and current overview of AF. We welcome submissions that enhance treatment strategies for AF and contribute to the overall improvement in patient care.

Dr. Roberto Scacciavillani
Dr. Gemma Pelargonio
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

  • atrial fibrillation
  • catheter ablation
  • radiofrequency
  • cryoablation
  • pulsed field ablation
  • cardioneuroablation
  • left bundle branch area pacing

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Published Papers (3 papers)

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Research

15 pages, 1091 KiB  
Article
Atrial Strain Analysis Predicts Atrial Arrhythmia Recurrence Following Cavotricuspid Isthmus Ablation of Typical Atrial Flutter
by Giulia Iannaccone, Roberto Scacciavillani, Francesca Graziani, Filippo Tusa, Carlo Piccinni, Francesca Augusta Gabrielli, Maria Lucia Narducci, Francesco Perna, Massimiliano Camilli, Maria Chiara Meucci, Rocco A. Montone, Gianluigi Bencardino, Gaetano Antonio Lanza, Gemma Pelargonio and Antonella Lombardo
J. Clin. Med. 2025, 14(15), 5247; https://doi.org/10.3390/jcm14155247 - 24 Jul 2025
Viewed by 25
Abstract
Background: This study aimed to evaluate the effectiveness of right and left atrial strain reservoir (RASr and LASr) in predicting the recurrence of atrial arrhythmias (AAs) following cavotricuspid isthmus ablation (CTIA) for typical atrial flutter (AFL). Methods: We retrospectively enrolled consecutive patients with [...] Read more.
Background: This study aimed to evaluate the effectiveness of right and left atrial strain reservoir (RASr and LASr) in predicting the recurrence of atrial arrhythmias (AAs) following cavotricuspid isthmus ablation (CTIA) for typical atrial flutter (AFL). Methods: We retrospectively enrolled consecutive patients with AFL who had undergone CTIA. Transthoracic echocardiography was conducted within one month before the procedure, and atrial two-dimensional speckle tracking analysis was performed offline. Results: Sixty-two subjects were evaluated (mean age 64.8 ± 13.2 years, 29% females). At a median follow-up of 12.1 months, AA recurrence occurred in 21 subjects (33.8%). The study endpoint occurred mainly among females (p = 0.021) and patients with lower RASr and LASr values (both p < 0.001). In Cox regression analysis, RASr and LASr remained independent predictors of AA recurrence (p = 0.02 and p = 0.03, respectively). In ROC curve analysis, RASr and LASr showed a similar and satisfactory ability to predict AA recurrence with optimal cut-off values of 16.8% and 17.7%, respectively. In survival analysis, RASr > 16.8% and LASr > 17.7% were associated with significantly higher freedom from AAs during follow-up (log rank p = 0.001 and p = 0.002, respectively). Conclusions: The results of this study suggest that pre-CTIA atrial speckle tracking analysis may aid in identifying AFL patients at an increased risk of AA recurrence, allowing for more frequent follow-up visits and extended antiarrhythmic therapy. Full article
(This article belongs to the Special Issue Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions)
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14 pages, 1128 KiB  
Article
Predictors of Atrial Fibrillation in Heart Failure Patients with Indications for ICD Implantation
by Tariel Atabekov, Roman Batalov, Evgenii Archakov, Irina Silivanova, Mikhail Khlynin, Irina Kisteneva, Sergey Krivolapov and Sergey Popov
J. Clin. Med. 2025, 14(12), 4358; https://doi.org/10.3390/jcm14124358 - 18 Jun 2025
Viewed by 433
Abstract
Background/Objectives: Atrial fibrillation (AF) is a prevalent arrhythmia that significantly complicates the management of heart failure (HF) patients, particularly those who have implantable cardioverter–defibrillators (ICDs). The interplay between AF and inappropriate ICD therapy poses a critical challenge in optimizing patient outcomes, as [...] Read more.
Background/Objectives: Atrial fibrillation (AF) is a prevalent arrhythmia that significantly complicates the management of heart failure (HF) patients, particularly those who have implantable cardioverter–defibrillators (ICDs). The interplay between AF and inappropriate ICD therapy poses a critical challenge in optimizing patient outcomes, as inappropriate shocks can lead to increased morbidity, psychological distress, and a reduced quality of life. We aimed to explore the various clinical and demographic predictors of AF in HF patients with indications for ICD implantation. Methods: This study included 122 patients who were indicated for ICD implantation and had undergone transthoracic echocardiography (TE). We evaluated the relationships between clinical and demographic factors and the occurrence of AF, which was recorded either before ICD implantation or during the follow-up period afterward. From our findings, we established predictors and a risk model for AF. Results: Out of 122 HF patients with ICDs, 52 (42.6%) experienced an episode of AF either prior to ICD implantation or during a follow-up period of 20.5 [6.0; 53.0] months, as recorded by the ICDs’ endogram. Patients with AF were older compared to those without AF (p < 0.001). Additionally, they exhibited a higher left ventricular early diastolic filling rate (LVE) (p = 0.006) and a greater left atrial index (LAI) (p = 0.002). These three factors—age, LVE and LAI—were found to be independently associated with AF in both univariable and multivariable logistic regression analyses. The final model, including age, LVE, and LAI, showed a good discrimination capability with an AUC of 0.775. At a cutoff value of >0.47, the model achieved a sensitivity of 67.3% and a specificity of 77.2% in identifying HF patients with ICDs at risk for AF. Conclusions: This study found that 42.6% of HF patients with ICDs experienced AF, with older age, higher LVE, and greater LAI identified as significant predictors. Full article
(This article belongs to the Special Issue Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions)
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15 pages, 1345 KiB  
Article
The Detection of Early Changes in Inflammatory Response After Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation Can Predict Late Atrial Fibrillation Recurrence
by Ana Lanca Bastiancic, Ivana Grgic Romic, Snjezana Hrabric Vlah, Vlatka Sotošek, Marina Klasan, Petra Baumgartner, Mate Mavric and Sandro Brusich
J. Clin. Med. 2025, 14(11), 3874; https://doi.org/10.3390/jcm14113874 - 30 May 2025
Viewed by 656
Abstract
Background: Inflammation plays an important role in the initiation of atrial fibrillation (AF) and the development of fibrosis following pulmonary vein isolation (PVI). We aimed to investigate whether early post-PVI levels of C-reactive protein (CRP), white blood cells, tumour necrosis factor alpha [...] Read more.
Background: Inflammation plays an important role in the initiation of atrial fibrillation (AF) and the development of fibrosis following pulmonary vein isolation (PVI). We aimed to investigate whether early post-PVI levels of C-reactive protein (CRP), white blood cells, tumour necrosis factor alpha (TNF-α) and transforming growth factor beta 1 (TGF-ß1) are associated with long-term arrhythmia recurrence. Methods: This prospective observational study included 48 patients with paroxysmal AF undergoing PVI. Peripheral venous blood samples were collected on the day of hospitalisation (T0), immediately after the procedure (T1) and after 24 h (T2), seven days (T3) and one month (T4) following the procedure. Blood samples were obtained from the coronary sinus (CS) before and after PVI. CRP levels, leukocyte (LKc) and neutrophile (Neu) counts were determined. TGF-β1 and TNF-α were analysed using the enzyme-linked immunosorbent assay (ELISA). After discharge, follow-up visits were scheduled at seven days and one-, three-, six-, nine- and twelve-months post-ablation, with 24 h Holter monitoring at each visit. Results: Patients were allocated into a recurrent and a non-recurrent group. Baseline characteristics did not differ between the groups, except for the duration of AF, which was found to be a significant arrhythmia recurrence predictor. Patients in the non-recurrent group had statistically significantly higher LKc at all time points, and Neu at T2 and T3. CRP and TGF-β1 concentrations were significantly higher in the non-recurrent group, while TNF-α concentration was significantly higher in the recurrent group at the T2 time point. Significantly higher concentrations of CS TNF-α at T1 and TGF-β1 at T0 and T1 were documented in the non-recurrent group. Conclusions: The study shows that an enhanced inflammatory response early after PVI, characterised by increased CRP, WBC and TGF-β1 levels, may play a protective role against late arrhythmia recurrence. Full article
(This article belongs to the Special Issue Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions)
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