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Advances in Ablation Therapy for Atrial Fibrillation: Innovations and Clinical Applications

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

Deadline for manuscript submissions: 25 May 2026 | Viewed by 2065

Special Issue Editor

Dr. Ioanna Koniari

E-Mail Website
Guest Editor
1. Cardiology Department, Lanchashire Cardiac Centre, Blackpool FY3 8NR, UK
2. Liverpool Centre for Cardiovascular Science, Liverpool L14 3PE, UK
Interests: cardiology; cardiac electrophysiology; cardiac devices; heart failure; atherosclerosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) represents the most frequent sustained cardiac arrhythmia and imposes a significant burden on patients and healthcare systems. Management strategies encompass a broad spectrum of both pharmacological therapies and interventional approaches tailored to patient-specific needs. Recent advances in ablation therapy have revolutionized AF treatment, with catheter ablation emerging as the most efficacious intervention for sustaining a normal sinus rhythm, surpassing other therapeutic modalities in long-term rhythm control.

Over the past two decades, significant progress has been made in ablation technology and strategy development, focusing on enhancing efficacy and safety. The evolution of radiofrequency (RF) ablation has progressed from traditional 4 mm tip catheters to advanced systems incorporating irrigated catheters and contact force sensing technology. The novel very-high-power short-duration (vHPSD) mode (90 W for ≤ 4 seconds) represents a significant advancement, offering theoretical advantages, including greater procedure efficiency and reduced collateral damage.

Among single-shot devices, the cryoballoon (CB) has demonstrated high procedural efficiency and favorable outcomes. Recent evidence has established CB-PVI as a superior first-line therapy compared to antiarrhythmic drugs, not only improving efficacy but also reducing AF progression. While pulmonary vein isolation remains fundamental, emerging non-thermal energy modalities, such as pulsed-field ablation (PFA), have gained significant interest due to their selective action and reduced thermal risks.

This Special Issue aims to highlight the latest advancements in AF ablation therapy, and we encourage submissions of original research, reviews, and meta-analyses focusing on novel interventional techniques and therapeutic strategies for AF management.

Dr. Ioanna Koniari
Guest Editor

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
  • ablation
  • PFA
  • PVI
  • non-thermal energy
  • mapping system

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Published Papers (3 papers)

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Research

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10 pages, 772 KB  
Article
Frailty Impact on Periprocedural Outcomes of Atrial Fibrillation Ablation
by Eran Leshem, Daniel Carny, Adam Folman, Mark Kazatsker, Ariel Roguin and Gilad Margolis
J. Clin. Med. 2026, 15(1), 170; https://doi.org/10.3390/jcm15010170 - 25 Dec 2025
Viewed by 391
Abstract
Background: Frail patients undergoing AF ablation face elevated periprocedural risks. However, prior studies often examined composite or long-term outcomes and did not stratify acute complication risks by frailty severity. Objective: The objective of this study was to assess the impact of frailty, measured [...] Read more.
Background: Frail patients undergoing AF ablation face elevated periprocedural risks. However, prior studies often examined composite or long-term outcomes and did not stratify acute complication risks by frailty severity. Objective: The objective of this study was to assess the impact of frailty, measured by the Hospital Frailty Risk Score (HFRS) on in-hospital outcomes after AF ablation, and to delineate the risk of specific acute complications across frailty levels. Methods: We analyzed a national inpatient cohort of AF ablation hospitalizations (2016–2021). Patients were stratified into low-, intermediate-, and high-frailty groups by HFRS. In-hospital mortality and major complications (stroke, respiratory failure, sepsis, acute dialysis, cardiac arrest, cardiogenic shock) were compared across frailty groups, and multivariable logistic regression identified independent predictors of these outcomes. Results: Among an estimated 42,830 AF ablation admissions, 80.0% were low-frailty, 15.0% intermediate, and 5.0% high-frailty. High-frailty patients had markedly higher complication rates than low-frailty patients. In-hospital mortality was 6.1% in high frailty vs. 1.0% in low frailty, and stroke occurred in 4.0% vs. 0.3%, respectively. Rates of respiratory failure (18.0% vs. 3.5%), sepsis (8.0% vs. 1.2%), and acute dialysis (4.0% vs. 0.5%) were also significantly higher in the high-frailty group (all p < 0.001). In multivariate analyses, frailty remained a strong independent predictor of complications; high frailty conferred over four-fold higher odds of in-hospital mortality and five-fold higher odds of stroke compared to low frailty. Conclusions: Frailty is a powerful predictor of periprocedural complications and mortality in AF ablation patients. Even after accounting for age and comorbidities, patients with higher frailty scores experienced substantially worse in-hospital outcomes. These findings highlight the importance of frailty assessment to identify high-risk patients and inform clinical decision-making for AF ablation. Full article
(This article belongs to the Special Issue Advances in Ablation Therapy for Atrial Fibrillation: Innovations and Clinical Applications)
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Review

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14 pages, 1350 KB  
Review
Current and Emerging Energy Sources for Atrial Fibrillation Ablation: A Comparative Analysis of Clinical Efficacy, Safety, and Procedural Implementation
by Cristian Martignani, Giulia Massaro, Alberto Spadotto, Jennifer Oppimitti, Maria Carelli, Andrea Angeletti, Alessandro Carecci, Igor Diemberger and Mauro Biffi
J. Clin. Med. 2026, 15(2), 751; https://doi.org/10.3390/jcm15020751 - 16 Jan 2026
Viewed by 264
Abstract
Atrial fibrillation (AF) management has historically relied on thermal ablation modalities—radiofrequency (RF) and cryoballoon—which have established a high benchmark for pulmonary vein isolation (PVI). However, the inherent risk of collateral thermal injury and lesion inconsistency has driven the search for alternative energy sources. [...] Read more.
Atrial fibrillation (AF) management has historically relied on thermal ablation modalities—radiofrequency (RF) and cryoballoon—which have established a high benchmark for pulmonary vein isolation (PVI). However, the inherent risk of collateral thermal injury and lesion inconsistency has driven the search for alternative energy sources. The recent clinical adoption of pulsed-field ablation (PFA), based on irreversible electroporation, represents a significant technological evolution. This narrative review provides a critical appraisal of the transition from thermal to pulsed-field technologies. We synthesized data from pivotal trials and recent health-economic analyses to evaluate the biophysical mechanisms, clinical efficacy, and safety profiles of contemporary devices. We conduct a head-to-head comparison of all modalities regarding critical safety endpoints (esophageal, neurological, and vascular), real-world procedural challenges (anesthesia, lesion assessment), and economic sustainability. While PFA offers distinct advantages in procedural speed and tissue selectivity, we highlight that thermal modalities—particularly cryoballoon and very-high-power RF—retain competitive profiles in terms of cost-effectiveness and established long-term durability. This review aims to provide a balanced roadmap for clinicians navigating the complex choice between established thermal efficacy and the promising, yet evolving, landscape of electroporation. Full article
(This article belongs to the Special Issue Advances in Ablation Therapy for Atrial Fibrillation: Innovations and Clinical Applications)
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18 pages, 1343 KB  
Review
Monitoring Atrial Fibrillation Using Wearable Digital Technologies: The Emerging Role of Smartwatches
by Panagiotis Stachteas, Marios G. Bantidos, Nikolaos Papoutsidakis, Athina Nasoufidou, Paschalis Karakasis, Georgios Sidiropoulos, Christos Kofos, Dimitrios Patoulias, Vasileios Ediaroglou, George Stavropoulos, Efstratios Karagiannidis, Barbara Fyntanidou, Dimitrios Tsalikakis, Emmanouil Smyrnakis, George Kassimis, Christodoulos E. Papadopoulos and Nikolaos Fragakis
J. Clin. Med. 2026, 15(1), 14; https://doi.org/10.3390/jcm15010014 - 19 Dec 2025
Viewed by 1069
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and a growing global health burden, yet conventional monitoring with Holter devices, event recorders and implantable loop recorders often fails to adequately capture recurrence. Rapid advances in digital health, wearable biosensors and artificial intelligence [...] Read more.
Atrial fibrillation (AF) is the most common sustained arrhythmia and a growing global health burden, yet conventional monitoring with Holter devices, event recorders and implantable loop recorders often fails to adequately capture recurrence. Rapid advances in digital health, wearable biosensors and artificial intelligence (AI) have transformed consumer smartwatches and wearables into potential clinical tools capable of continuous, real-world rhythm surveillance. This narrative review synthesizes contemporary evidence on smartwatch-based AF monitoring, spanning core technologies—photoplethysmography, single-lead electrocardiography and AI fusion algorithms—and validation studies across post-ablation follow-up. Compared with traditional modalities, smartwatch-based AF monitoring demonstrates improved detection of AF recurrence, enhanced characterization of AF burden, symptom–rhythm correlation, and greater patient engagement. At the same time, key limitations are critically examined, including motion artifacts, false-positive alerts, short recording windows, adherence dependence, digital literacy and access gaps, as well as unresolved issues around regulation, interoperability and data privacy. By integrating engineering advances with guideline-directed care pathways, smartwatch-based AF monitoring holds promise to complement, rather than immediately replace, established diagnostic tools and to enable more proactive, individualized AF management. Future work must focus on robust clinical validation, equitable implementation and clear regulatory frameworks to safely scale these technologies. Full article
(This article belongs to the Special Issue Advances in Ablation Therapy for Atrial Fibrillation: Innovations and Clinical Applications)
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