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Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence
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Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence

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

Deadline for manuscript submissions: 30 September 2025 | Viewed by 9571

Special Issue Editor

Dr. Roberto Galea

E-Mail Website
Guest Editor
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
Interests: atrial fibrillation; structural heart intervention; stroke; left atrial appendage; cardiac computed tomography angiography

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, with a rising incidence and prevalence globally. AF represents an increasing healthcare issue due to the multiple potential associated complications, including a 5-fold increase in stroke and heart failure and 2-fold increase in myocardial infarction, as well as dementia and cognitive decline. Over the past decade, several therapeutic strategies have emerged in clinical practice, with the aim of preventing such complications. Oral anticoagulation reduces the risk of ischemic stroke by almost 70% but is associated with bleeding risk. Percutaneous left atrial appendage closure is a valuable alternative therapeutic strategy for stroke prevention in patients with AF at an increased risk of bleeding. Anti-arrhythmic drugs and catheter ablation are effective in reducing the AF burden and improving patients’ quality of life.

We are pleased to invite you to submit original research papers or state-of-the-art reviews for consideration for this Special Issue focusing on preventive strategies for AF and its complications, emphasizing both the supporting evidence and limitations related to current pharmacological and interventional approaches.

We look forward to receiving your contributions.

Dr. Roberto Galea
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 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
  • oral anticoagulation
  • left atrial appendage closure
  • stroke prevention

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Published Papers (7 papers)

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Research

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19 pages, 3013 KiB  
Article
Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Patients with Acute Decompensated Heart Failure
by Yoshifumi Ikeda, Ritsushi Kato, Hitoshi Mori, Kenta Tsutsui, Kazuhisa Matsumoto, Masataka Narita, Wataru Sasaki, Daisuke Kudo, Naomichi Tanaka and Kazuo Matsumoto
J. Clin. Med. 2025, 14(2), 629; https://doi.org/10.3390/jcm14020629 - 19 Jan 2025
Viewed by 816
Abstract
Background: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. Methods [...] Read more.
Background: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. Methods: We retrospectively analyzed ADHF patients with AF who were admitted to our institution from 2007 to 2017. Results: In total, 472 patients were included in this study, with a mean follow-up duration of 32.8 ± 32.9 months. The 5-year event-free rate (cardiovascular death and HF hospitalization) was 61.4%, and the 10-year event-free rate was 42.7%. A comparative analysis of the event group and control group revealed that patients in the event group were older (event group vs. control group: 72.1 ± 11.0 vs. 68.8 ± 13.4 years, p = 0.008) and had a higher proportion of Clinical Scenario 3 classifications (event group vs. control group: 24% vs. 12%, p = 0.001). Notably, patients in the event group had a lower sinus rhythm maintenance rate (event group vs. control group: 17% vs. 31%, p < 0.001) and CA rate (event group vs. control group: 9% vs. 21%, p = 0.003). The CA group had a higher event-free rate than the non-CA group, and this trend persisted even after matching the patients’ backgrounds (log-rank test: p < 0.001). Conclusions: Patients presenting with AF at the onset of ADHF showed a poor prognosis, whereas CA demonstrated potential for improving the prognosis for some of these patients. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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16 pages, 751 KiB  
Article
Consequences of the Poor Anticoagulation Control of Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonists
by Antoni Sicras Mainar, Joel Salazar-Mendiguchía, María Isabel del Campo Alonso, Ainara Echeto, David Vilanova Larena and Josep Comín Colet
J. Clin. Med. 2024, 13(21), 6495; https://doi.org/10.3390/jcm13216495 - 30 Oct 2024
Viewed by 1169
Abstract
Background: The prevention of thromboembolisms through anticoagulation and heart rate control is crucial in managing non-valvular atrial fibrillation (NVAF). This study aimed to analyze the consequences of poor anticoagulation control with vitamin K antagonists (VKAs) in Spanish patients with NVAF, focusing on thrombotic [...] Read more.
Background: The prevention of thromboembolisms through anticoagulation and heart rate control is crucial in managing non-valvular atrial fibrillation (NVAF). This study aimed to analyze the consequences of poor anticoagulation control with vitamin K antagonists (VKAs) in Spanish patients with NVAF, focusing on thrombotic events, bleeding, mortality, healthcare resources (HRU), and costs. Methods: This observational, retrospective study used electronic medical records (BIG-PAC® database) of NVAF patients who started VKA treatment between 1 January 2016 and 31 December 2018. Patients were followed up for two years and classified by poor or adequate anticoagulation control. Demographic and clinical characteristics, treatments, incidence of cardiovascular events, mortality rates, HRU, and costs were analyzed. Results: Patients with poor control (n = 2136) had a 75% greater probability of suffering a cardiovascular event compared to patients with adequate control (n = 2351) (HR, 1.75 [95%CI: 1.43–2.14; p < 0.001]). Cardiovascular events, major bleeding, minor bleeding, systemic thromboembolism, and ischemic strokes were reduced by 32.1%, 46.2%, 29.6%, 22.2%, and 16.1%, respectively. It was estimated that adequate anticoagulant control saved EUR 455/patient with NAVF due to reduced hospitalization for cardiovascular events. Conclusions: For VKA-treated NVAF patients, poor anticoagulation control was associated with a higher number of cardiovascular events, greater consumption of HRU, and higher management costs than for patients with adequate control. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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11 pages, 858 KiB  
Article
Safety and Effectiveness of Oral Anticoagulants in Atrial Fibrillation: Real-World Insights Using Natural Language Processing and Machine Learning
by Juan Cosín-Sales, Manuel Anguita Sánchez, Carmen Suárez, Carlos Arias-Cabrales, Luisa Martínez-Sanchez, Savana Research Group, Daniel Arumi and Susana Fernández de Cabo
J. Clin. Med. 2024, 13(20), 6226; https://doi.org/10.3390/jcm13206226 - 18 Oct 2024
Cited by 1 | Viewed by 1591
Abstract
Background/Objectives: We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. Methods: This is a retrospective study in 15 Spanish hospitals (2014–2020), including adult AF patients with [...] Read more.
Background/Objectives: We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. Methods: This is a retrospective study in 15 Spanish hospitals (2014–2020), including adult AF patients with no history of anticoagulation, thrombosis events, rheumatic mitral valvular heart disease, mitral valve stenosis, or pregnancy. We employed EHRead® technology based on natural language processing (NLP) and machine learning (ML), along with SNOMED-CT terminology, to extract clinical data from electronic health records (EHRs). Using propensity score matching (PSM), the effectiveness, safety, and hospital mortality of VKAs versus DOACs were analyzed through Kaplan–Meier curves and Cox regression. Results: Out of 138,773,332 EHRs from 4.6 million individuals evaluated, 44,292 patients were included, 79.6% on VKAs and 20.4% on DOACs. Most patients were elderly [VKA 78 (70, 84) and DOAC 75 (66, 83) years], with numerous comorbidities (75.5% and 70.2% hypertension, 47.2% and 39.9% diabetes, and 40.3% and 34.8% heart failure, respectively). Additionally, 60.4% of VKA and 48.7% of DOAC users had a CHA2DS2-VASc Score ≥4. After PSM, 8929 patients per subgroup were selected. DOAC users showed a lower risk of thrombotic events [HR 0.81 (95% CI 0.70–0.94)], minor bleeding [HR 0.89 (95% CI 0.83–0.96)], and mortality [HR 0.80 (95% CI 0.69–0.92)]. Conclusions: Applying NLP and ML, we generated valuable real-world evidence on anticoagulated AF patients in Spain. Even in complex populations, DOACs have demonstrated a better safety and effectiveness profile than VKAs. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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Review

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14 pages, 1349 KiB  
Review
Percutaneous Left Atrial Appendage Closure: Supporting Evidence, Limitations and Future Directions
by Giuseppe Imperatore, Stijn Lochy, Mohamed Ben Yedder, Roberto Galea and Adel Aminian
J. Clin. Med. 2025, 14(7), 2300; https://doi.org/10.3390/jcm14072300 - 27 Mar 2025
Viewed by 409
Abstract
Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a promising intervention for stroke prevention in patients with atrial fibrillation who are contraindicated for long-term anticoagulation therapy. Despite its growing adoption, a comprehensive review of the LAAO procedure is essential to consolidate the [...] Read more.
Percutaneous Left Atrial Appendage Occlusion (LAAO) has emerged as a promising intervention for stroke prevention in patients with atrial fibrillation who are contraindicated for long-term anticoagulation therapy. Despite its growing adoption, a comprehensive review of the LAAO procedure is essential to consolidate the supporting evidence, identify limitations, and outline future directions. This review aims to evaluate the efficacy and safety of LAAO, drawing on clinical trials and real-world studies to provide a balanced perspective. Additionally, we address the limitations of current research, including variability in patient selection, procedural techniques, and follow-up protocols. By highlighting gaps in the knowledge and areas for improvement, this review aims to guide future research efforts to optimize and expand the therapeutic potential of LAAO. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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22 pages, 4534 KiB  
Review
Catheter Ablation of Atrial Fibrillation: Technique and Future Perspectives
by Francesco Peruzza, Andrea Candelora, Carlo Angheben, Massimiliano Maines, Mauro Laurente, Domenico Catanzariti, Maurizio Del Greco and Antonio Madaffari
J. Clin. Med. 2025, 14(6), 1788; https://doi.org/10.3390/jcm14061788 - 7 Mar 2025
Viewed by 791
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia with a significant impact on quality of life in terms of symptoms and reduction of functional status. Also, it is associated with an increased risk of mortality, stroke, and peripheral embolism. Catheter ablation for [...] Read more.
Atrial fibrillation is the most common sustained cardiac arrhythmia with a significant impact on quality of life in terms of symptoms and reduction of functional status. Also, it is associated with an increased risk of mortality, stroke, and peripheral embolism. Catheter ablation for atrial fibrillation has become a well-established treatment, improving arrhythmia outcomes without increasing the risk of serious adverse events compared to antiarrhythmic drug therapy. The field has undergone significant advancements in recent years, yet pulmonary vein isolation continues to be the cornerstone of any atrial fibrillation ablation procedure. The purpose of this review is to provide an overview of the current techniques, emerging technologies, and future directions. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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16 pages, 947 KiB  
Review
Endurance Sports and Atrial Fibrillation: A Puzzling Conundrum
by Marina Ostojic, Mladen Ostojic, Olga Petrovic, Olga Nedeljkovic-Arsenovic, Francesco Perone, Marko Banovic, Tamara Stojmenovic, Dragutin Stojmenovic, Vojislav Giga, Branko Beleslin and Ivana Nedeljkovic
J. Clin. Med. 2024, 13(24), 7691; https://doi.org/10.3390/jcm13247691 - 17 Dec 2024
Viewed by 1446
Abstract
The confirmed benefits of regular moderate exercise on cardiovascular health have positioned athletes as an illustration of well-being. However, concerns have arisen regarding the potential predisposition to arrhythmias in individuals engaged in prolonged strenuous exercise. Atrial fibrillation (AF), the most common heart arrhythmia, [...] Read more.
The confirmed benefits of regular moderate exercise on cardiovascular health have positioned athletes as an illustration of well-being. However, concerns have arisen regarding the potential predisposition to arrhythmias in individuals engaged in prolonged strenuous exercise. Atrial fibrillation (AF), the most common heart arrhythmia, is typically associated with age-related risks but has been documented in otherwise healthy young and middle-aged endurance athletes. The mechanism responsible for AF involves atrial remodeling, fibrosis, inflammation, and alterations in autonomic tone, all of which intersect with the demands of endurance sports, cumulative training hours, and competitive participation. This unique lifestyle requires a tailored therapeutic approach, often favoring radiofrequency ablation as the preferred treatment. As the number of professional and non-professional athletes engaging in high-level daily sports activities rises, awareness of AF within this demographic becomes imperative. This review delivers the etiology, pathophysiology, and therapeutic considerations surrounding AF in endurance sports. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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Other

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8 pages, 1698 KiB  
Opinion
Subclinical Atrial Fibrillation: To Anticoagulate or Not?
by Sharath Kommu and Param P. Sharma
J. Clin. Med. 2024, 13(11), 3236; https://doi.org/10.3390/jcm13113236 - 30 May 2024
Cited by 1 | Viewed by 2574
Abstract
Atrial fibrillation (AF) carries a stroke risk, often necessitating anticoagulation, especially in patients with risk factors. With the advent of implantable and wearable heart monitors, episodes of short bouts of atrial arrhythmias called atrial high-rate episodes (AHREs) or subclinical AF (SCAF) are commonly [...] Read more.
Atrial fibrillation (AF) carries a stroke risk, often necessitating anticoagulation, especially in patients with risk factors. With the advent of implantable and wearable heart monitors, episodes of short bouts of atrial arrhythmias called atrial high-rate episodes (AHREs) or subclinical AF (SCAF) are commonly identified. The necessity of anticoagulation in patients with SCAF is unclear. However, recent randomized controlled trials, the NOAH-AFNET 6 and ARTESIA, have offered insights into this matter. Furthermore, a study-level meta-analysis combining data from both these trials has provided more detailed information. Reviewing the information thus far, we can conclude that DOACs can result in a notable reduction in the risk of ischemic stroke and can potentially decrease the risk of debilitating stroke, albeit with an increased risk of major bleeding. Thus, informed, shared decision-making is essential, weighing the potential benefits of stroke prevention against the risk of major bleeding when considering anticoagulation in this patient population. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)
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