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Atrial Fibrillation: Therapeutic Strategies and Challenges
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Atrial Fibrillation: Therapeutic Strategies and Challenges

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

Deadline for manuscript submissions: closed (15 October 2024) | Viewed by 7330

Special Issue Editors

Dr. Michael D. Faulx

E-Mail Website
Guest Editor
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
Interests: sleep apnea and cardiovascular disease; general clinical cardiology; cardiovascular hemodynamics; critical care cardiology; medical education
Dr. John Rickard

E-Mail Website
Guest Editor
Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
Interests: cardiac electrophysiology; atrial fibrillation; catheter-based management of cardiac arrhythmia; cardiac device therapies; clinical research
Dr. Eoin Donnellan

E-Mail Website
Guest Editor
Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, New Orleans, LA, USA
Interests: cardiac electrophysiology; drivers of atrial fibrillation risk; catheter-based management of cardiac arrhythmia; cardiac device therapies; clinical research

Special Issue Information

Dear Colleagues,

Atrial fibrillation is the most common rhythm disorder affecting men and women. Atrial fibrillation independently increases mortality risk, and its presence is associated with a heightened risk for stroke, a higher likelihood of the worsening of other cardiovascular conditions, and a reduced quality of life. The presence of clinical and current disease is also a unique and not uncommon issue with atrial fibrillation. Globally, both the incidence and prevalence of atrial fibrillation are increasing, making this diagnosis increasingly relevant to medical practitioners worldwide. 

Clinical trials of patients with atrial fibrillation randomized to receive a rhythm control versus rate control strategy with equivalent stroke prevention have established the paradigm that aggressive rhythm control confers no significant survival benefit; however, the past decade has seen a rapid growth in our understanding of the electrophysiology of atrial fibrillation as well as the emergence of greater options for the pharmacologic and catheter-based treatment of this arrhythmia. Not surprisingly, more contemporary reviews of the clinical management of atrial fibrillation have challenged the paradigm that early rhythm control is not superior to rate control in subjects with atrial fibrillation.

The aim of this Special Issue of the Journal of Clinical Medicine is to provide the reader with a comprehensive and up-to-date overview of atrial fibrillation, including current thinking regarding its pathogenesis, novel contributors to clinical risk, contemporary approaches to diagnosis, and state-of-the-art pharmacotherapy as well as catheter-based management. We hope to provide the reader with the most current understanding of this common rhythm disorder to equip them with the knowledge to better understand current management options to appreciate the science behind current society-based management guidelines.

In this Special Issue, we invite basic science and clinical researchers to submit high-quality original manuscripts providing current insights into the prevalence, pathophysiology, diagnosis, prevention, and treatment of atrial fibrillation. 

Dr. Michael D. Faulx
Dr. John Rickard
Dr. Eoin Donnellan
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
  • epidemiology
  • pathogenesis
  • catheter-based therapies
  • anti-arrhythmic therapy
  • stroke prevention

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Published Papers (5 papers)

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Research

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13 pages, 235 KiB  
Article
Gender Disparity in Oral Anticoagulation Therapy in Hospitalised Patients with Atrial Fibrillation During the Ongoing Syrian Conflict: Unbalanced Treatment in Turbulent Times
by Ibrahim Antoun, Alkassem Alkhayer, Aref Jalal Eldin, Alamer Alkhayer, Khaled Yazji, Riyaz Somani, G. André Ng and Mustafa Zakkar
J. Clin. Med. 2025, 14(4), 1173; https://doi.org/10.3390/jcm14041173 - 11 Feb 2025
Cited by 3 | Viewed by 581
Abstract
Background: Disparities in the therapy and outcomes of males and females with atrial fibrillation (AF) are known in the developed world. Still, data regarding these disparities in the developing world are scarce. This study explores gender trends and outcomes in oral anticoagulation prescription [...] Read more.
Background: Disparities in the therapy and outcomes of males and females with atrial fibrillation (AF) are known in the developed world. Still, data regarding these disparities in the developing world are scarce. This study explores gender trends and outcomes in oral anticoagulation prescription during the Syrian conflict. Methods: We included adult patients with an index admission with AF to Latakia’s tertiary centre between September 2021 and February 2024. Data regarding treatments and comorbidities were taken from patients’ medical notes. The composite outcome was a readmission with a cerebrovascular event (CVA) or a bleeding event within 60 days of index discharge. A regression model was used to assess predictors of composite outcomes. Results: A total of 683 consecutive patients admitted and treated for AF satisfied the study criteria, of whom 347 (51%) were females. In patients with a guideline indication for anticoagulation (n = 553), males were prescribed more DOACs and fewer VKAs than females (93% versus 71%, p < 0.001 and 7% versus 29%, p = 0.01, respectively). Composite outcomes occurred significantly more in females than males (16% versus 6%, p = 0.03). Females on VKAs had significantly more composite outcomes than males (70% versus 53%, p < 0.001). Independent predictors of composite outcomes included females compared to males (hazard ratio [HR]: 2.3 and 6.2, 95% confidence interval [CI]: 1.3–4.2 and 3.7–10.8, p = 0.001 and <0.001) and VKAs compared to direct oral anticoagulants (DOACs) (HR: 8.4, 95%CI: 4.8–15.3, p < 0.001). Conclusions: Females at this Syrian centre had a higher use of VKAs and a lower use of DOACs compared to males, resulting in a higher rate of composite outcomes of CVA and bleeding events. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Therapeutic Strategies and Challenges)
13 pages, 1283 KiB  
Article
Increased Mortality Associated with Amiodarone Compared to Other Antiarrhythmic Drugs in New-Onset Atrial Fibrillation
by Yun Gi Kim, Hyoung Seok Lee, Hoseob Kim, Mina Kim, Joo Hee Jeong, Yun Young Choi, Jaemin Shim, Jong-Il Choi and Young-Hoon Kim
J. Clin. Med. 2025, 14(4), 1168; https://doi.org/10.3390/jcm14041168 - 11 Feb 2025
Viewed by 876
Abstract
Background and Aims: Antiarrhythmic drugs (AADs) are the primary treatment for maintaining sinus rhythm in patients with atrial fibrillation (AF). While amiodarone is mainly used in patients with structural heart disease, its effects on all-cause mortality compared to other AADs remain unclear. Methods: [...] Read more.
Background and Aims: Antiarrhythmic drugs (AADs) are the primary treatment for maintaining sinus rhythm in patients with atrial fibrillation (AF). While amiodarone is mainly used in patients with structural heart disease, its effects on all-cause mortality compared to other AADs remain unclear. Methods: This study utilized nationwide healthcare insurance data involving patients with new-onset AF from 2013 to 2019. We identified patients who were prescribed with AADs ≥ six months within the first year of diagnosis (medication possession ratio ≥ 0.5). All-cause mortality was assessed between amiodarone and other AAD users up to three years post-AAD-prescription. Results: Among 770,977 new-onset AF patients, 12,243 were amiodarone users and 33,036 were prescribed with other AADs. Significant differences in mean age and prevalence of medical conditions such as heart failure, myocardial infarction, chronic kidney disease, diabetes, and dyslipidemia were noted. After propensity score matching, 12,017 amiodarone users were compared to an equal number of other AAD users with similar baseline characteristics. Multivariate analysis indicated a 2.9-fold increase in all-cause mortality for amiodarone users (hazard ratio = 2.88; 95% confidence interval = 2.64–3.15; p < 0.001). This increased risk was more pronounced among women compared with men (hazard ratio = 3.38 vs. 2.56; p for interaction = 0.004). Amiodarone was associated with increased mortality in AF patients with heart failure and myocardial infarction. Conclusions: Amiodarone, compared with non-amiodarone AADs, was associated with increased risk of all-cause mortality in AAD-naive new-onset AF patients. Increased all-cause mortality associated with amiodarone was consistent throughout various subgroups. Significant interaction was observed with the sex category, with women being more vulnerable to amiodarone. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Therapeutic Strategies and Challenges)
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12 pages, 1734 KiB  
Article
Left Atrium Volume Measured with Multislice Computed Tomography as a Prognostic Predictor for Atrial Fibrillation Catheter Ablation Outcomes
by Jae-Hong Park, Dong-Hyun Yang, Ji-Hyun Kim and Yoo-Ri Kim
J. Clin. Med. 2024, 13(7), 1859; https://doi.org/10.3390/jcm13071859 - 23 Mar 2024
Cited by 2 | Viewed by 1398
Abstract
Background: Current guidelines consider atrial fibrillation (AF) type as the prognostic factor for a recommendation of catheter ablation. We aimed to determine whether LA and LA appendage (LAA) volumes measured using multislice computed tomography (MSCT) were related to long-term outcomes in AF following [...] Read more.
Background: Current guidelines consider atrial fibrillation (AF) type as the prognostic factor for a recommendation of catheter ablation. We aimed to determine whether LA and LA appendage (LAA) volumes measured using multislice computed tomography (MSCT) were related to long-term outcomes in AF following radiofrequency catheter ablation (RFCA). Methods: We evaluated 152 consecutive patients with drug-refractory AF (median age, 55.8 ± 9.6 years), including 110 male patients, who underwent RFCA in a single center. All patients underwent MSCT imaging for anatomical assessment. The endpoint of this study was documented AF recurrence after RFCA. Results: The overall procedure success rate was 77.6% (n = 118) during a mean follow-up period of 12.6 months. The LA volume was significantly larger for those who experienced AF recurrence after RFCA than for the patients without recurrent AF after the procedure (153.8 ± 29.9 mL vs. 139.2 ± 34.1 mL, p = 0.025). However, LAA volumes were nearly equivalent between the patients with and without AF recurrence after RFCA (16.2 ± 6.3 mL and 14.7 ± 6.5 mL, respectively; p = 0.235). LA volume ≥ 153.2 mL was the optimal cutoff value for estimating AF recurrence after RFCA, with 94% sensitivity and 66% specificity. LA volume remained an independent predictor of both AF recurrence and permanent AF. Conclusions: LA volume as assessed by MSCT might be helpful for identifying patients likely to achieve successful AF ablation. LA volume ≥ 153.2 mL, but not LAA volume, showed good accuracy in predicting AF recurrence after RFCA. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Therapeutic Strategies and Challenges)
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Review

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39 pages, 2200 KiB  
Review
Exploring Anti-Inflammatory Treatment as Upstream Therapy in the Management of Atrial Fibrillation
by Edward Zheng, Izabela Warchoł, Maja Mejza, Maria Możdżan, Monika Strzemińska, Anna Bajer, Paulina Madura, Juliusz Żak and Michał Plewka
J. Clin. Med. 2025, 14(3), 882; https://doi.org/10.3390/jcm14030882 - 29 Jan 2025
Cited by 1 | Viewed by 1585
Abstract
Inflammation has been widely recognized as one of the major pathophysiological drivers of the development of atrial fibrillation (AF), which works in tandem with other risk factors of AF including obesity, diabetes, hypertension, and heart failure (HF). Our current understanding of the role [...] Read more.
Inflammation has been widely recognized as one of the major pathophysiological drivers of the development of atrial fibrillation (AF), which works in tandem with other risk factors of AF including obesity, diabetes, hypertension, and heart failure (HF). Our current understanding of the role of inflammation in the natural history of AF remains elusive; however, several key players, including the NLRP3 (NLR family pyrin domain containing 3) inflammasome, have been acknowledged to be heavily influential on chronic inflammation in the atrial myocardium, which leads to fibrosis and eventual degradation of its electrical function. Nevertheless, our current methods of pharmacological modalities with reported immunomodulatory properties, including well-established classes of drugs e.g., drugs targeting the renin–angiotensin–aldosterone system (RAAS), statins, and vitamin D, have proven effective in reducing the overall risk of developing AF, the onset of postoperative atrial fibrillation (POAF), and reducing overall mortality among patients with AF. This might bring hope for further progress in developing new treatment modalities targeting cellular checkpoints of the NLRP3 inflammasome pathway, or revisiting other well-known anti-inflammatory drugs e.g., colchicine, vitamin C, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, and antimalarial drugs. In our review, we aim to find relevant upstream anti-inflammatory treatment methods for the management of AF and present the most current real-world evidence of their clinical utility. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Therapeutic Strategies and Challenges)
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24 pages, 1851 KiB  
Review
Ablation Strategies for Persistent Atrial Fibrillation: Beyond the Pulmonary Veins
by Omar Baqal, Areez Shafqat, Narathorn Kulthamrongsri, Neysa Sanghavi, Shruti K. Iyengar, Hema S. Vemulapalli and Hicham Z. El Masry
J. Clin. Med. 2024, 13(17), 5031; https://doi.org/10.3390/jcm13175031 - 25 Aug 2024
Viewed by 2179
Abstract
Despite advances in ablative therapies, outcomes remain less favorable for persistent atrial fibrillation often due to presence of non-pulmonary vein triggers and abnormal atrial substrates. This review highlights advances in ablation technologies and notable scientific literature on clinical outcomes associated with pursuing adjunctive [...] Read more.
Despite advances in ablative therapies, outcomes remain less favorable for persistent atrial fibrillation often due to presence of non-pulmonary vein triggers and abnormal atrial substrates. This review highlights advances in ablation technologies and notable scientific literature on clinical outcomes associated with pursuing adjunctive ablation targets and substrate modification during persistent atrial fibrillation ablation, while also highlighting notable future directions. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Therapeutic Strategies and Challenges)
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