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Atrial Fibrillation: Catheter Ablation Techniques and Management Strategies

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

Deadline for manuscript submissions: closed (25 April 2025) | Viewed by 590

Special Issue Editor


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Guest Editor
Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Interests: electrophysiology; zero-fluoro ablation; atrial fibrillation; intracardiac echography; ventricular tachycardia ablation; conduction system pacing; sudden cardiac death

Special Issue Information

Dear Colleagues,

Cardiac electrophysiology is one of the most rapidly developing fields of cardiology. We are witnessing the advent of new energy modalities for ablation, novel physiologic options for pacing, and the opportunity to develop completely X-ray-free EP labs. Some older ablation concepts are being revisited, like high-power short-duration radiofrequency ablation, novel resizable cryoballoon devices, and hybrid, epicardial AF ablation. However, the hottest topic is electroporation, which is gradually becoming the dominant energy source for pulmonary vein isolation and wider ablation in the atria. Currently, there are a variety of PFE catheters available on the market, such as Varipulse, Farawawe, PulseSelect, Affera, etc. We know that not all PFE systems are created equally; so far, little data exist comparing these new ablation systems. Secondly, left appendage occluders are now widely used, and new studies have a potential to further expand LAAOcc usage, potentially as a second step in AF ablation.

Considering these developments, this Special Issue, ‘Atrial Fibrillation: Catheter Ablation Techniques and Management Strategies’, aims to collect high-quality, original research papers and comprehensive reviews on the recent developments in the field of cardiac electrophysiology, with a focus on atrial fibrillation. The topics of interests include, but are not limited to, the following:

  1. Pulse field ablation for atrial fibrillation treatment.
  2. Comparisons of different PFA systems.
  3. Zero-fluoro.
  4. High-power short-duration RF ablation.
  5. Resizable cryoballoons for AF ablation.
  6. Hybrid AF ablation.
  7. Left atrial appendage occluders.

Dr. Vedran Velagić
Guest Editor

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Keywords

  • atrial fibrillation
  • pulse field ablation
  • cryoablation
  • RF ablation
  • zero-fluoro procedures
  • LAA occluders

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Published Papers (1 paper)

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Research

11 pages, 599 KiB  
Article
Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation
by Botond Bocz, Dorottya Debreceni, Kristof-Ferenc Jánosi, Dalma Torma and Peter Kupo
J. Clin. Med. 2025, 14(6), 2119; https://doi.org/10.3390/jcm14062119 - 20 Mar 2025
Viewed by 347
Abstract
Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation [...] Read more.
Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators’ decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time. Full article
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