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From Substrate to Therapy: Integrating Approaches in Arrhythmia Management

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Cardiology".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 1717

Editors


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Guest Editor
Arrhythmia Unit, Cardiology Department, Donostia University Hospital, Barcelona, Spain
Interests: imaging; cardiac magnetic resonance; ventricular tachycardia substrate; ventricular tachycardia ablation; high density mapping; pulse field ablation

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Guest Editor
Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
Interests: imaging; cardiac magnetic resonance; ventricular tachycardia substrate; ventricular tachycardia ablation; high density mapping

Special Issue Information

Dear Colleagues,

Improved anatomical and functional characterization of arrhythmogenic substrates has enhanced our understanding of arrhythmia mechanisms. The integration of imaging (cardiac MRI, CT and ICE) and mapping techniques (ECGi and high-density electroanatomical mapping) allows more precise characterization of the electrophysiological substrates responsible for arrhythmia initiation and maintenance. In parallel, the emergence of novel therapeutic technologies—including pulsed-field ablation and stereotactic body radiotherapy—has expanded the therapeutic landscape, enabling safe and effective targeting of complex substrates. Together, these developments are fostering a shift toward personalized, precision-guided strategies for the management of both atrial and ventricular arrhythmias.

This Special Issue brings together contributions that explore the evolving interface between arrhythmogenic substrate characterization and contemporary ablation strategies. It focuses on the integration of modern imaging modalities, non-invasive and invasive high-density mapping, and innovative ablation approaches to advance both the understanding and treatment of complex arrhythmias. By highlighting work that addresses clinical application, this Special Issue underscores strategies that enable more precise, individualized, and outcome-oriented arrhythmia management.

Topics of interest for publication include, but are not limited to, the following:

  • Characterization of arrhythmogenic substrates through imaging (MRI, CT and ICE) and non-invasive mapping
  • Advanced strategies for high-density invasive mapping and functional assessment of arrhythmia substrates
  • Innovative approaches to target complex or difficult-to-access substrates, including bipolar ablation, coronary venous ethanol ablation, stereotactic body radiotherapy, and remote-controlled magnetic navigation systems
  • Emerging therapeutic technologies and their impact on cardiac ablation outcomes, such as pulsed-field ablation and ultra-cryotherapy

Dr. Sara Vázquez-Calvo
Dr. Ivo Roca-Luque
Guest Editors

Manuscript Submission Information

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Keywords

  • cardiac arrhythmias
  • substrate characterization
  • non-invasive mapping
  • ECGi
  • cardiac imaging
  • high-density mapping
  • emerging ablation technologies
  • pulsed-field ablation
  • ultra-cryotherapy
  • stereotactic body radiotherapy
  • personalized arrhythmia management

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Published Papers (1 paper)

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Review

38 pages, 5209 KB  
Review
Cardioneuroablation for Reflex Syncope and Functional Bradyarrhythmias: A State-of-the-Art Review
by Rodolfo San Antonio, Juan Ismael Almonte, Carlos García-Filloy, Jordi Mercé, Julián Rodríguez-García, Jesús Rodríguez-Silva, Marcos Rodríguez-García, Alfredo Chauca, Andrea Di Marco, Paolo D. Dallaglio and Ignasi Anguera
J. Clin. Med. 2026, 15(15), 6012; https://doi.org/10.3390/jcm15156012 - 2 Aug 2026
Viewed by 1304
Abstract
Cardioneuroablation (CNA), defined as endocardial catheter ablation of atrial ganglionated plexi within the intrinsic cardiac autonomic nervous system, has emerged as a mechanism-directed therapy for cardioinhibitory reflex syncope and functional bradyarrhythmias. By attenuating postganglionic parasympathetic input to the sinoatrial and atrioventricular nodes, CNA [...] Read more.
Cardioneuroablation (CNA), defined as endocardial catheter ablation of atrial ganglionated plexi within the intrinsic cardiac autonomic nervous system, has emerged as a mechanism-directed therapy for cardioinhibitory reflex syncope and functional bradyarrhythmias. By attenuating postganglionic parasympathetic input to the sinoatrial and atrioventricular nodes, CNA targets the autonomic substrate of cardioinhibition rather than merely treating its bradycardic consequence. Over the past two decades, the evidence base has progressed from pioneering single-center experiences to multicenter registries, systematic reviews, meta-analyses, and randomized clinical trials, with reported freedom from recurrent syncope of approximately 80–94% in carefully selected patients at medium-term follow-up. This state-of-the-art narrative review summarizes the rationale, anatomy, patient-selection principles, mapping and ablation strategies, procedural endpoints, clinical outcomes, safety profile, and emerging applications of CNA. Particular emphasis is placed on the unresolved questions that will define the future of the field: the absence, to date, of adequately powered sham-controlled efficacy data; the lack of a universally validated intraprocedural endpoint; the biological and clinical significance of vagal reinnervation; and the gap between expert-center and broader real-world outcomes. Current evidence supports CNA as a promising, anatomically grounded neuromodulatory therapy, but its transition from expert-center innovation to guideline-endorsed treatment will depend on rigorous patient selection, standardized procedural endpoints, and the results of ongoing randomized trials. Full article
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