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Cardiac Electrophysiology: Focus on Clinical Practice
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Cardiac Electrophysiology: Focus on Clinical Practice

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

Deadline for manuscript submissions: 15 February 2026 | Viewed by 3219

Special Issue Editor

Dr. Andreas Müssigbrodt

E-Mail Website
Guest Editor
Department of Cardiology, CHU Martinique (University Hospital of Martinique), BP 632, 97200 Fort de France, France
Interests: atrial fibrillation; electrocardiography; arrhythmia; ventricular tachycardia; ablation; cardiomyopathy; LBBAP; CSP; sports cardiology; genetics
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Special Issue Information

Dear Colleagues,

Cardiac electrophysiology is a rapidly advancing field, contributing to significant improvements in the diagnosis and management of arrhythmias. Ongoing developments in mapping techniques, ablation strategies, device therapies, and clinical guidelines are reshaping clinical practice and research.

The Journal of Clinical Medicine (https://www.mdpi.com/journal/jcm, IF 3.0, ISSN 2077-0383) invites researchers and clinicians to submit manuscripts to a Special Issue on "Cardiac Electrophysiology: Focus on Clinical Practice". This Special Issue aims to bring together original research articles, comprehensive reviews, and case reports that address recent advances, unresolved challenges, and emerging trends in this area. Topics of interest include arrhythmia mechanisms, innovative therapeutic approaches, and interdisciplinary perspectives on the integration of electrophysiology in clinical practice.

As an open-access journal indexed in PubMed, all published articles will be freely available to a global audience, ensuring maximum visibility and accessibility for your scientific work. To support this model, Article Processing Charges (APCs) are required after acceptance of the manuscript. Discounts on the APC may be provided for selected submissions upon request. All manuscripts will undergo rigorous peer review to ensure high scientific quality.

As Guest Editor, I look forward to receiving your submissions for this Special Issue.

Dr. Andreas Müssigbrodt
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

  • cardiomyopathy
  • arrhythmia
  • heart rhythm
  • atrial fibrillation
  • ventricular tachycardia
  • sudden cardiac death
  • mapping
  • ablation
  • pulsed field ablation (PFA)
  • device
  • pacemaker
  • left bundle branch area pacing (LBBAP)
  • conduction system pacing (CSP)
  • implantable cardioverter-defibrillator (ICD)
  • leadless pacing
  • extraction

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Published Papers (4 papers)

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Research

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13 pages, 839 KB  
Article
Retrospective Observational Study of the Carbon Dioxide Insufflation Technique for Epicardial Access Ablation of Refractory Arrhythmias
by Margarida G. Figueiredo, Bruno Valente, Leonor Magalhães, Guilherme Portugal, Hélder Santos, Ana Lousinha, Pedro Silva Cunha, Rui Cruz Ferreira and Mário Martins Oliveira
J. Clin. Med. 2025, 14(24), 8888; https://doi.org/10.3390/jcm14248888 - 16 Dec 2025
Viewed by 229
Abstract
Background/Objectives: Accessing intramural or epicardial arrhythmogenic substrates is limited in endocardial ablation, and in these circumstances, epicardial ablation may overcome these limitations. Because epicardial access may be associated with severe complications, intentional distal coronary vein exit and carbon dioxide (CO2) [...] Read more.
Background/Objectives: Accessing intramural or epicardial arrhythmogenic substrates is limited in endocardial ablation, and in these circumstances, epicardial ablation may overcome these limitations. Because epicardial access may be associated with severe complications, intentional distal coronary vein exit and carbon dioxide (CO2) insufflation have emerged as techniques to facilitate safer access. Methods: We conducted a single-centre retrospective observational analysis of all patients who underwent epicardial ablation using the CO2 insufflation technique between September 2021 and October 2024. Results: Among 21 patients selected for the procedure, successful pericardial access was achieved in 19 (90.5%). The main indication for ablation was ventricular tachycardia (14 patients, 66.7%), and 16 patients (76.2%) had previously undergone endocardial ablation for the same arrhythmia. Most patients had non-ischemic cardiomyopathy (17 patients, 81.0%). Three intra-procedural complications occurred: one (5.3%) was access-related, and two (10.5%) were ablation-related. Early post-procedural complications occurred in three patients (15.8%). Acute procedural success was achieved in 16 of 17 patients (94.1%) who underwent ablation. In-hospital mortality occurred in three cases (15.8%), including one procedure-related death (5.3%). Conclusions: Intentional coronary vein exit and CO2 insufflation provide a safe and reproducible technique to obtain subxiphoid pericardial access for epicardial ablation. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: Focus on Clinical Practice)
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9 pages, 607 KB  
Article
Proper QRS for EMBLEM S-ICD Across Micra Recipients—Pilot Study
by Bruno Hrymniak, Przemysław Skoczyński, Bartosz Skonieczny, Bartosz Biel, Krystian Josiak, Patrycja Aktanorowicz, Tomasz Wieczorek, Dorota Zyśko, Waldemar Banasiak and Dariusz Jagielski
J. Clin. Med. 2025, 14(5), 1420; https://doi.org/10.3390/jcm14051420 - 20 Feb 2025
Viewed by 1106
Abstract
Background: In total, 6.6% to 11% of patients with an initially implanted implantable cardioverter-defibrillator (ICD) will develop significant bradycardia and the need for pacing in subsequent years. As the leadless pacemaker (LP) and subcutaneous implantable cardioverter-defibrillator (S-ICD) population comorbidities are often similar, both [...] Read more.
Background: In total, 6.6% to 11% of patients with an initially implanted implantable cardioverter-defibrillator (ICD) will develop significant bradycardia and the need for pacing in subsequent years. As the leadless pacemaker (LP) and subcutaneous implantable cardioverter-defibrillator (S-ICD) population comorbidities are often similar, both groups would benefit from a hybrid solution. Unfortunately, currently, there is no commercially available and sufficiently validated interconnected set of S-ICD and LP. Methods: In this single-center, prospective observational study, 32 pacing-dependent patients after implantation of a Micra LP were screened for S-ICD on the left and right sides of the sternum using the EMBLEM Automated Screening Tool. At least one positive, both in the supine and standing positions, was considered a positive screening. The impact of various clinical variables and morphology of paced QRS on screening results was assessed. Moreover, the function of the tricuspid valve was evaluated before and after LP implantation to consider whether there is a relationship between paced QRS and worsening tricuspid regurgitation. Results: Patients with paced heart rhythm were divided into two groups based on screening results for S-ICD. The positive screening outcome was achieved in 10 patients (31.25%). No correlation between any clinical variable and screening results was found. However, right axis deviation [RAD] of paced QRS seems to be a strong predictor of positive S-ICD screening (RAD in 9/32 patients, sensitivity 90%, specificity 100%, PPV 100%, NPV 96% for passing screening), and negative polarity of paced QRS in inferior leads predicts negative screening results (positive polarity in II, III, and aVF in 12/32 patients, sensitivity 100%, specificity 90%, PPV 83%, NPV 100% for passing screening). Conclusions: Right axis deviation of the paced rhythm, positive QRS polarity of leads II, III, and aVF, and negative QRS polarity in leads I and aVL seem to predict a positive screening result for S-ICD. Such a position of LP does not seem to worsen tricuspid regurgitation. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: Focus on Clinical Practice)
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Review

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10 pages, 1658 KB  
Review
Left Bundle Branch Area Pacing in Transthyretin Cardiac Amyloidosis: A Narrative Review
by Maria Herrera Bethencourt, Arnt V. Kristen, Vincent Algalarrondo, Guram Imnadze and Andreas Müssigbrodt
J. Clin. Med. 2026, 15(1), 305; https://doi.org/10.3390/jcm15010305 - 31 Dec 2025
Viewed by 187
Abstract
Background/Objectives: Transthyretin cardiomyopathy (ATTR-CM) is frequently associated with conduction disease requiring pacing. Conventional right ventricular pacing may worsen cardiac function, whereas left bundle branch area pacing (LBBAP) aims to preserve physiological activation. Evidence for LBBAP in ATTR-CM remains limited. Methods: A [...] Read more.
Background/Objectives: Transthyretin cardiomyopathy (ATTR-CM) is frequently associated with conduction disease requiring pacing. Conventional right ventricular pacing may worsen cardiac function, whereas left bundle branch area pacing (LBBAP) aims to preserve physiological activation. Evidence for LBBAP in ATTR-CM remains limited. Methods: A structured narrative review of PubMed and Google Scholar was performed through November 2025 using predefined terms related to LBBAP and ATTR-CM. Peer-reviewed articles, case reports, case series, and relevant abstracts were included. Studies exclusively on light-chain cardiac amyloidosis were excluded. Results: Ten publications met inclusion criteria, comprising three case reports, five case series, one retrospective cohort without a comparator, and one cohort comparing LBBAP with cardiac resynchronization therapy (CRT). In total, 56 patients with ATTR-CM underwent LBBAP. Implantation success was high, with stable acute and mid-term electrical parameters. Follow-up (typically 3–12 months) showed stable electrical parameters with narrow paced QRS complexes and preserved or improved left ventricular ejection fraction in most reports. Symptomatic improvement and reductions in natriuretic peptides were variably described. No major lead-related complications were reported. Comparative data remain sparse and inconclusive. Conclusions: This review suggests that LBBAP is a feasible and safe pacing approach in patients with ATTR-CM and may help to stabilize or improve heart failure symptoms. Further prospective studies are needed to confirm its clinical effectiveness. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: Focus on Clinical Practice)
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12 pages, 2170 KB  
Review
Uncommon and Accessory Electrocardiographic Findings in Brugada Syndrome: A Review
by Antonino Micari, Paolo Bellocchi, Asya Cautela, Alice Moncada, Matteo Pluchino, Maurizio Cusmà-Piccione, Lilia Oreto, Giampiero Vizzari, Giuseppe Dattilo and Pasquale Crea
J. Clin. Med. 2025, 14(16), 5895; https://doi.org/10.3390/jcm14165895 - 21 Aug 2025
Viewed by 1020
Abstract
Brugada syndrome (BrS) is a cardiac arrhythmic disorder associated with distinctive electrocardiographic (ECG) abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias. While the classic BrS ECG pattern is a coved ST-segment elevation in the right precordial leads, a [...] Read more.
Brugada syndrome (BrS) is a cardiac arrhythmic disorder associated with distinctive electrocardiographic (ECG) abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias. While the classic BrS ECG pattern is a coved ST-segment elevation in the right precordial leads, a wide spectrum of atypical ECG presentations can mislead the diagnosis. This review discusses rare and under-recognized ECG findings associated with BrS, including its coexistence with right and left bundle branch block, alterations in peripheral leads and in the morphology of the QRS complex, as well as atrioventricular conduction abnormalities. Emphasis is placed on the clinical relevance of these findings, their underlying electrophysiological mechanisms, and their prognostic implications. Recognizing these atypical manifestations is critical to avoid misdiagnosing or failing to recognize the condition in patients with BrS. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: Focus on Clinical Practice)
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