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Advances in Atrial Fibrillation Treatment

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Dr. Iwona Woźniak-Skowerska

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First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
Interests: atrial fibrillation; electrocardiography; cardiology; pulmonary hypertension

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue of Journal of Clinical Medicine “Advances in Atrial Fibrillation Treatment”. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, significantly impacting morbidity, mortality, and healthcare systems worldwide. Advances in the diagnosis, management, and treatment of AF continue to shape clinical practice and improve patient outcomes.

This Special Issue aims to explore the latest developments in atrial fibrillation treatment, including novel therapeutic approaches, advancements in catheter ablation techniques, innovations in pharmacological therapies, and cutting-edge strategies for stroke prevention and risk factor modification. Special attention will also be given to individualized treatment strategies, the management of comorbidities, and the integration of wearable technology and artificial intelligence in AF care.

We welcome original research articles, systematic reviews, and meta-analyses focusing on the following topics:

Emerging pharmacological therapies for rate and rhythm control;
Advances in catheter ablation technologies and outcomes;
Personalized approaches to stroke prevention in AF patients;
Integration of digital tools and AI in AF monitoring and management;
Long-term outcomes and safety of novel AF treatment strategies;
Management of AF in special populations (e.g., the elderly, patients with heart failure, or chronic kidney disease).

We look forward to receiving your valuable contributions to this Special Issue, which will serve as a platform for advancing knowledge and fostering collaboration in the field of atrial fibrillation management.

Dr. Iwona Woźniak-Skowerska
Guest Editor

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Research

10 pages, 2978 KiB

Open AccessArticle

Acute Effects of Fusion Pacing Versus Standard CRT on Myocardial Function in Heart Failure Patients with LBBB

by Michał Kucio, Andrzej Kułach, Tomasz Skowerski, Mariusz Bałys, Mariusz Skowerski and Grzegorz Smolka

J. Clin. Med. 2025, 14(13), 4433; https://doi.org/10.3390/jcm14134433 - 22 Jun 2025

Viewed by 335

Abstract

Background/Objectives: Although cardiac resynchronization therapy (CRT) plays an established role in the management of heart failure, a significant proportion of patients do not respond despite appropriate candidate selection. The optimization of CRT pacing is one strategy to enhance response. Fusion pacing algorithms aim to synchronize intrinsic right ventricular (RV) conduction with paced left ventricular (LV) activation, resulting in a more physiological ventricular depolarization pattern. This approach may improve electrical synchrony and enhance left ventricular contraction compared to conventional simultaneous biventricular pacing. The aim of this study was to compare the acute, beat-to-beat effects of standard biventricular pacing versus fusion pacing on myocardial function, using both conventional and speckle-tracking echocardiography in heart failure patients with left bundle branch block (LBBB). Methods: In total, 27 heart failure patients (21 men and 6 women) with reduced ejection fraction (EF < 35%), left bundle branch block (QRS > 150 ms), and newly implanted CRT-D systems (Abbott) underwent echocardiographic assessment immediately after device implantation. Echocardiographic parameters—including left atrial strain, left ventricular strain, TAPSE, mitral and tricuspid valve function, and cardiac output—were measured at 5 min intervals under three different pacing conditions: pacing off, simultaneous biventricular pacing, and fusion pacing using Abbott’s SyncAV^® algorithm. Results: In our study, CRT led to a significant shortening of the QRS duration from 169 ± 19 ms at baseline to 131 ± 17 ms with standard biventricular pacing, and further to 118 ± 16 ms with fusion pacing (p < 0.05). Despite the electrical improvement, no significant changes were observed in global longitudinal strain (GLS: −9.15 vs. −9.39 vs. −9.13; p = NS), left ventricular stroke volume (67.5 mL vs. 68.4 mL vs. 68.5 mL; p = NS), or left atrial parameters including strain, area, and ejection fraction. However, fusion pacing was associated with more homogeneous segmental strain patterns, improved aortic valve closure time, and enhanced right ventricular function as reflected by tissue Doppler-derived S’. Conclusions: Immediate QRS narrowing observed in CRT patients—particularly with fusion pacing optimization—is associated with a more homogeneous pattern of left ventricular contractility and improvements in selected measures of mechanical synchrony. However, these acute electrical changes do not translate into immediate improvements in stroke volume, global LV strain, or left atrial function. Longer-term follow-up is needed to determine whether the electrical benefits of CRT, especially with fusion pacing, lead to meaningful hemodynamic improvements. Full article

(This article belongs to the Special Issue Advances in Atrial Fibrillation Treatment)

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