New Insights into Cardiac Electrophysiology and Personalized Medicine

Dear Colleagues,

In recent years, remarkable progress has been made in the field of cardiac electrophysiology, leading to enhanced diagnostic and therapeutic strategies. Advancements in this discipline are propelled by state-of-the-art technological developments, the integration of machine learning algorithms, cross-disciplinary research efforts, and an increasingly sophisticated comprehension of cardiac electrophysiological dynamics. Personalized medicine consists of the tailored application of medical/interventional treatment at an individual level, considering the specific phenotypic arrhythmia appearance of each patient. Catheter ablation has become the primary treatment modality for various cardiac arrhythmias, offering effective rhythm control through targeted tissue modification. Pulmonary vein isolation (PVI) represents the most commonly employed ablation technique in cardiac electrophysiology and serves as a cornerstone intervention for maintaining sinus rhythm in patients with atrial fibrillation. Moreover, ablation therapies targeting premature ventricular contractions (PVCs) and ventricular tachycardia (VT) have substantially enhanced patient outcomes, offering effective management for these challenging arrhythmias. Over the past decades, various thermal and non-thermal modalities for cardiac catheter ablation have emerged. These include 3D mapping-integrated point-by-point radiofrequency ablation, single-shot cryoballoon PVI, and pulsed-field ablation. Pulsed field ablation (PFA) represents a groundbreaking advancement in cardiac electrophysiology, employing precisely controlled electric pulses to trigger irreversible electroporation, thereby achieving selective myocardial tissue ablation. As insights into arrhythmic substrates, modulatory factors, and triggering mechanisms continue to expand, substrate-based ablation is emerging as a focal point in advanced arrhythmia management.

The application of machine learning (ML) in cardiac electrophysiology and arrhythmias beyond ECG interpretation, however, remains less known. This includes its role in fundamental research on arrhythmic mechanisms—both experimental and computational—as well as in advancing techniques for mapping cardiac electrical activity and contributing to translational research focused on arrhythmia treatment, further resulting in enhanced diagnostic accuracy, the emergence of novel treatment approaches, and the refinement of preventive strategies for various cardiac arrhythmias and related disorders. The implementation of personalized medicine in electrophysiology is essential due to the high costs involved and the multiple novel treatment approaches.

Dr. Ioanna Koniari
Guest Editor

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• ablation
• AF
• PVI
• PFA
• ventricular arrhythmias
• supraventricular arrhythmias
• pacemakers
• ICDs
• CRT
• conduction system pacing