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Life
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Atrial Fibrillation and Heart Failure
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Atrial Fibrillation and Heart Failure

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 12084

Special Issue Editors

Dr. Gabriel Cismaru

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Guest Editor
5th Department of Internal Medicine, Cardiology Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Interests: catheter ablation; supraventricular tachycardia; atrial fibrillation; heart failure; ventricular tachycardia; pacemaker implantation; statistics
Dr. Alina Negru

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Guest Editor
Department of Cardiology, University of Medicine and Pharmacy, 300041 Timișoara, Romania
Interests: heart failure; pediatric cardiology; catheter ablation; cardiac resynchronization therapy
Dr. Ernst R. Schwarz

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Guest Editor
Cedars Sinai Med Ctr, Cedars Sinai Heart Inst, Los Angeles, CA 90048, USA
Interests: internal medicine; cardiology

Special Issue Information

Dear Colleagues,

Many risk factors are shared by atrial fibrillation and heart failure, including hypertension, obesity, diabetes, and ischemic heart disease. This is why atrial fibrillation and heart failure are two clinical entities that can present alone but are frequently encountered together; it is not surprising for a patient to have both at the same time. Atrial fibrillation is currently the leading cause of ischemic stroke, as it causes blood clots at the level of the left atrial appendage or left atrium, which may break off and travel to the cerebral arteries. Heart failure can be caused by any condition that prevents the heart from pumping blood to the body or from completely filling the left ventricle, which is a feature of atrial fibrillation.

Pharmacological rhythm control is especially difficult in heart failure patients. Because of their negative inotropic effects, antiarrhythmic drugs such as flecainide and propafenone cannot be used. Amiodarone is the only AAD drug approved for HFrEF heart failure with a low ejection fraction, but it has a variety of side effects. As a result, rate versus rhythm strategies have been used to determine whether rhythm control is beneficial. If a person with AF does not respond to medication, or side effects occur, then catheter ablation may be necessary. Pulmonary vein isolation is considered the cornerstone of catheter ablation for AF because no other ablation options have shown benefit thus far.

However, there are still knowledge gaps in the appropriate management of patients with concomitant AF and HF: What is the best method to quantify atrial fibrosis in patients with heart failure? What is the optimal ablation strategy for persistent atrial fibrillation? What is the role of left atrial appendage occlusion or exclusion in patients with AF and HF? Is CRT implantation +AV node ablation superior to pulmonary vein isolation in patients with decreased LV ejection fraction and heart failure? In order for all of these questions to be answered, observational and prospective studies are expected in the near future.

For this Special Issue, we welcome original research, narrative review articles and meta-analyses on any topic related to atrial fibrillation and heart failure, from experimental research to epidemiological observations and therapeutic trials.

Topics relevant to this Special Issue include, but are not limited to:

  1. Experimental development of atrial fibrosis;
  2. Experimental induction of atrial fibrillation and heart failure in animals, and challenges in systemic thrombolysis;
  3. Observational studies on AF prevalence in the United States, Europe, Asia, Australia, Africa, and the Americas;
  4. Reviews on the pathophysiology and cellular basis of AF and HF;
  5. Arrhythmia-induced cardiomyopathy due to atrial fibrillation;
  6. Anticoagulation particularities in patients with AF and HF;
  7. Role of LA appendage exclusion and occlusion in AF and HF;
  8. Antiarrhythmic drugs for AF therapy in patients with HF;
  9. Reviews of catheter ablation trials versus medical treatment in AF with systolic dysfunction;
  10. Role of atrioventricular node ablation plus CRT in patients with AF and low ejection left ventricle.

Dr. Gabriel Cismaru
Dr. Alina Negru
Dr. Ernst R. Schwarz
Guest Editors

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 100 words) can be sent to the Editorial Office for announcement on this website.

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. Life is an international peer-reviewed open access monthly 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

  • atrial fibrillation
  • heart failure
  • stroke
  • catheter ablation
  • cardiac resynchronization therapy
  • atrial fibrosis
  • imaging
  • antiarrhythmic drugs

Published Papers (6 papers)

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Editorial

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2 pages, 149 KiB  
Editorial
Atrial Fibrillation and Heart Failure
by Gabriel Cismaru and Alina-Gabriela Negru
Life 2024, 14(5), 572; https://doi.org/10.3390/life14050572 - 29 Apr 2024
Viewed by 206
Abstract
Recent years have witnessed progress in the management of heart failure through the development of SGLT2 inhibitors and angiotensin receptor neprilysin inhibitors [...] Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)

Research

Jump to: Editorial

14 pages, 2492 KiB  
Article
The Impact of Atrial Fibrillation on All Heart Chambers Remodeling and Function in Patients with Dilated Cardiomyopathy—A Two- and Three-Dimensional Echocardiography Study
by Maria L. Iovănescu, Diana R. Hădăreanu, Despina M. Toader, Cristina Florescu, Octavian Istrătoaie, Ionuţ Donoiu and Constantin Militaru
Life 2023, 13(6), 1421; https://doi.org/10.3390/life13061421 - 20 Jun 2023
Cited by 2 | Viewed by 1286
Abstract
Atrial fibrillation is frequently seen in patients with dilated cardiomyopathy (DCM), and its presence impacts the function of the heart, with clinical and prognostic consequences. In this prospective single-center study, we aimed to assess the impact of atrial fibrillation on cardiac structure and [...] Read more.
Atrial fibrillation is frequently seen in patients with dilated cardiomyopathy (DCM), and its presence impacts the function of the heart, with clinical and prognostic consequences. In this prospective single-center study, we aimed to assess the impact of atrial fibrillation on cardiac structure and function, using comprehensive two- and three-dimensional echocardiography. We included 41 patients with DCM and persistent or permanent atrial fibrillation (38 male, age 58.8 ± 11 years), as well as 47 patients with DCM and in sinus rhythm (35 male, age 58 ± 12.5 years). Cardiac chambers and mitral and tricuspid valves’ structure and function were assessed via standard two-dimensional, speckle-tracking, and three-dimensional echocardiography (3DE). Patients with DCM and atrial fibrillation had a more impaired left ventricular global longitudinal strain, higher 3DE left atrial volumes, and reduced function compared to patients in sinus rhythm in the presence of similar left ventricle volumes. Mitral annulus configuration was altered in atrial fibrillation DCM patients. Also, right heart volumes were larger, with more severe atrial and ventricular dysfunction, despite similar estimated pulmonary artery pressures and severity of tricuspid regurgitation. Using advanced echocardiography techniques, we demonstrated that atrial fibrillation induces significant remodeling in all heart chambers. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)
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16 pages, 1598 KiB  
Article
Sacubitril/Valsartan Improves Left Atrial and Ventricular Strain and Strain Rate in Patients with Heart Failure with Reduced Ejection Fraction
by Pedro Garcia Brás, António Valentim Gonçalves, Luísa Moura Branco, Rita Ilhão Moreira, Tiago Pereira-da-Silva, Ana Galrinho, Ana Teresa Timóteo, Pedro Rio, Ana Leal, Fernanda Gameiro, Rui M. Soares and Rui Cruz Ferreira
Life 2023, 13(4), 995; https://doi.org/10.3390/life13040995 - 12 Apr 2023
Cited by 3 | Viewed by 1696
Abstract
Background: Data on the impact of sacubitril/valsartan (SV) therapy on phasic left atrial (LA) and left ventricular (LV) strain in heart failure with reduced ejection fraction (HFrEF) are limited. The aim of this study was to evaluate changes in two-dimensional speckle tracking (2D-STE) [...] Read more.
Background: Data on the impact of sacubitril/valsartan (SV) therapy on phasic left atrial (LA) and left ventricular (LV) strain in heart failure with reduced ejection fraction (HFrEF) are limited. The aim of this study was to evaluate changes in two-dimensional speckle tracking (2D-STE) parameters with SV therapy in HFrEF patients. Methods: Prospective evaluation of HFrEF patients receiving optimized medical therapy. Two-dimensional speckle tracking (2D-STE) parameters were assessed at baseline and after 6 months of SV therapy. LA strain and strain rate (SR) in reservoir, conduit, and contraction phases were compared with LV longitudinal, radial, and circumferential strain and SR and stratified according to heart rhythm and HFrEF etiology. Results: A total of 35 patients completed the 6-month follow-up, with a mean age of 59 ± 11 years, 40% in atrial fibrillation, 43% with ischemic etiology, and LVEF of 29 ± 6%. There were significant improvements in LA reservoir, conduit, and contractile strain and SR following SV therapy, particularly among patients in sinus rhythm. There were significant improvements in longitudinal, radial, and circumferential LV function indices. Conclusion: SV therapy in HFrEF was associated with improved longitudinal, radial, and circumferential function, particularly among patients in sinus rhythm. These findings can provide insights into the mechanisms underlying the improvement of cardiac function and help assess subclinical responses to the treatment. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)
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12 pages, 1030 KiB  
Article
Association of Electrical Cardioversion with Brain Perfusion and Cognitive Function in Patients with Atrial Fibrillation
by Josip Kedžo, Sanja Lovrić Kojundžić, Maja Marinović Guić, Leida Tandara, Toni Brešković and Zrinka Jurišić
Life 2023, 13(4), 935; https://doi.org/10.3390/life13040935 - 03 Apr 2023
Cited by 1 | Viewed by 962
Abstract
Background: The association of atrial fibrillation (AF) and brain perfusion (BP) has not been well-defined. This study aimed to determine the association of persistent AF with BP and cognition, in comparison to control subjects and with regards to electrical cardioversion (ECV). Methods: This [...] Read more.
Background: The association of atrial fibrillation (AF) and brain perfusion (BP) has not been well-defined. This study aimed to determine the association of persistent AF with BP and cognition, in comparison to control subjects and with regards to electrical cardioversion (ECV). Methods: This study compared 25 patients with persistent AF undergoing elective ECV with 16 age/sex-matched controls. We measured regional BP by using the magnetic resonance (MRI) arterial spin labelling technique. Cognitive function was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) cognitive function index. Measurements were performed at baseline and 6 weeks after ECV. Results: There was no significant difference in BP between AF patients and control subjects (p > 0.05). Following the ECV, there was a significant improvement in BP in 15 patients who maintained sinus rhythm, while there was no significant change in the recurrence group (297 ± 24 before vs. 328 ± 37 after ECV, p = 0.008, and 297 ± 22 before vs. 307 ± 24 after ECV, p = 0.45, respectively). There was no difference in the cognitive assessment between AF patients and control subjects, as well as before and after ECV within the AF group (52.2 ± 9.6 vs. 51.2 ± 6.2, p = 0.71 and 53 ± 10 vs. 54 ± 9, p = 0.46, respectively). Conclusions: This study did not show difference in BP between persistent AF patients and matched control subjects. Restoration of sinus rhythm was associated with significantly improved BP. There was no association of ECV and changes in cognitive function. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)
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12 pages, 1307 KiB  
Article
The Minimum Number of Ablation Lines for Complete Isolation of the Pulmonary Veins during Thoracoscopic Ablation for Atrial Fibrillation
by Min Suk Choi, Yoonseo Lee and Dong Seop Jeong
Life 2023, 13(3), 770; https://doi.org/10.3390/life13030770 - 13 Mar 2023
Cited by 1 | Viewed by 1336
Abstract
Total thoracoscopic ablation has been recommended as a class IIa indication for atrial fibrillation. However, the optimal number of ablation lines for pulmonary vein isolation has not yet been proposed. This study aimed to report the minimum number of ablation lines required to [...] Read more.
Total thoracoscopic ablation has been recommended as a class IIa indication for atrial fibrillation. However, the optimal number of ablation lines for pulmonary vein isolation has not yet been proposed. This study aimed to report the minimum number of ablation lines required to achieve an intraoperative conduction block. This study included a total of 20 patients who underwent total thoracoscopic ablation from December 2020 to July 2021. The epicardial conduction block was checked after each ablation line of pulmonary vein antral clamping. The median age was 61 years old. The median duration of atrial fibrillation since the first diagnosis was 78 months. Pulmonary vein isolation with bidirectional conduction block was confirmed in 90% of patients. A median of six ablation lines around each pulmonary vein antrum were performed according to our protocol even after the conduction block was verified. The median number of ablations to achieve an exit block was two on the right side and 3.5 on the left side. We found that most conduction blocks were achieved within three ablations around the pulmonary vein antrum. Our results may provide evidence to reduce the number of unnecessary ablation lines in the future. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)
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10 pages, 1051 KiB  
Article
Low Atrial Rhythm in a Large Cohort of Children from Transylvania, Romania
by Anne-Kathrin Henckell, Gabriel Gusetu, Radu Rosu, Dana Mihaela Ciobanu, Sabina Istratoaie, Lucian Muresan, Cecilia Lazea, Dana Pop, Gabriel Cismaru, Cristian Bârsu, Stefan Lucian Popa, Alina Gabriela Negru, Andrei Cismaru, Dumitru Zdrenghea and Simona Sorana Cainap
Life 2022, 12(11), 1895; https://doi.org/10.3390/life12111895 - 15 Nov 2022
Cited by 1 | Viewed by 5794
Abstract
Low atrial rhythm (LAR) is an ectopic rhythm originating in the lower part of the right or left atrium. Prior observational studies attempted to quantify the prevalence of low atrial rhythm in the pediatric population, but the observed prevalence was highly variable with [...] Read more.
Low atrial rhythm (LAR) is an ectopic rhythm originating in the lower part of the right or left atrium. Prior observational studies attempted to quantify the prevalence of low atrial rhythm in the pediatric population, but the observed prevalence was highly variable with relatively small sample sizes. We aimed to characterize low atrial rhythm and determine its prevalence in a large population of 24,316 asymptomatic children from northwestern Transylvania. We found a prevalence of 0.6% (145 children) for low atrial rhythm. Children with LAR had a significantly lower heart rate (mean 78.6 ± 8.3 bpm), than the control sinus rhythm group (85.02 ± 4.5 bpm). Furthermore, a shorter PR interval was seen in children with LAR (132.7 ± 12.7 ms) than in the children from the control group (141.7 ± 5.4; p = 0.0001).There was no significant association between gender and the presence of left LAR (LLAR) or right LAR (RLAR) (p = 0.5876). The heart rate of children with LLAR was significantly higher (81.7 ± 11.6 bpm) than that of the children with LRAR (77.6 ± 11.1 bpm) (p = 0.037). Pediatric cardiologists should recognize low atrial rhythm and be aware that asymptomatic, healthy children can exhibit this pattern, which does not require therapeutic intervention. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure)
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