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Medicina
Special Issues
Atrial Fibrillation: Clinical Complications and Treatment
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Atrial Fibrillation: Clinical Complications and Treatment

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 January 2026) | Viewed by 2317

Special Issue Editor

Prof. Dr. Oskars Kalejs

E-Mail Website
Guest Editor
1. Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
2. Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
Interests: cardiology; atrial fibrillation; pharmacological and non-pharmacological treatment

Special Issue Information

Dear Colleagues,

Atrial fibrillation remains the most common arrhythmia. Although a large amount of scientific research has been continuously conducted for decades to tackle this issue, many uncertainties remain, and the complications caused by atrial fibrillation still pose a great burden on the health care system.

This Special Issue aims to promote the exchange of information between various clinicians and scientists, sharing experience both on the use of instrumental methods and the nuances associated with them, and on the prevention of complications, including the prevention of strokes and systemic embolisms. Notability, AFib contributes to the development of heart failure and we should be mindful that prothrombotic problems are present throughout the circulatory system. Finally, the classic question in arrhythmia research, "Which came first—the chicken or the egg?", may be approached, and discussion on rhythm and rate control, for which patient, at which stage, under what conditions, may be investigated.

EAST-AFNET 4, CABANA, STROKESTOP, EARLY-AF, RACE study group, RATE-AF, GARFIELD-AF, and many other large-scale clinical trials show progress in the research into the pathophysiology of AFib, and the introduction of new catheter ablation methods and direct oral anticoagulants into clinical practice have significantly improved the management prospects for patients with atrial fibrillation, but the condition remains very significant.

I invite you to submit the results of your scientific work on various aspects and directions of atrial fibrillation treatment to help us address this disease with even more success.

With sincere respect,

Prof. Dr. Oskars Kalejs
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. Medicina 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 2200 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 [AFib]
  • rhythm control
  • rate control
  • triggers of AFib
  • antiarrhythmic pharmacy
  • upstream therapy
  • non-direct antiarrhythmic pharmacy
  • catheter ablation
  • prevention of stroke and systemic embolism
  • anticoagulants
  • AF-CARE concept

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Published Papers (2 papers)

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Research

11 pages, 536 KB  
Article
Waiting Time for Pulmonary Vein Isolation: A Single-Center Retrospective Cohort Study of Atrial Fibrillation Progression and Complications
by Kaspars Kupics, Matīss Linde, Kristīne Jubele, Oskars Kalējs, Natālija Nikrus, Sandis Sakne, Daiņus Gilis, Georgijs Ņesterovičs, Maija Vikmane, Evija Kanačniece, Ieva Ansaberga, Everita Kupriša, Matīss Karantajers and Andrejs Ērglis
Medicina 2026, 62(2), 276; https://doi.org/10.3390/medicina62020276 - 28 Jan 2026
Viewed by 852
Abstract
Background and Objectives: Pulmonary vein isolation (PVI) is an established rhythm control strategy for atrial fibrillation (AF). In many healthcare systems, increasing demand and limited procedural capacity have resulted in prolonged waiting times. The primary aim of this study was to evaluate [...] Read more.
Background and Objectives: Pulmonary vein isolation (PVI) is an established rhythm control strategy for atrial fibrillation (AF). In many healthcare systems, increasing demand and limited procedural capacity have resulted in prolonged waiting times. The primary aim of this study was to evaluate the association between waiting time for PVI and AF progression. Secondary aims were to assess the relationship between waiting time and AF-related complications, healthcare utilization, and clinical factors associated with higher risk of progression. Materials and Methods: We performed a single-center observational cohort study of patients on the waiting list for PVI at Pauls Stradiņš Clinical University Hospital between 2016 and 2023. Results: A total of 341 patients completed structured ambulatory follow-up to assess the complication and progression rates of AF. The mean age was 64.8 ± 10.5 years, 50.9% were male, and the median waiting time was 37.2 months (IQR 15.0–61.3). AF progression occurred in 25.7% (n = 88) of patients, with longer waiting time independently associated with progression (OR, 1.017 per month; 95% CI, 1.006–1.028; p < 0.05). Electrical cardioversion during the waiting period was associated with a lower likelihood of progression (OR, 0.32; p = 0.029), and Class IC antiarrhythmic therapy was associated with reduced risk of AF progression (HR 0.78; p = 0.013). During follow-up, 45.2% of patients were hospitalized for AF paroxysms, 29.6% underwent electrical cardioversion, and 13.5% experienced complications including stroke and heart failure decompensation. Left atrial volume index and left ventricular ejection fraction were inversely correlated (ρ = −0.355, p < 0.05), but neither was associated with waiting time. Conclusions: Longer waiting times for PVI are associated with AF progression and substantial interim healthcare utilization due to complications. Strategies to prioritize higher-risk patients may help prevent disease progression and reduce complication burden. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Clinical Complications and Treatment)
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11 pages, 827 KB  
Article
Comparison of Cryoballoon Ablation Methods in Pulmonary Vein Isolation
by Kaspars Kupics, Raivis Bricis, Kristine Jubele, Ieva Ansaberga, Oskars Kalējs and Andrejs Erglis
Medicina 2025, 61(11), 1920; https://doi.org/10.3390/medicina61111920 - 26 Oct 2025
Viewed by 1173
Abstract
Background and Objectives: Cryoballoon ablation is a well-established therapy for atrial fibrillation (AF), enabling pulmonary vein isolation (PVI) using a single-shot technique. The two primary systems—Medtronic Arctic Front and the newer Boston Scientific POLARx—differ in design and performance characteristics, but few direct comparisons [...] Read more.
Background and Objectives: Cryoballoon ablation is a well-established therapy for atrial fibrillation (AF), enabling pulmonary vein isolation (PVI) using a single-shot technique. The two primary systems—Medtronic Arctic Front and the newer Boston Scientific POLARx—differ in design and performance characteristics, but few direct comparisons exist. This study aimed to compare the biophysical parameters and mid-term outcomes of the POLARx and Arctic Front cryoballoon systems. Materials and Methods: In a retrospective analysis of 200 patients who underwent cryoballoon ablation for paroxysmal or persistent AF, patients were grouped by ablation system: POLARx (n = 107) and Arctic Front (n = 93). Key parameters including nadir balloon temperatures, time to reach −40 °C, procedure duration, dose area product (DAP), complication rates, and recurrence of AF were assessed. Results: The POLARx system achieved significantly lower nadir temperatures in all pulmonary veins compared to Arctic Front (left superior PV: −57.6 ± 5.0 °C vs. −50.1 ± 5.7 °C, p < 0.001). Time to reach −40 °C was also shorter with POLARx (left superior PV: 23.3 ± 7.3 s vs. 33.3 ± 11.5 s, p < 0.001). Despite these advantages, procedure time was longer in the POLARx group (64.7 ± 14.8 min vs. 51.6 ± 19.7 min, p < 0.001). AF recurrence at 11.8 months was similar (33.6% in POLARx vs. 39.8% in Arctic Front, p = 0.93). Phrenic nerve palsy occurred in 5.0% (POLARx) and 4.3% (Arctic Front), with no cases of cardiac tamponade. Conclusions: While both systems demonstrated similar efficacy and safety, POLARx was associated with superior cooling kinetics and biophysical performance. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Clinical Complications and Treatment)
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