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Extensive Approach to Atrial Fibrillation: Background and Future Perspectives
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Extensive Approach to Atrial Fibrillation: Background and Future Perspectives

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: 31 January 2025 | Viewed by 7039

Special Issue Editors

Prof. Dr. Matteo Anselmino

E-Mail Website
Guest Editor
Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, 10126 Torino, Italy
Interests: mechanisms and pathophysiology of cardiac arrhythmias; clinical and epidemiological aspects of patients with arrhythmia; technological innovation (devices and mapping systems) for the improvement of safety and efficacy of the treatment of complex cardiac arrhythmias; optimization and research of alternative energy sources for the percutaneous treatment of cardiac arrhythmias; computational models of systemic and cerebral circulation in the course of arrhythmia; epidemiological aspects, risk stratification and innovative treatments of sudden death; statistical models of risk stratification
Dr. Henri Xhakupi

E-Mail
Guest Editor
Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, 10126 Torino, Italy
Interests: electrophysiology; arrhythmology; radiation risks

Special Issue Information

Dear Colleagues,

This Special Issue is focused on atrial fibrillation, aiming to assess  the complex interactions between prevention, prognostic and metabolic markers and therapies of atrial fibrillation (AF) from a comprehensive point of view. AF management cannot be limited to stroke prevention by anticoagulants and rhythm/rate control by drugs and/or transcatheter ablation. Increasing evidence has demonstrated the importance of a more extensive management and international guidelines have highlighted the importance of comorbidities optimization and risk factors management to improve symptoms and to reduce AF burden and complications. The final goal is to slow disease progression or even, ideally, avoid AF. On top of well-known factors, new parameters such as alcohol consumption, physical activity, social stress, autonomic tone, adipose tissue, lipid profile, diabetes, obstructive sleep apnea, and genetics are emerging. In this Special Issue we are aiming to collect articles focusing on comprehensive approaches to AF. Moreover, we seek scientific works which transfer this knowledge in therapeutic actions, overcoming the standard electrophysiological management of AF.

Prof. Dr. Matteo Anselmino
Dr. Henri Xhakupi
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. Journal of Cardiovascular Development and Disease 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 2700 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
  • omic approach
  • metabolomics
  • genomics
  • risk factors
  • prevention
  • ablation
  • stroke
  • dementia

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Published Papers (4 papers)

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Research

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12 pages, 1113 KiB  
Article
Long-Term Patient-Reported Outcomes After Radiofrequency Ablation and Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: The Effect of Additional Ablations
by Ibrahim Antoun, Ahmed I. Kotb, Zakkariya Vali, Ahmed Abdelrazik, Ivelin Koev, Kassem Safwan, Edward Y. M. Lau, Riyaz Somani and Ghulam André Ng
J. Cardiovasc. Dev. Dis. 2024, 11(12), 385; https://doi.org/10.3390/jcdd11120385 - 30 Nov 2024
Viewed by 653
Abstract
Background: pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) improves health-related quality of life (QoL). This study compares QoL improvement after radiofrequency ablation (RF) and cryoballoon ablation (cryo) and assesses additional ablations’ role in QoL improvement. Methods: we evaluated the QoL of [...] Read more.
Background: pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) improves health-related quality of life (QoL). This study compares QoL improvement after radiofrequency ablation (RF) and cryoballoon ablation (cryo) and assesses additional ablations’ role in QoL improvement. Methods: we evaluated the QoL of consecutive patients with first-time RF and cryo for PAF between January 2017 and June 2019. A combined EQ-VAS, AFEQT, and EQ-5D-3L paper questionnaire was sent to patients at baseline, 12, and 30 months after the procedure. Procedure and patient details were collected from medical notes. Results: the analysis included 207 patients, of which 127 (61%) had RF and 144 (70%) were males. RF patients had more additional ablations (52 [41%] versus 22 [28%], p = 0.01). There was a significant improvement from baseline to 12 months post-RF in AFEQT (43 ± 9 to 83 ± 7.8, p < 0.001), EQ-5D-3L (−0.01 ± 0.01 to 1.1 ± 0.02, p < 0.001), and EQ-VAS (51 ± 8 to 77 ± 13, p = 0.01). Similarly, an improvement at 12 months was observed after cryo in AFEQT (55 ± 11 to 77 ± 9, p < 0.001), EQ-5D-3L (−0.04 ± 0.03 to 1.3 ± 0.03, p < 0.001), and EQ-VAS (56 ± 7 to 85 ± 9, p = 0.01). QoL improvement was similar between RF and cryo. Additional ablations provided no additional QoL improvement compared to patients with PVI alone. Conclusions: Patients undergoing first-time PVI for PAF, RF, and cryo showed similar QoL improvement at 12 months, which was sustained at 30 months. Additional ablations did not provide further QoL benefits. Full article
(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)
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Figure 1

Figure 1
<p>Comparison of quality of life scores between radiofrequency ablation and cryoballoon ablation at follow-ups. Cryo: cryoballoon. * Represents <span class="html-italic">p</span> &lt; 0.05. ** Represents <span class="html-italic">p</span> &gt; 0.05.</p> Full article ">Figure 2
<p>Comparing the effect of additional ablation outside the pulmonary veins on the quality of life in radiofrequency and cryoballoon ablation. Cryo: cryoballoon. * Represents <span class="html-italic">p</span> &lt; 0.05. ** Represents <span class="html-italic">p</span> &gt; 0.05.</p> Full article ">
19 pages, 551 KiB  
Article
The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study
by Ibrahim Antoun, Xin Li, Ahmed I. Kotb, Zakkariya Vali, Ahmed Abdelrazik, Abdulmalik Koya, Akash Mavilakandy, Ivelin Koev, Ali Nizam, Hany Eldeeb, Riyaz Somani and André Ng
J. Cardiovasc. Dev. Dis. 2024, 11(9), 277; https://doi.org/10.3390/jcdd11090277 - 5 Sep 2024
Cited by 1 | Viewed by 1216
Abstract
Background: Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. Methods: This single-centre [...] Read more.
Background: Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. Methods: This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1–50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes. Results: Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53–0.95), lead II (HR: 0.45, 95% CI: 0.22–0.65), aVL (HR: 0.58, 95% CI: 0.22–0.98), and aVF (HR: 0.67, 95% CI: 0.58–0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21–0.76), lead II (HR: 0.48, 95% CI: 0.34–0.87), aVL (HR: 0.65, 95% CI: 0.45–0.96), and aVF (HR: 0.61, 95% CI: 0.32–0.89), and the presence of IAB (HR: 2, 95% CI: 1.4–4.2, p = 0.02). PWDisp and PTFV1 were not correlated with PVI outcome. Conclusions: PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months. Full article
(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)
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Figure 1

Figure 1
<p>MatLab screenshots demonstrating P wave annotations. PWD: P wave duration; PWV: P wave amplitude; PTFV1: P wave terminal force in V1.</p> Full article ">

Review

Jump to: Research

13 pages, 1525 KiB  
Review
Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature
by Christos Kourek, Alexandros Briasoulis, Elias Tsougos and Ioannis Paraskevaidis
J. Cardiovasc. Dev. Dis. 2024, 11(10), 315; https://doi.org/10.3390/jcdd11100315 - 9 Oct 2024
Viewed by 1638
Abstract
Although the benefits of exercise training have been shown repeatedly in many studies, its relationship with the occurrence of atrial fibrillation (AF) in competitive athletes still remains controversial. In the present review, we sought to demonstrate a comprehensive report of the incidence, pathophysiology, [...] Read more.
Although the benefits of exercise training have been shown repeatedly in many studies, its relationship with the occurrence of atrial fibrillation (AF) in competitive athletes still remains controversial. In the present review, we sought to demonstrate a comprehensive report of the incidence, pathophysiology, and therapeutic approaches to AF in elite athletes. A 2 to 10 times higher frequency of AF has been shown in many studies in high-intensity endurance athletes compared to individuals who do not exercise. Moreover, a U-shaped relationship between male elite athletes and AF is demonstrated through this finding, while the type and the years of physical activity seem to relate to AF development. A strong correlation seems to exist among the type of exercise (endurance sports), age (>55 years), gender (males), and the time of exercise training, all contributing to an increased risk of AF. The pathophysiology of AF still remains unclear; however, several theories suggest that complex mechanisms are involved, such as bi-atrial dilatation, pulmonary vein stretching, cardiac inflammation, fibrosis, and increased vagal tone. Elite athletes with AF require a comprehensive clinical evaluation and risk factor optimization, similar to the approach taken for nonathletes. Although anticoagulation and rate or rhythm control are cornerstones of AF management, there are still no specific guidelines for elite athletes. Full article
(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)
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Figure 1

Figure 1
<p>Atrial fibrillation (AF) risk varies across the spectrum of exercise training. Approaching the extreme borders of physical activities (minimum physical activity at the one border and endurance sports at the other), there is an increase in AF incidence.</p> Full article ">Figure 2
<p>Presumed mechanisms of AF in elite athletes.</p> Full article ">Figure 3
<p>A proposed algorithm of clinical assessment and therapeutic strategy of an elite athlete with AF.</p> Full article ">
19 pages, 1677 KiB  
Review
Beyond Clinical Factors: Harnessing Artificial Intelligence and Multimodal Cardiac Imaging to Predict Atrial Fibrillation Recurrence Post-Catheter Ablation
by Edward T. Truong, Yiheng Lyu, Abdul Rahman Ihdayhid, Nick S. R. Lan and Girish Dwivedi
J. Cardiovasc. Dev. Dis. 2024, 11(9), 291; https://doi.org/10.3390/jcdd11090291 - 19 Sep 2024
Viewed by 3047
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, with catheter ablation being a key alternative to medical treatment for restoring normal sinus rhythm. Despite advances in understanding AF pathogenesis, approximately 35% of patients experience AF recurrence at 12 months after [...] Read more.
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, with catheter ablation being a key alternative to medical treatment for restoring normal sinus rhythm. Despite advances in understanding AF pathogenesis, approximately 35% of patients experience AF recurrence at 12 months after catheter ablation. Therefore, accurate prediction of AF recurrence occurring after catheter ablation is important for patient selection and management. Conventional methods for predicting post-catheter ablation AF recurrence, which involve the use of univariate predictors and scoring systems, have played a supportive role in clinical decision-making. In an ever-changing landscape where technology is becoming ubiquitous within medicine, cardiac imaging and artificial intelligence (AI) could prove pivotal in enhancing AF recurrence predictions by providing data with independent predictive power and identifying key relationships in the data. This review comprehensively explores the existing methods for predicting the recurrence of AF following catheter ablation from different perspectives, including conventional predictors and scoring systems, cardiac imaging-based methods, and AI-based methods developed using a combination of demographic and imaging variables. By summarising state-of-the-art technologies, this review serves as a roadmap for developing future prediction models with enhanced accuracy, generalisability, and explainability, potentially contributing to improved care for patients with AF. Full article
(This article belongs to the Special Issue Extensive Approach to Atrial Fibrillation: Background and Future Perspectives)
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Figure 1

Figure 1
<p>Annotated diagram of a left atrial (LA) strain curve during normal sinus rhythm. The strain curve highlights reservoir (atrial filling), conduit (ventricular filling), and contractile (atrial emptying) phases of the LA cardiac cycle. LA left wall strain (green), LA right wall strain (blue), LA roof strain (red), and average LA strain (white) are shown. eD: end diastole; eS: end systole.</p> Full article ">Figure 2
<p>Hypothetical workflow demonstrating how artificial intelligence (AI) can be used to improve clinician decision-making and patient care for patients with atrial fibrillation (AF).</p> Full article ">Figure 3
<p>A multimodal AI framework for the personalised care of patients with atrial fibrillation. CCT, cardiac computed tomography; CMR, cardiac magnetic resonance; AI, artificial intelligence.</p> Full article ">
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