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State of the Art: Catheter Ablation of Atrial Fibrillation
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State of the Art: Catheter Ablation of Atrial Fibrillation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 10 February 2025 | Viewed by 1559

Special Issue Editors

Dr. Roberto Menè

E-Mail Website
Guest Editor
Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, L’Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux, France
Interests: atrial fibrillation; catheter ablation; pulsed-field ablation; supraventricular arrhythmias; atrial substrate
Dr. Cinzia Monaco

E-Mail Website
Guest Editor
1. Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
2. Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, L’Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, Bordeaux, France
Interests: ventricular arrhythmias; ventricular fibrillation; channelopathis; Brugada Syndrome; atrial fibrillation; chateter ablation

Special Issue Information

Dear Colleagues,

Catheter ablation for atrial fibrillation has evolved significantly since its inception, transforming from an experimental procedure to a cornerstone of AF management. Currently, it is on the verge of a major transformation, driven by new technologies that offer a deeper understanding of the mechanisms underlying this arrhythmia and by ablation techniques, such as pulsed field ablation, that are poised to greatly enhance the safety and efficacy of these procedures.

This Special Issue aims to explore the latest breakthroughs in catheter ablation for AF, focusing on revolutionary technologies and methodologies. We seek to provide a comprehensive overview of the current state of the art, emphasizing innovations that deepen our understanding of AF mechanisms and improve procedural outcomes. We will feature cutting-edge research that delves into the electrophysiological underpinnings of AF, as well as studies showcasing the latest ablation strategies and technologies.

We invite original research articles and reviews that address novel insights into AF pathophysiology, state-of-the-art ablation techniques, and technological advancements. Papers that highlight the clinical application and outcomes of new technologies, particularly PFA, are highly encouraged.

We look forward to receiving your contributions.

Dr. Roberto Menè
Dr. Cinzia Monaco
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 Clinical Medicine is an international peer-reviewed open access semimonthly 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
  • catheter ablation
  • pulsed-field ablation
  • supraventricular arrhythmias
  • atrial substrate

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Published Papers (3 papers)

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Research

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19 pages, 3875 KiB  
Article
AFTER-CA: Autonomic Function Transformation and Evaluation Following Catheter Ablation in Atrial Fibrillation
by Monica Ferreira, Pedro Silva Cunha, Ana Clara Felix, Helena Fonseca, Mario Oliveira, Sergio Laranjo and Isabel Rocha
J. Clin. Med. 2024, 13(19), 5796; https://doi.org/10.3390/jcm13195796 - 28 Sep 2024
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Abstract
Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: [...] Read more.
Background: Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). However, its effects on autonomic function and underlying mechanisms remain poorly understood. This study investigated autonomic and haemodynamic changes following CA and explored their potential implications for patient outcomes. Methods: Seventy-eight patients with AF underwent CA and were followed up at one, three, and six months. Autonomic function was assessed using a combination of head-up tilt (HUT), handgrip (HG), and deep breathing (DB) manoeuvres along with baroreflex sensitivity (BRS) and baroreflex effectiveness index (BEI) evaluation. Heart rate (HR), blood pressure (BP), and their variability were measured at each time point. Results: Significant autonomic alterations were observed after ablation, particularly at one month, with reductions in parasympathetic tone and baroreflex function. These changes gradually normalised by six months. Both pulmonary vein isolation (PVI) and cryoablation (CryO) had similar effects on autonomic regulation. Improvements in quality of life, measured by the AFEQT scores, were consistent with these physiological changes. Conclusions: CA for AF induces significant time-dependent autonomic and haemodynamic changes with recovery over six months. These findings underscore the need for ongoing monitoring and personalised post-ablation management. Further research is required to explore the mechanisms driving these alterations and their long-term impacts on patient outcomes. Full article
(This article belongs to the Special Issue State of the Art: Catheter Ablation of Atrial Fibrillation)
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16 pages, 4516 KiB  
Article
Left Atrial Wall Thickness Estimated by Cardiac CT: Implications for Catheter Ablation of Atrial Fibrillation
by Pedro Silva Cunha, Sérgio Laranjo, Sofia Monteiro, Inês Grácio Almeida, Tiago Mendonça, Iládia Fontes, Rui Cruz Ferreira, Ana G. Almeida, Maxim Didenko and Mário Martins Oliveira
J. Clin. Med. 2024, 13(18), 5379; https://doi.org/10.3390/jcm13185379 - 11 Sep 2024
Viewed by 607
Abstract
Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF [...] Read more.
Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 ± 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment. Full article
(This article belongs to the Special Issue State of the Art: Catheter Ablation of Atrial Fibrillation)
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Review

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18 pages, 3091 KiB  
Review
Anatomical Treatment Strategies for Persistent Atrial Fibrillation with Ethanol Infusion within the Vein of Marshall—Current Challenges and Future Directions
by Masaaki Yokoyama, Konstantinos Vlachos, Chizute Ogbedeh, Ciro Ascione, Christopher Kowalewski, Miruna Popa, Cinzia Monaco, Karim Benali, Kinan Kneizeh, Roberto Mené, Marine Arnaud, Samuel Buliard, Benjamin Bouyer, Romain Tixier, Rémi Chauvel, Josselin Duchateau, Thomas Pambrun, Frédéric Sacher, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs and Nicolas Dervaladd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(19), 5910; https://doi.org/10.3390/jcm13195910 - 3 Oct 2024
Viewed by 465
Abstract
Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach—improving both its [...] Read more.
Currently, pulmonary vein isolation (PVI) is the gold standard in catheter ablation for atrial fibrillation (AF). However, PVI alone may be insufficient in the management of persistent AF, and complementary methods are being explored. One such method takes an anatomical approach—improving both its success rate and lesion durability may lead to improved treatment outcomes. An additional approach complementary to the anatomical one is also attracting attention, one that focuses on epicardial conduction. This involves ethanol ablation of the vein of Marshall (VOM) and can be very effective in blocking epicardial conduction related to Marshall structure; it is becoming incorporated into standard treatment. However, the pitfall of this “Marshall-PLAN”, a method that combines an anatomical approach with ethanol infusion within the VOM (Et-VOM), is that Et-VOM and other line creations are not always successfully completed. This has led to cases of AF and/or atrial tachycardia (AT) recurrence even after completing this lesion set. Investigating effective adjunctive methods will enable us to complete the lesion set with the aim to lower the rates of recurrence of AF and/or AT in the future. Full article
(This article belongs to the Special Issue State of the Art: Catheter Ablation of Atrial Fibrillation)
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