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Advances in Cardiac Electrophysiology and Pacing: Part II
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Advances in Cardiac Electrophysiology and Pacing: Part II

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

Deadline for manuscript submissions: closed (20 June 2024) | Viewed by 5561

Special Issue Editors

Dr. Gianfranco Mitacchione

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Guest Editor
Cardiology Department, Electrophysiology and Cardiac Pacing Unit, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157 Milan, MI, Italy
Interests: catheter ablation; implantable cardioverter defibrillator (ICD); subcutaneous implantable cardioverter defibrillator (S-ICD); cardiac pacing; leadless pacemaker; transseptal catheterization; atrial fibrillation ablation; cardiac resynchronization therapy (CRT); lead extraction
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Antonio Curnis

E-Mail Website
Guest Editor
Cardiology Department, Electrophysiology and Cardiac Pacing Unit, Spedali Civili Hospital, University of Brescia, Brescia, Italy
Interests: cardiac pacing; lead extraction; atrial fibrillation ablation; cardiac resynchronization therapy (CRTD); cardiac arrhythmias; leadless pacemaker; catheter ablation; implantable cardioverter defibrillators (ICD); subcutaneous implantable cardioverter defibrillator (S-ICD)
Prof. Dr. Giovanni Battista Forleo

E-Mail Website
Guest Editor
Cardiology Department, Electrophysiology and Cardiac Pacing Unit, Luigi Sacco, University Hospital, Milan, Italy
Interests: ventricular tachycardia ablation; atrial fibrillation ablation; cardiac pacing; cardiac resynchronization therapy (CRTD); implantable cardioverter defibrillators; lead extraction; subcutaneous implantable cardioverter defibrillator (S-ICD)

Special Issue Information

Dear Colleagues,

Today, the interventional treatment of cardiac arrhythmias represents a continuous challenge. This is mainly due to the widening of indications for implantable electronic devices (CIEDs) and for catheter ablation (CA), as well as the continuous improvement of technologies. Despite international guidelines and worldwide consensus updates, evidence gaps persist at all points. The aim of this Special Issue is to provide a comprehensive overview of advances in the diagnosis and treatment of cardiac arrhythmias, with a particular interest in the use of innovative techniques and technologies in interventional therapies. Therefore, researchers in the fields of clinical arrhythmology and electrophysiology are encouraged to submit their findings as original articles or reviews to this Special Issue.

It is my pleasure to invite you to contribute to this Special Issue. This is a new volume; we published 12 papers in the first volume. For more details, please visit the link below: https://www.mdpi.com/journal/jcm/special_issues/Cardiac_Electrophysiology_Pacing.

Dr. Gianfranco Mitacchione
Prof. Dr. Antonio Curnis
Prof. Dr. Giovanni Battista Forleo
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

  • cardiac arrhythmias
  • cardiac implantable electronic device
  • catheter ablation
  • sudden cardiac death
  • lead extraction
  • atrial fibrillation
  • ventricular tachycardia
  • defibrillator therapy

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Related Special Issue

Published Papers (4 papers)

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Research

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13 pages, 629 KiB  
Article
“Ablate and Pace” with Conduction System Pacing: Concomitant versus Delayed Atrioventricular Junction Ablation
by Pietro Palmisano, Matteo Ziacchi, Gabriele Dell’Era, Paolo Donateo, Lorenzo Bartoli, Giuseppe Patti, Jacopo Senes, Antonio Parlavecchio, Mauro Biffi, Michele Accogli and Giovanni Coluccia
J. Clin. Med. 2024, 13(8), 2157; https://doi.org/10.3390/jcm13082157 - 9 Apr 2024
Viewed by 876
Abstract
Objectives: Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve the outcomes in patients with symptomatic, refractory atrial fibrillation (AF). In this setting, AVJA can be performed simultaneously with implantation or in a second procedure a few weeks after implantation. Comparison data [...] Read more.
Objectives: Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve the outcomes in patients with symptomatic, refractory atrial fibrillation (AF). In this setting, AVJA can be performed simultaneously with implantation or in a second procedure a few weeks after implantation. Comparison data on these two alternative strategies are lacking. Methods: A prospective, multicentre, observational study enrolled consecutive patients with symptomatic, refractory AF undergoing CSP and AVJA performed in a single procedure or in two separate procedures. Data on the long-term outcomes and healthcare resource utilization were prospectively collected. Results: A total of 147 patients were enrolled: for 105 patients, CSP implantation and AVJA were performed simultaneously (concomitant AVJA); in 42, AVJA was performed in a second procedure, with a mean of 28.8 ± 19.3 days from implantation (delayed AVJA). After a mean follow-up of 12 months, the rate of procedure-related complications was similar in both groups (3.8% vs. 2.4%; p = 0.666). Concomitant AVJA was associated with a lower number of procedure-related hospitalizations per patient (1.0 ± 0.1 vs. 2.0 ± 0.3; p < 0.001) and with a lower number of hospital treatment days per patient (4.7 ± 1.8 vs. 7.4 ± 1.9; p < 0.001). Conclusions: Concomitant AVJA resulted as being as safe as delayed AVJA and was associated with a lower utilization of healthcare resources. Full article
(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)
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13 pages, 929 KiB  
Article
Detailed One-Year Follow-Up in Left Bundle Branch Area Pacing: Echocardiography, Natriuretic Peptide, Electrical Parameters and Complications
by Maciej Fularz and Przemysław Mitkowski
J. Clin. Med. 2024, 13(6), 1532; https://doi.org/10.3390/jcm13061532 - 7 Mar 2024
Viewed by 876
Abstract
Background: LBBAP is a promising method of cardiac pacing. Data on some follow-up details are still limited. We aimed to evaluate LBBAP over a one-year follow-up period. Methods: The studied population consisted of 110 patients who underwent LBBAP device implantation (93 [...] Read more.
Background: LBBAP is a promising method of cardiac pacing. Data on some follow-up details are still limited. We aimed to evaluate LBBAP over a one-year follow-up period. Methods: The studied population consisted of 110 patients who underwent LBBAP device implantation (93 for bradycardia indications, 17 for CRT). Echocardiography and NT-proBNP measurement were performed before the procedure and after one year. Electrical parameters, complications and some other conditions that required attention were noted during the observation period. Results: In total, 89 patients completed the one-year follow-up. NT-proBNP and echocardiographic parameters (LVEF, left ventricular end-diastolic dimension, left atrium dimension) improved after the one-year follow-up, especially in the patients with CRT indications, but also in the bradycardia patients. The independent predictors of a positive heart function response were higher baseline NT-proBNP and the presence of either RBBB or LBBB. The electrical parameters were satisfactory but a slight raise in the pacing threshold was observed at subsequent control visits. Major complications occurred in 4.5% of patients in the acute phase and in 4.4% during the follow-up (the most common was dislodgement of the non-LBBAP lead). One patient is presumed to have developed pacing-induced cardiomyopathy. The most frequent mild complications were intraprocedural RBBB (9.1%) and conversion to deep septal pacing during the follow-up period (5.5%). In addition, 4.4% of the patients required individual programming of the pacing output to maintain the optimal type of capture. Conclusions: The impact of LBBAP device implantation on cardiac function parameters is positive in a wide range of indications, especially in patients with RBBB or LBBB. The prevalence of complications is relatively high but major complications are rarely associated with LBBAP issues. Full article
(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)
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Review

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19 pages, 4253 KiB  
Review
Is Conduction System Pacing Going to Be the New Gold Standard for Cardiac Resynchronization Therapy?
by Michael Derndorfer, Georgios Kollias, Martin Martinek and Helmut Pürerfellner
J. Clin. Med. 2024, 13(15), 4320; https://doi.org/10.3390/jcm13154320 - 24 Jul 2024
Viewed by 1353
Abstract
The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) [...] Read more.
The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) has emerged as a variant for advanced cardiac device therapy. It provides pacing with preserved intrinsic cardiac activation by direct stimulation of the specific cardiac conduction system. The term CSP integrates the modalities of HIS bundle pacing (HBP) and left bundle branch area pacing (LBBAP), both of which have provided convincing data in smaller randomized and big non-randomized studies for the prevention of pacemaker-induced cardiomyopathy and for providing effective cardiac resynchronization therapy in patients with classical CRT-indication (primary approach or after failed CRT). Recent American guidelines proposed the term “cardiac physiological pacing” (CPP), which summarizes CSP including left ventricular septal pacing (LVSP), a technical variant of LBBAP together with classical BiV-CRT. The terms HOT-CRT (HIS-optimized CRT) and LOT-CRT (LBBP-optimized CRT) describe hybrid technologies that combine CSP with an additional coronary-sinus electrode, which is sometimes useful in patients with advanced HF and diffuse interventricular conduction delay. If CSP continues providing promising data that can be confirmed in big, randomized trials, it is likely to become the new gold standard for patients with an expected high percentage of pacing (>20%), possibly also for cardiac resynchronization therapy. CSP is a sophisticated new treatment option that has the potential to raise the term “cardiac resynchronization therapy” to a new level. The aim of this review is to provide basic technical, anatomical, and functional knowledge of these new pacemaker techniques in order to facilitate the understanding of the different modalities, as well as to provide an up-to-date overview of the existing randomized and non-randomized evidence, particularly in direct comparison to right ventricular and classical biventricular pacing. Full article
(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)
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22 pages, 330 KiB  
Review
Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications
by Nicola Pierucci, Marco Valerio Mariani, Domenico Laviola, Giacomo Silvetti, Pietro Cipollone, Antonio Vernile, Sara Trivigno, Vincenzo Mirco La Fazia, Agostino Piro, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle
J. Clin. Med. 2024, 13(10), 2980; https://doi.org/10.3390/jcm13102980 - 18 May 2024
Cited by 3 | Viewed by 2015
Abstract
Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed [...] Read more.
Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA’s ability to achieve pulmonary vein isolation—a cornerstone of AF treatment—rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA’s effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols. Full article
(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)
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