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Pathogenesis, Diagnosis and Management of Atrial Fibrillation

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 21362

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Special Issue Editor

Dr. Vasileios Vassilikos

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Guest Editor

Third Department of Cardiology, Hippokration Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 43 Thessaloniki, Greece
Interests: identification of early substrate changes in paroxysmal atrial fibrillation using various signal processing techniques (wavelet analysis); ECG signal processing in patients with syncope, heart failure, in patients with CRTs, and in patients with LBBB; development of smartphone apps for patients with heart failure, and paroxysmal atrial fibrillation

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) is the most common clinical arrhythmia encountered in the general population, with an estimated prevalence of about 1–3%, which further rises with advancing age. AF-associated morbidity creates a significant socioeconomic burden and underscores the importance of AF prevention. While sustained, long-term, and team-based efforts are well recognized as critical elements of successful prevention strategies, limited evidence from clinical trials exists to support specific preventive interventions, and data show that current practices for risk factor control are insufficient. Furthermore, a prompt identification and early initiation of anticoagulation therapy is challenging, currently available rhythm-control strategies are modestly effective in a considerable proportion of patients. And the integration of AF management services with other cardiology and medical care services is often limited. There are also no globally accepted quality standards, indicators, and markers to evaluate the effectiveness of the implemented services and management policies. Contemporary digital technologies (e.g., smartphone applications, smartwatches, portable electrocardiographic monitors) form new opportunities to overcome existing limitations in the screening, diagnosis, and monitoring of AF. Artificial intelligence algorithms are expected to facilitate the processing and interpretation of large volumes of clinical data in order to identify individuals at the highest risk of developing AF. Advances and development of the currently available techniques and technologies for AF ablation are expected to improve the disease-free period and the quality of life of patients.

Dr. Vasileios Vassilikos
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 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. Diagnostics 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.

Published Papers (7 papers)

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Research

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14 pages, 530 KiB

Open AccessArticle

P-Wave Beat-to-Beat Analysis to Predict Atrial Fibrillation Recurrence after Catheter Ablation

by Dimitrios Tachmatzidis, Anastasios Tsarouchas, Dimitrios Mouselimis, Dimitrios Filos, Antonios P. Antoniadis, Dimitrios N. Lysitsas, Nikolaos Mezilis, Antigoni Sakellaropoulou, Georgios Giannopoulos, Constantinos Bakogiannis, Konstantinos Triantafyllou, Nikolaos Fragakis, Konstantinos P. Letsas, Dimitrios Asvestas, Michael Efremidis, Charalampos Lazaridis, Ioanna Chouvarda and Vassilios P. Vassilikos

Diagnostics 2022, 12(4), 830; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12040830 - 28 Mar 2022

Cited by 3 | Viewed by 1976

Abstract

The identification of patients prone to atrial fibrillation (AF) relapse after catheter ablation is essential for better patient selection and risk stratification. The current prospective cohort study aims to validate a novel P-wave index based on beat-to-beat (B2B) P-wave morphological and wavelet analysis designed to detect patients with low burden AF as a predictor of AF recurrence within a year after successful catheter ablation. From a total of 138 consecutive patients scheduled for AF ablation, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained. Univariate analysis revealed that patients with higher B2B P-wave index had a two-fold risk for AF recurrence (HR: 2.35, 95% CI: 1.24–4.44, p: 0.010), along with prolonged P-wave, interatrial block, early AF recurrence, female gender, heart failure history, previous stroke, and CHA₂DS₂-VASc score. Multivariate analysis of assessable predictors before ablation revealed that B2B P-wave index, along with heart failure history and a history of previous stroke or transient ischemic attack, are independent predicting factors of atrial fibrillation recurrence. Further studies are needed to assess the predictive value of the B2B index with greater accuracy and evaluate a possible relationship with atrial substrate analysis. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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12 pages, 1129 KiB

Open AccessArticle

Reduced Radiation Exposure Protocol during Computer Tomography of the Left Atrium Prior to Catheter Ablation in Patients with Atrial Fibrillation

by Tomasz Jadczyk, Jiri Wolf, Martin Pesl, Filip Soucek, Frantisek Lehar, Jiri Jez, Tomas Kulik, Bohdan Tyshchenko, Silvie Belaskova, Petr Ourednicek, Guido Caluori, Miroslav Novak and Zdenek Starek

Diagnostics 2022, 12(3), 612; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030612 - 01 Mar 2022

Cited by 1 | Viewed by 2353

Abstract

(1) Background: Computer tomography (CT) is an imaging modality used in the pre-planning of radiofrequency catheter ablation (RFA) procedure in patients with cardiac arrhythmias. However, it is associated with a considerable ionizing radiation dose for patients. This study aims to develop and validate low-dose CT scanning protocols of the left atrium (LA) for RFA guidance. (2) Methods: 68 patients scheduled for RFA of atrial fibrillation were sequentially assigned to four groups of ECG-gated scanning protocols, based on the set tube current (TC): Group A (n = 20, TC = 33 mAs), Group B (n = 18, TC = 67 mAs), Group C (n = 10, TC = 135 mAs), and control Group D (n = 20, TC = 600 mAs). We used a 256-row multidetector CT with body weight-dependent tube voltage of 80 kVp (<70 kg), 100 kVp (70–90 kg), and 120 kVp (>90 kg). We evaluated scanning parameters including radiation dose, total scanning procedure time and signal-to-noise ratio (SNR). (3) Results: The average effective radiation dose (ED) was lower in Group A in comparison to Group B, C and D (0.83 (0.76–1.10), 1.55 (1.36–1.67), 2.91 (2.32–2.96) and 9.35 (8.00–10.04) mSv, p < 0.05). The total amount of contrast media was not significantly different between groups. The mean SNR was 6.5 (5.8–7.3), 7.1 (5.7–8.2), 10.8 (10.1–11.3), and 12.2 (9.9–15.7) for Group A, B, C and D, respectively. The comparisons of SNR in group A vs. B and C vs. D were without significant differences. (4) Conclusions: Optimized pre-ablation CT scanning protocols of the LA can reduce an average ED by 88.7%. Three dimensional (3D) models created with the lowest radiation protocol are useful for the integration of electro-anatomic-guided RFA procedures. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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11 pages, 1961 KiB

Open AccessArticle

The Adult Congenital Heart Disease Anatomic and Physiological Classification: Associations with Clinical Outcomes in Patients with Atrial Arrhythmias

by Anastasios Kartas, Andreas S. Papazoglou, Diamantis Kosmidis, Dimitrios V. Moysidis, Amalia Baroutidou, Ioannis Doundoulakis, Stefanos Despotopoulos, Elena Vrana, Athanasios Koutsakis, Georgios P. Rampidis, Despoina Ntiloudi, Sotiria Liori, Tereza Mousiama, Dimosthenis Avramidis, Sotiria Apostolopoulou, Alexandra Frogoudaki, Afrodite Tzifa, Haralambos Karvounis and George Giannakoulas

Diagnostics 2022, 12(2), 466; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020466 - 11 Feb 2022

Cited by 5 | Viewed by 1607

Abstract

The implications of the adult congenital heart disease anatomic and physiological classification (AP-ACHD) for risk assessment have not been adequately studied. A retrospective cohort study was conducted using data from an ongoing national, multicentre registry of patients with ACHD and atrial arrhythmias (AA) receiving apixaban (PROTECT-AR study, NCT03854149). At enrollment, patients were stratified according to Anatomic class (AnatC, range I to III) and physiological stage (PhyS, range B to D). A follow-up was conducted between May 2019 and September 2021. The primary outcome was a composite of death from any cause, any major thromboembolic event, major or clinically relevant non-major bleeding, or hospitalization. Cox proportional-hazards regression modeling was used to evaluate the risks for the outcome among AP-ACHD classes. Over a median 20-month follow-up period, 47 of 157 (29.9%) ACHD patients with AA experienced the composite outcome. Adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for the outcome in PhyS C and PhyS D were 1.79 (95% CI 0.69 to 4.67) and 8.15 (95% CI 1.52 to 43.59), respectively, as compared with PhyS B. The corresponding aHRs in AnatC II and AnatC III were 1.12 (95% CI 0.37 to 3.41) and 1.06 (95% CI 0.24 to 4.63), respectively, as compared with AnatC I. In conclusion, the PhyS component of the AP-ACHD classification was an independent predictor of net adverse clinical events among ACHD patients with AA. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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Review

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14 pages, 770 KiB

Open AccessReview

Current Advancement in Diagnosing Atrial Fibrillation by Utilizing Wearable Devices and Artificial Intelligence: A Review Study

by Yu-Chiang Wang, Xiaobo Xu, Adrija Hajra, Samuel Apple, Amrin Kharawala, Gustavo Duarte, Wasla Liaqat, Yiwen Fu, Weijia Li, Yiyun Chen and Robert T. Faillace

Diagnostics 2022, 12(3), 689; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030689 - 11 Mar 2022

Cited by 20 | Viewed by 6448

Abstract

Atrial fibrillation (AF) is a common arrhythmia affecting 8–10% of the population older than 80 years old. The importance of early diagnosis of atrial fibrillation has been broadly recognized since arrhythmias significantly increase the risk of stroke, heart failure and tachycardia-induced cardiomyopathy with reduced cardiac function. However, the prevalence of atrial fibrillation is often underestimated due to the high frequency of clinically silent atrial fibrillation as well as paroxysmal atrial fibrillation, both of which are hard to catch by routine physical examination or 12-lead electrocardiogram (ECG). The development of wearable devices has provided a reliable way for healthcare providers to uncover undiagnosed atrial fibrillation in the population, especially those most at risk. Furthermore, with the advancement of artificial intelligence and machine learning, the technology is now able to utilize the database in assisting detection of arrhythmias from the data collected by the devices. In this review study, we compare the different wearable devices available on the market and review the current advancement in artificial intelligence in diagnosing atrial fibrillation. We believe that with the aid of the progressive development of technologies, the diagnosis of atrial fibrillation shall be made more effectively and accurately in the near future. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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19 pages, 822 KiB

Open AccessReview

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

by Konstantinos A. Papathanasiou, Sotiria G. Giotaki, Dimitrios A. Vrachatis, Gerasimos Siasos, Vaia Lambadiari, Konstantinos E. Iliodromitis, Charalampos Kossyvakis, Andreas Kaoukis, Konstantinos Raisakis, Gerasimos Deftereos, Theodore G. Papaioannou, Georgios Giannopoulos, Dimitrios Avramides and Spyridon G. Deftereos

Diagnostics 2021, 11(9), 1584; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11091584 - 31 Aug 2021

Cited by 8 | Viewed by 3699

Abstract

The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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Other

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10 pages, 921 KiB

Open AccessSystematic Review

Alcohol Consumption and the Risk of Incident Atrial Fibrillation: A Meta-Analysis

by Georgios Giannopoulos, Ioannis Anagnostopoulos, Maria Kousta, Stavros Vergopoulos, Spyridon Deftereos and Vassilios Vassilikos

Diagnostics 2022, 12(2), 479; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020479 - 13 Feb 2022

Cited by 7 | Viewed by 2331

Abstract

Alcohol consumption is a known, modifiable risk factor for incident atrial fibrillation (AF). However, it remains unclear whether the protective effect of moderate alcohol consumption-that has been reported for various cardiovascular diseases also applies to the risk for new-onset AF. The purpose of this meta-analysis was to evaluate the role of different drinking patterns (low: <14 grams/week; moderate: <168 grams/week; and heavy: >168 grams/week) on the risk for incident AF. Major electronic databases were searched for observational cohorts examining the role of different drinking behaviors on the risk for incident AF. We analyzed 16 studies (13,044,007 patients). Incident AF rate was 2.3%. Moderate alcohol consumption significantly reduced the risk for new-onset AF when compared to both abstainers (logOR: −0.20; 95%CI: −0.28–−0.12; I2: 96.71%) and heavy drinkers (logOR: −0.28; 95%CI: −0.37–−0.18; I2: 95.18%). Heavy-drinking pattern compared to low also increased the risk for incident AF (logOR: 0.14; 95%CI: 0.01–0.2; I2: 98.13%). Substantial heterogeneity was noted, with more homogeneous results documented in cohorts with follow-up shorter than five years. Our findings suggest a J-shaped relationship between alcohol consumption and incident AF. Up to 14 drinks per week seem to decrease the risk for developing AF. Because of the substantial heterogeneity observed, no robust conclusion can be drawn. In any case, our results suggest that the association between alcohol consumption and incident AF is far from being a straightforward dose-response effect. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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15 pages, 2707 KiB

Open AccessSystematic Review

Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials

by Emmanouil Charitakis, Silvia Metelli, Lars O. Karlsson, Antonios P. Antoniadis, Ioan Liuba, Henrik Almroth, Anders Hassel Jönsson, Jonas Schwieler, Skevos Sideris, Dimitrios Tsartsalis, Elena Dragioti, Nikolaos Fragakis and Anna Chaimani

Diagnostics 2022, 12(2), 433; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020433 - 09 Feb 2022

Cited by 2 | Viewed by 2055

Abstract

Although catheter ablation (CA) is an established treatment for paroxysmal atrial fibrillation (PAF), there is no consensus regarding the most efficient CA strategy. The objective of this network meta-analysis (NMA) was to compare the efficacy and safety of different CA strategies for PAF. A systematic search was performed in PubMed, Web of Science, and CENTRAL until the final search date, 5 October 2020. Randomised controlled trials (RCT) comparing different CA strategies and methods for pulmonary vein isolation (PVI) were included. Efficacy was defined as lack of arrhythmia recurrence after CA and safety as any reported complication related to the procedure during a minimum follow-up time of six months. In total, 43 RCTs comparing 11 different CA strategies involving 6701 patients were included. The risk of recurrence was significantly decreased in comparison with PVI with radiofrequency only for the following treatments: PVI with adjuvant ablation (RR: 0.79, CI: 0.65–0.97) and PVI with sympathetic modulation (RR: 0.64, CI: 0.46–0.88). However, PVI with radiofrequency was superior to non-PVI strategies (RR: 1.65, CI: 1.2–2.26). No statistically significant difference was found in safety between different CA strategies. Concerning different PVI strategies, no difference was observed either in efficacy or in safety between tested strategies. This NMA suggests that different PVI strategies are generally similar in terms of efficacy, while PVI with additional ablation or sympathetic modulation may be more effective than PVI alone. This study provides decision-makers with insights into the efficacy and safety of different CA strategies. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnosis and Management of Atrial Fibrillation)

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