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Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation...
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Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis

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: 15 December 2024 | Viewed by 4868

Special Issue Editors

Dr. Yves De Greef

E-Mail Website
Guest Editor
1. Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020 Antwerp, Belgium
2. Heart Rhythm Management Centre, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
Interests: atrial fibrillation; ablation technologies and strategies; electro-anatomical mapping
Dr. Wim Anné

E-Mail Website
Guest Editor
Department of Cardiology, Dienst Cardiologie AZ Delta, Deltalaan 1, 8800 Roeselare, Belgium
Interests: atrial fibrillation ablation technologies; structural remodeling underlying atrial fibrillation

Special Issue Information

Dear Colleagues,

We are launching a Special Issue on catheter ablation and atrial fibrillation.

Catheter ablation has become a very powerful tool in the treatment of atrial fibrillation, with far better outcomes than medical treatment. Trial evidence now supports a broad recommendation for (early) first-line treatment with AF ablation in paroxysmal AF patients. The results of the EAST-AF NET 4 trial showed that early control of heart rhythm either by ablation or anti-arrhythmic drugs improved outcomes better than rate control. Early timing of rhythm-control strategy with ablation as a new powerful instrument therefore seems to be the way forward. However, many questions remain: How will new emerging technologies such as pulsed-field ablation impact our field of ablation? How will we tackle the new bread-and-butter in EP, “persistent isolated pulmonary veins at redo ablations?” Which strategies beyond the PVs show promise? Are there predictors of the persistence of PV isolation? Additionally, persistent AF patients are less-responsive to catheter ablation, so how can we tackle this issue and improve outcome in these patients? Finally, ablation improves quality of life in our patients, but will it have a future role in improving hard endpoints such as heart failure and mortality? We invite you to submit your high-quality research on any of these topics. We will accept original research articles and reviews that highlight new advancements in the catheter ablation of atrial fibrillation.

Dr. Yves De Greef
Dr. Wim Anné
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

  • advanced ablation technologies (pulsed field ablation and others)
  • persistent pulmonary vein isolation (predictors and ablation strategies)
  • ablation strategies in persistent AF
  • impact of ablation on ‘hard’ endpoints such as heart failure
  • mortality (role of ablation in improving prognosis)

Published Papers (4 papers)

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9 pages, 1896 KiB  
Article
Assessment of Esophageal Shifts during Catheter Ablation of Atrial Fibrillation Using Intracardiac Ultrasound Integrated with 3-Dimensional Electroanatomical Mapping System
by Andrej Pernat, Mark Zavrtanik, Antonio Gianluca Robles, Silvio Romano, Luigi Sciarra and Bor Antolič
J. Cardiovasc. Dev. Dis. 2024, 11(4), 110; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd11040110 - 31 Mar 2024
Viewed by 469
Abstract
Purpose: Atrioesophageal fistula is one of the most feared complications of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) as it is associated with high mortality. Determining the esophagus location during RFCA might reduce the risk of esophageal injury. The present study aims [...] Read more.
Purpose: Atrioesophageal fistula is one of the most feared complications of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) as it is associated with high mortality. Determining the esophagus location during RFCA might reduce the risk of esophageal injury. The present study aims to evaluate the feasibility of using intracardiac echocardiography integrated into a 3-dimensional electroanatomical mapping system (ICE/3D EAM) for the assessment of esophageal position and shifts in response to ablation. Methods: We prospectively enrolled 20 patients that underwent RFCA of AF under conscious analgosedation. The virtual anatomy of the left atrium, the pulmonary vein (PV) ostia, and the esophagus was created with ICE/3D EAM. The esophageal positions were obtained at the beginning of the procedure and then after left and right PV isolation (PVI). Esophageal shifts were measured offline after the procedure using the tools available in the 3D EAM system. Results: Most esophagi moved away from the ablated PV ostia. After the left PVI, the median of the shifts was 2.8 mm (IQR 1.0–6.3). In 25% of patients, the esophagus shifted by >5.0 mm (max. 13.4 mm). After right PVI, the median of shifts was 2.0 mm (IQR 0.7–4.9). In 10% of patients, the esophageal shift was >5.0 mm (max. 7.8 mm). Conclusions: ICE/3D EAM enables the intraprocedural visualization of baseline esophageal position and its shifts after PVI. The shifts are variable, but they tend to be small and directed away from the ablation site. Repeated intraprocedural visualization of the esophagus may be needed to reduce the risk of esophageal injury. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)
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16 pages, 2014 KiB  
Article
Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis
by Maxime Tijskens, Juan Pablo Abugattas, Hendrik Thoen, Antanas Strazdas, Bruno Schwagten, Michael Wolf and Yves De Greef
J. Cardiovasc. Dev. Dis. 2024, 11(2), 57; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd11020057 - 06 Feb 2024
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Abstract
Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at [...] Read more.
Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHA2DS2-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200). Clinical success was defined as freedom of documented AF or atrial tachycardia (AT) > 30 s. PV reconnection patterns were characterized in repeat ablations. Results: At 1 year, 77 (19.25%) patients had recurrence of AF/AT, significantly lower than in the mapping group: 21 (10.5%) vs. 56 (28%), p < 0.001. Procedure time was shorter (72.2 ± 25.4 vs. 78.2 ± 29.3 min, p = 0.034) and radiation exposure lower (4465.0 ± 3454.6 Gy.cm2 vs. 5940.5 ± 4290.5 Gy.cm2, p = 0.037). Use of mapping was protective towards AF/AT recurrence (HR = 0.348; 95% CI 0.210–0.579; p < 0.001), independent of persistent AF type (HR = 1.723; 95% CI 1.034–2.872; p = 0.037), and LA diameter (HR = 1.055; 95% CI 1.015–1.096; p = 0.006). At repeat ablation (N = 90), persistent complete PVI was seen in 14/20 (70.0%) versus 23/70 (32.9%) in the mapping and conventional group, respectively (p = 0.03). Reconnection rate of the right inferior PV was lower with mapping (10.0% vs. 34,3%, p = 0.035). Conclusions: Adding electroanatomical LA voltage mapping to CBA improves 1-year clinical outcome and lowers both procedure time and radiation exposure. At repeat, use of mapping increases complete persistent PVI mainly by improving PVI durability of the RIPV. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)
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10 pages, 3338 KiB  
Article
Accuracy of the Injection-Based Occlusion Tool Utilizing Saline and Glucose Solution in Cryoballoon Ablation Guided by a Novel Dielectric Imaging System
by Binfeng Mo, Jiali Yuan, Xiaoming Lian, Xingxing Cai, Qunshan Wang and Yigang Li
J. Cardiovasc. Dev. Dis. 2023, 10(10), 427; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10100427 - 17 Oct 2023
Viewed by 1395
Abstract
Introduction: The aim of this study is to assess the accuracy of the injection-based occlusion (IBO) tool utilizing saline and glucose solution in verifying pulmonary vein (PV) occlusion during cryoballoon ablation guided by a novel dielectric system (KODEX–EPD system). Methods: In this retrospective [...] Read more.
Introduction: The aim of this study is to assess the accuracy of the injection-based occlusion (IBO) tool utilizing saline and glucose solution in verifying pulmonary vein (PV) occlusion during cryoballoon ablation guided by a novel dielectric system (KODEX–EPD system). Methods: In this retrospective study, we enrolled 34 consecutive patients with paroxysmal atrial fibrillation (AF) who underwent their initial cryoballoon ablation procedure guided by the KODEX-EPD system. PV occlusion was firstly assessed by the IBO tool utilizing saline or glucose solution and then verified by direct contrast angiography. Patients were divided into two groups according to the fluid used in the IBO tool: the Saline Group and the Glucose Group. Results: The overall procedure time and fluoroscopy time were comparable between the Saline Group and the Glucose Group (113.7 ± 18.3 vs. 108.4 ± 15.9 min; p = 0.375 and 10.1 ± 3.7 vs. 9.3 ± 3.5 min; p = 0.559). The IBO tool was utilized a total of 138 times in the Saline Group and 135 times in the Glucose Group. When assessing PV occlusion, the IBO tool using saline demonstrated a sensitivity of 92.6% and a specificity of 95.2% compared to angiography. Similarly, the IBO tool utilizing glucose solution showed a sensitivity of 93.2% and a specificity of 96.1%. Conclusions: The IBO tool utilizing non-contrast fluid, saline and glucose solution, demonstrates a high level of sensitivity and specificity in accurately predicting PV occlusion during cryoablation procedures. Both the saline and glucose solutions used in the IBO tool show promising results in effectively assessing PV occlusion. Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)
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7 pages, 1590 KiB  
Opinion
Ablative Management of Persistent Atrial Fibrillation (PeAF) with Posterior Wall Isolation (PWI): Where Do We Stand?
by Omar Baqal and Hicham Z. El Masry
J. Cardiovasc. Dev. Dis. 2023, 10(7), 273; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10070273 - 27 Jun 2023
Cited by 1 | Viewed by 1253
Abstract
Atrial fibrillation is a diverse clinical entity, with persistent atrial fibrillation (PeAF) being particularly challenging to manage. Through this paper, we discuss notable developments in our understanding of ablative strategies for managing PeAF, with a special focus on posterior wall isolation (PWI). Full article
(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: New Emerging Technologies, Promising Ablation Strategies beyond the Pulmonary Veins and Potential Role of Ablation in Improving Patient Prognosis)
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