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Cardiac Ablation - Current Practice and Future Trends

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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 April 2022) | Viewed by 15337

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Special Issue Editors

Dr. Mariusz Kowalewski

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Guest Editor

1. Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str, 02-507 Warsaw, Poland
2. Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands
Interests: coronary revascularization; neuroprotection; surgical ablation; minimally invasive cardiac surgery
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Piotr Suwalski

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Guest Editor

Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
Interests: minimally invasive cardiac surgery; mitral valve repair; surgical ablation; hybrid coronary revascularization

Special Issue Information

Dear Colleagues,

Cardiac arrhythmias and, in particular, atrial fibrillation (AF), have become a burden in today’s aging society, and are often associated with numerous other comorbidities. While largely impacting heart function and quality of life, at the same time, the loss of proper cardiac contractility heralds the risk of systemic thromboembolism and stroke. On the positive side, new treatments are emerging for rhythm control, rate control and stroke prevention. Together with recent advancements in surgical and catheter ablation, we now have what seems to be a wide arumentarium to face rhythm disturbances. As also reflected in the recent 2020 ESC guidelines, cardiac ablation has gained higher recognition and its class of indication has been moved from IIa to I in many clinical scenarios.

The focus of this Special Issue is to outline the trends for the future, as what has been forgotten in the field of cardiac arrhythmias is often a patient-oriented, individualized approach; in fact, both optimizing shared decision making about arrhythmia treatment options and ensuring that patient values need to be taken into account are of great importance. In addition, it is now recommended and pursued that patient-reported outcomes are routinely collected to measure treatment success and improve patient care and the quality of healthcare. With greater emphasis on the need for lifestyle modifications and targeted therapy for intercurrent conditions, both the reduction of the AF burden and the improvement of outcomes are now possible and warranted.

It is our great privilege to invite you to contribute your work to this Special Issue on cardiac ablation. We ask that you provide your point of view or best results in terms of the individualized diagnosis and management of cardiac arrhythmias both in surgical and electrophysiological settings.

Dr. Mariusz Kowalewski
Prof. Dr. Piotr Suwalski
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 arrhythmia
atrial fibrillation
ablation
rhythm correction
electrophysiology
left atrial appendage

Published Papers (5 papers)

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Research

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8 pages, 238 KiB

Open AccessArticle

Efficacy and Safety of Zero-Fluoroscopy Approach during Catheter Ablation of Accessory Pathway

by Dariusz Rodkiewicz, Edward Koźluk, Agnieszka Piątkowska, Aleksandra Gąsecka, Krzysztof Krzemiński and Grzegorz Opolski

J. Clin. Med. 2022, 11(7), 1814; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071814 - 25 Mar 2022

Cited by 2 | Viewed by 1432

Abstract

Background: Catheter ablation (CA) is a safe and efficient treatment in patients with an atrioventricular accessory pathway (AP). Electroanatomical mapping (EAM) systems are useful during CA of AP, especially for reducing fluoroscopy. There are limited data about the feasibility of CA procedures performed with the use of the EAM system entirely without fluoroscopy in adults with AP. The aim of the study is to assess the feasibility, efficacy and safety of CA with the use of EAM without fluoroscopy, compared to CA with EAM and fluoroscopy in patients with AP. Methods: The study included 83 consecutive patients (age 38.25 ± 15.8 years), who were subjected to CA for AP. In 40 patients CA was performed with the use of EAM without fluoroscopy (EAM group), and in 43 patients CA was performed with EAM and fluoroscopy (control group). Baseline characteristics, procedure parameters and complications were obtained from the medical records. Data on permanent success rate was obtained after the mean follow-up time of 1 year. Primary outcomes were acute procedural success rate, long term success rate at 1-year follow-up and complications. Secondary outcomes were the procedure time and number of applications. Results: There were no statistically significant differences in baseline characteristics between the groups, except for the AP locations. Right-sided AP was more common in the EAM group, while left-sided AP was more common in the control group (p = 0.007 and p = 0.004, respectively). Acute procedural success was achieved in 38 patients (95.0%) in the EAM group and in 39 patients (90.7%) in the control group (p = 0.449). Long term success rate was achieved in 36 patients (90.0%) in the EAM group and in 36 (83.7%) patients in the control group (p = 0.399). There was one minor complication in the form of RBBB in the EAM group (p = 0.138). The mean procedure time was shorter in the EAM group compared to the control group (93.0 ± 58.3 min vs. 127.6 ± 57.5 min; p = 0.009). Conclusions: CA of both right-sided and left-sided AP completely guided by EAM without the use of fluoroscopy is feasible, safe and effective. Full article

(This article belongs to the Special Issue Cardiac Ablation - Current Practice and Future Trends)

7 pages, 1232 KiB

Open AccessArticle

Does Unidirectional Block Exist after a Radiofrequency Line Creation? Insights from Ultra-High-Density Mapping (The UNIBLOCK Study)

by Sok-Sithikun Bun, Antoine Da Costa, Jean-Baptiste Guichard, Ziad Khoueiry, Fabien Squara, Didier Scarlatti, Philippe Taghji, Pamela Moceri and Emile Ferrari

J. Clin. Med. 2021, 10(11), 2512; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112512 - 06 Jun 2021

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Abstract

Background: Whether unidirectional conduction block (UB) can be observed after creation of a radiofrequency (RF) line is still debated. Previous studies reported a prevalence of 9 to 33% of UB, but the assessment was performed using a point-by-point recording across the line. Ultra-high-density (UHD) system may bring some new insights on the exact prevalence of UB. Purpose: A prospective study was conducted to assess the prevalence of UB and bidirectional block (BB) using UHD system after RF line creation. Methods: Patients referred for atrial RF ablation procedure were included in this multicenter prospective study. UHD maps were performed by pacing both sides of the created line. Results: A total of 80 maps were created in 40 patients (67 ± 12 years, 70% male) by pacing (mean cycle length 600 ± 57 ms) from both sides of the cavotricuspid isthmus line. After a 47 ± 17 min waiting time after the last RF application, UHD maps (mean number of 4842 ± 5010 electrograms, acquired during 6 ± 5 min) showed that BB was unambiguously confirmed on all of them. UB was not observed in any map. After a mean follow-up of 12 ± 4 months, 6 (14%) patients experienced an arrhythmia recurrence. Conclusion: After creation of an RF line, no case of UB was observed using UHD mapping, suggesting that the presence of a conduction block along a RF line is always associated with a block in the opposite direction. Full article

(This article belongs to the Special Issue Cardiac Ablation - Current Practice and Future Trends)

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Review

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15 pages, 567 KiB

Open AccessReview

Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview

by Roberto De Ponti, Raffaella Marazzi, Manola Vilotta, Fabio Angeli and Jacopo Marazzato

J. Clin. Med. 2022, 11(12), 3323; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11123323 - 09 Jun 2022

Cited by 3 | Viewed by 1818

Abstract

Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings. Full article

(This article belongs to the Special Issue Cardiac Ablation - Current Practice and Future Trends)

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32 pages, 15316 KiB

Open AccessReview

Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

by Patrick M. McCarthy, James L. Cox, Olga N. Kislitsina, Jane Kruse, Andrei Churyla, S. Chris Malaisrie and Christopher K. Mehta

J. Clin. Med. 2022, 11(1), 210; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11010210 - 31 Dec 2021

Cited by 13 | Viewed by 5463

Abstract

Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including catheter ablation and surgical ablation. The increasing prevalence and the morbidity/mortality associated with AF warrants a more aggressive approach to its treatment. It is the purpose of this invited editorial to describe the past, present, and anticipated future directions of the interventional therapy of AF, and to crystallize the problems that remain. Full article

(This article belongs to the Special Issue Cardiac Ablation - Current Practice and Future Trends)

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16 pages, 1723 KiB

Open AccessReview

Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)—A Comprehensive Review

by Marcin Miszczyk, Tomasz Jadczyk, Krzysztof Gołba, Wojciech Wojakowski, Krystian Wita, Jacek Bednarek and Sławomir Blamek

J. Clin. Med. 2021, 10(6), 1238; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10061238 - 17 Mar 2021

Cited by 18 | Viewed by 3352

Abstract

The electrophysiology-guided noninvasive cardiac radioablation, also known as STAR (stereotactic arrhythmia radioablation) is an emerging treatment method for persistent ventricular tachycardia. Since its first application in 2012 in Stanford Cancer Institute, and a year later in University Hospital Ostrava, Czech Republic, the authors from all around the world have published case reports and case series, and several prospective trials were established. In this article, we would like to discuss the available clinical evidence, analyze the potentially clinically relevant differences in methodology, and address some of the unique challenges that come with this treatment method. Full article

(This article belongs to the Special Issue Cardiac Ablation - Current Practice and Future Trends)

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