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Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision...
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Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision Medicine

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 3922

Special Issue Editors

Dr. Riccardo Vio

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Guest Editor
Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, Mestre-Venice, Italy
Interests: atrial fibrillation; arrhythmias; clinical electrophysiology; interventional electrophysiology; catheter ablation; cardiac pacing; anticoagulant therapy; antiarrhythmic drugs; cardiomyopathies; sports cardiology
Prof. Dr. Riccardo Proietti

E-Mail Website
Guest Editor
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
Interests: arrhythmias; atrial fibrillation; pacemakers; cardiac electrophysiology; catheter ablation; clinical electrophysiology; interventional electrophysiology
Dr. Paolo China

E-Mail Website
Guest Editor
Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, Mestre-Venice, Italy
Interests: atrial fibrillation; catheter ablation; arrhythmias; clinical electrophysiology; interventional electrophysiology; cardiac pacing

Special Issue Information

Dear Colleagues,

The global burden of atrial arrhythmias is growing, mostly driven by the increased detection of atrial fibrillation (AF). New tools for atrial arrhythmia diagnosis, together with the remote monitoring of cardiac implantable electronic devices, shorten the delay from arrhythmia onset to diagnosis. However, the diagnostic implications of subclinical atrial arrhythmias are still a matter of debate, and their treatment varies greatly based on their duration. Furthermore, even the management of clinically overt atrial tachyarrhythmias might depend on the burden of the arrhythmia. The treatment of these common arrhythmias either aims to improve symptoms or to reduce the associated risk of thromboembolic events. Cather ablation is superior to antiarrhythmic drugs to eliminate or reduce AF recurrences, but timely diagnosis and intervention are fundamental. Despite the constant research, there are still some safety concerns in the use of oral anticoagulants, which must be offered to select patients based on their thrombotic and hemorrhagic risks. To ameliorate the safety profile of direct oral anticoagulants, recent studies have focused on populations which are under-represented in clinical trials and pharmacological interactions. Moreover, newer anticoagulants are under investigation. Alternative interventional solutions exist for those with contraindication for anticoagulation (i.e., left atrial appendage occlusion). Finally, precision approaches to atrial arrhythmias are emerging. In the near future, genetic testing may help to predict AF onset and recurrence, and could influence the choice of strategy (rhythm vs. rate control) and antiarrhythmic or anticoagulant therapy.

The aim of this Special Issue is to gather up-to-date scientific evidence on the management of atrial arrhythmias, with particular reference to diagnostic implications, clinical management and precision medicine. We are pleased to invite you and your co-workers to submit your original research articles and review articles on this topic.

Dr. Riccardo Vio
Prof. Dr. Riccardo Proietti
Dr. Paolo China
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. Medicina 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 1800 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
  • atrial arrhythmia
  • anticoagulation
  • stroke
  • antiarrhythmic drug
  • catheter ablation
  • precision medicine

Published Papers (4 papers)

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Review

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13 pages, 1122 KiB  
Review
Atrial Fibrillation Burden: Impact on Stroke Risk and Beyond
by Ahmed AlTurki and Vidal Essebag
Medicina 2024, 60(4), 536; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60040536 - 26 Mar 2024
Viewed by 618
Abstract
Atrial fibrillation (AF) is an important independent risk factor for stroke. Current guidelines handle AF as a binary entity with risk driven by the presence of clinical risk factors, which guides the decision to treat with an oral anticoagulant. Recent studies in the [...] Read more.
Atrial fibrillation (AF) is an important independent risk factor for stroke. Current guidelines handle AF as a binary entity with risk driven by the presence of clinical risk factors, which guides the decision to treat with an oral anticoagulant. Recent studies in the literature suggest a dose–response relationship between AF burden and stroke risk, in both clinical AF and subclinical atrial fibrillation (SCAF), which differs from current guidance to disregard burden and utilize clinical risk scores alone. Within clinical classification and at the same risk levels in various scores, the risk of stroke increases with AF burden. This opens the possibility of incorporating burden into risk profiles, which has already shown promise. Long-term rhythm monitoring is needed to elucidate SCAF in patients with stroke. Recent data from randomized trials are controversial regarding whether there is an independent risk from AF episodes with a duration of less than 24 h, including the duration of SCAF greater than six minutes but less than 24 h. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision Medicine)
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19 pages, 379 KiB  
Review
Early Detection of Atrial Fibrillation in Chronic Obstructive Pulmonary Disease Patients
by Stanislav Kotlyarov and Alexander Lyubavin
Medicina 2024, 60(3), 352; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60030352 - 20 Feb 2024
Viewed by 1047
Abstract
Atrial fibrillation (AF) is an important medical problem, as it significantly affects patients’ quality of life and prognosis. AF often complicates the course of chronic obstructive pulmonary disease (COPD), a widespread disease with heavy economic and social burdens. A growing body of evidence [...] Read more.
Atrial fibrillation (AF) is an important medical problem, as it significantly affects patients’ quality of life and prognosis. AF often complicates the course of chronic obstructive pulmonary disease (COPD), a widespread disease with heavy economic and social burdens. A growing body of evidence suggests multiple links between COPD and AF. This review considers the common pathogenetic mechanisms (chronic hypoxia, persistent inflammation, endothelial dysfunction, and myocardial remodeling) of these diseases and describes the main risk factors for the development of AF in patients with COPD. The most effective models based on clinical, laboratory, and functional indices are also described, which enable the identification of patients suffering from COPD with a high risk of AF development. Thus, AF in COPD patients is a frequent problem, and the search for new tools to identify patients at a high risk of AF among COPD patients remains an urgent medical problem. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision Medicine)
12 pages, 587 KiB  
Review
A New Player in the Game: Can Exergame Be of Support in the Management of Atrial Fibrillation?
by Donato Giuseppe Leo and Riccardo Proietti
Medicina 2024, 60(1), 172; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60010172 - 17 Jan 2024
Viewed by 1009
Abstract
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, currently affecting 2–3% of the world’s population. Traditional exercise and physical activity interventions have been successfully implemented in the management of AF, with the aim of improving patients’ quality of life and [...] Read more.
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, currently affecting 2–3% of the world’s population. Traditional exercise and physical activity interventions have been successfully implemented in the management of AF, with the aim of improving patients’ quality of life and their exercise capacity, as well as reducing their mortality rate. Currently, new technology-mediated approaches to exercise, defined as exergame, have been shown to be successful in the delivery of exercise home-based interventions in patients with cardiovascular diseases. However, data on the effects of exergame on AF are not yet available. In this paper, we summarise the current literature on the role of traditional exercise in AF and how it affects the pathophysiology of this condition. We also review the current literature on exergame and its employment in cardiac rehabilitation and suggest its potential role in the management of AF patients. A review of the evidence suggests that traditional exercise (of light-to-moderate intensity) is beneficial in patients with AF. Additionally, exergame seems to be a promising approach for delivering exercise interventions in patients with cardiovascular diseases. Exergame may be a promising tool to improve the quality of life and exercise capacity in patients with AF, with the additional advantage of being remotely delivered, and the potential to increase patients’ engagement. Proper guidelines are required to prescribe exergame interventions, considering the principles of traditional exercise prescription and applying them to this new e-health approach. Further studies are needed to validate the use of exergame in patients with AF. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision Medicine)
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Other

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7 pages, 11588 KiB  
Case Report
Catheter Ablation of Atrial Tachycardia after Pulmonary Vein Isolation in a Patient with Common Ostium of Inferior Pulmonary Veins: Case Report
by Milos Babic, Branko Djurdjevic, Dejan Vukajlovic, Mihailo Jovicic, Masa Petrovic, Jelena Kljajevic, Milosav Tomovic and Aleksandra Nikolic
Medicina 2024, 60(2), 264; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina60020264 - 02 Feb 2024
Viewed by 748
Abstract
Background and Objectives: Atrial fibrillation (AF), a prevalent cardiac arrhythmia, significantly impacts the quality of life of those affected. The preferred treatment for symptomatic AF, particularly when pharmacological methods fall short, is catheter ablation with pulmonary vein isolation (PVI). While common pulmonary [...] Read more.
Background and Objectives: Atrial fibrillation (AF), a prevalent cardiac arrhythmia, significantly impacts the quality of life of those affected. The preferred treatment for symptomatic AF, particularly when pharmacological methods fall short, is catheter ablation with pulmonary vein isolation (PVI). While common pulmonary vein (PV) anatomical variants, such as the right accessory pulmonary vein and the common ostium of left pulmonary veins (LCPV), have been studied extensively, their impact on the long-term outcome of PVI is known to be minimal. However, data on less common anomalies, like the common ostium of the left and right inferior pulmonary vein (CIPV), remain scarce in the medical literature. This report aims to shed light on the challenges and outcomes of catheter ablation in a patient with a rare CIPV anomaly. By presenting this case, we contribute to the limited knowledge about the management of such unique anatomical variations in AF treatment and discuss the importance of individualized treatment approaches. Case Presentation: We present a case involving a 56-year-old male diagnosed with AF in 2018. Initial PVI treatment was successful, but the patient experienced symptom recurrence after three years. A preprocedural CT scan before the second ablation revealed a CIPV anomaly. During the repeat procedure, a right superior pulmonary vein (RSPV) reisolation was performed due to identified gaps in the previous ablation line. Post-procedure, the patient maintained a sinus rhythm and reported no further symptoms. Conclusions: This case highlights the importance of recognizing rare PV anatomies like CIPV in the effective management of AF. Tailored ablation strategies, accounting for unique anatomical conditions, can lead to successful long-term outcomes, reinforcing the need for personalized approaches in AF treatment, especially in cases involving complex anatomical variations. Full article
(This article belongs to the Special Issue Atrial Arrhythmias: Advances in Diagnostic Implications, Clinical Management and Precision Medicine)
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