Pathogenesis, Diagnosis and Treatment of Cardiomyopathy and Cardiac Arrhythmias

Dear Colleagues,

Arrhythmias significantly contribute to increased morbidity and mortality, and cardiomyopathies (CM) are the leading cause of syncope and sudden cardiac death (SCD) in young people. Electrocardiographic findings and arrhythmias are closely related to cardiomyopathies. Both may be an early indication of a specific diagnosis or are the consequence of structural changes in a heart with myocardial fibrosis and decreased contractility. The spectrum of arrhythmias ranges from bradyarrhythmia to atrial and/or ventricular premature beats to atrial tachyarrhythmia and/or life-threatening ventricular arrhythmia. Atrial fibrillation (AF) represents the most common arrhythmia and is associated with an increased risk of cardio-thromboembolic events, heart failure and mortality in patients with CM, and there is growing evidence for atrial fibrillation ablation in an era of steadily increasing catheter ablation in patients with atrial fibrillation without CM. SCD prevention plays an important role in the new recommendations. These guidelines include five Class I indications for intracardiac defibrillator (ICD) treatment for CM as secondary preventions and are consistent with the 2022 ESC Guidelines for ventricular arrhythmia patient management and SCD prevention. This extends previously established individualized decision-making concepts and supports individual management and risk stratification by etiology. Recommendations for genetic testing have increased, and the guidelines acknowledge the growing evidence for specific high-risk genotypes, regardless of left ventricular morphology and function. For example, this includes a Class I recommendation for genetic testing in all patients who meet the diagnostic criteria for CM and serial genetic testing of relatives if there is a possibility of pathologic variants in the index patient. Alongside genetic testing, the role of cardiac MRI has increased in recent years, but randomized trials to guide ICD therapy are still lacking. Therefore, most guidelines emphasize the importance of an etiology-based, tailored, individualized management approach that integrates the patient's medical history, electrocardiogram (ECG) and echocardiography, CMR, laboratory analyses, genetics and electrophysiological studies.

The scope of this Special Issue encompasses various aspects of cardiomyopathy and cardiac arrhythmias, including but not limited to:

• The identification and characterization of underlying mechanisms and genetic factors contributing to cardiomyopathy and cardiac arrhythmias.
• Advances in diagnostic modalities, such as innovative imaging techniques, molecular markers, genetics and electrophysiological studies.
• Evaluation of novel therapeutic strategies and pharmacological interventions.

Dr. Sung Il Im
Guest Editor

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• arrhythmia
• cardiomyopathy
• pathogenesis
• diagnosis