Advances in the Diagnosis and Management of Atrial Fibrillation and Heart Failure

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

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 1366

Special Issue Editor


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Guest Editor
E.N. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia
Interests: atrial fibrillation; heart failure

Special Issue Information

Dear Colleagues,

The interaction between atrial fibrillation (AF) and heart failure (HF) is a complex and multifactorial problem that requires further investigation. The coexistence of AF and HF can lead to a vicious cycle where each condition exacerbates the other through mechanisms such as structural cardiac remodeling and activation of neurohormonal systems. The clinical course of AF and HF varies depending on the cause and type of CHF and AF.

Age and HF severity are significant risk factors for the development of AF in patients with HF, and the clinical course seems more favorable when AF causes HF than with other causes of HF. However, the development of AF in patients with chronic HF is associated with a worse prognosis, including stroke and increased mortality.

New cardiac-specific biomarkers, cardiac imaging and remote monitoring can potentially improve the diagnosis and understanding of AF and HF disease progression, but more research is needed to determine their influence on both diseases.

With the advancements in digital technology, there are many opportunities for early diagnosis of AF and CHF. The Special Issue will explore the latest research on this topic and provide insights into the prevention, diagnosis, and treatment of both conditions. This issue aims to add value to the scientific community and improve the lives of patients suffering from AF and HF by providing a comprehensive understanding of the interaction between these two conditions and the optimal management of patients with both AF and HF.

Dr. Denis Losik
Guest Editor

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Keywords

  • atrial fibrillation
  • heart failure
  • biomarkers
  • cardiac imaging
  • remote monitoring

Published Papers (1 paper)

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Research

16 pages, 1790 KiB  
Article
Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure
by Jian Sun, Rui Zhang, Mei Yang, Wei Li, Peng-Pai Zhang, Bin-Feng Mo, Qun-Shan Wang, Mu Chen and Yi-Gang Li
Diagnostics 2023, 13(21), 3325; https://doi.org/10.3390/diagnostics13213325 - 26 Oct 2023
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Abstract
Background: Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation [...] Read more.
Background: Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF. Methods: AF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison. Results: Among 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415–4.449, p = 0.002) and with the respective rates predicted by risk scores. Conclusions: Combining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort. Full article
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