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Modern Approach to Complex Arrhythmias, 2nd Edition
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Modern Approach to Complex Arrhythmias, 2nd Edition

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: 30 November 2025 | Viewed by 2908

Special Issue Editor

Prof. Dr. Matteo Bertini

E-Mail Website
Guest Editor
Cardiological Center, Translational Medicine Department, University of Ferrara, 944121 Ferrara, Italy
Interests: arrhythmias; PM; ICD; ablation; sudden cardiac death
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, several advancements have been made in the field of electrophysiology, and these are leading to changes in patient management. In particular, the use of zero-fluoroscopy, ultradensity mapping and new energy forms for complex arrhythmia ablation is increasing, conferring obvious advantages for patients.

This Special Issue will be focused on innovation in the field of electrophysiology, on the clinical relevance of novel methods acquired thus far, and on the near-future perspectives derived by changes in the management of patients.

Prof. Dr. Matteo Bertini
Guest Editor

Manuscript Submission Information

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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

  • arrhythmias
  • ablation
  • zerofluorsocopy
  • ultra-density mapping
  • new energy forms

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Published Papers (5 papers)

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Research

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11 pages, 2027 KB  
Article
Optimization of Outflow-Tract Ventricular Arrhythmia Ablation Using a Universal Right Ventricle Model
by Krystian Szkoła, Łukasz Zarębski, Paweł Turek, Marian Futyma, Łukasz Wiśniowski and Piotr Futyma
J. Cardiovasc. Dev. Dis. 2025, 12(9), 323; https://doi.org/10.3390/jcdd12090323 - 24 Aug 2025
Viewed by 348
Abstract
Introduction: The radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) originating from the right ventricular outflow tract (RVOT) is a well-established therapy. Traditionally, RFCA is guided using electroanatomical 3D mapping systems involving manual catheter navigation within cardiac chambers. While effective, this approach may [...] Read more.
Introduction: The radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) originating from the right ventricular outflow tract (RVOT) is a well-established therapy. Traditionally, RFCA is guided using electroanatomical 3D mapping systems involving manual catheter navigation within cardiac chambers. While effective, this approach may be time-consuming, and it carries a potential risk of cardiac wall perforation. Although the risk is low, it cannot be underestimated. Therefore, alternative mapping methods are sought to reduce procedural times and improve the overall efficiency of RVOT-VAs ablation. Aim: To evaluate the safety, feasibility, and efficacy of a universal RVOT 3D model implementation for the ablation of idiopathic RVOT-VAs. Methods: Consecutive patients undergoing VA ablation supported with a universal RVOT 3D model (3D-MODEL group) were included in the study. The RVOT universal model in this group was created by processing DICOM images for the improved segmentation of anatomical structures, followed by production using 3D printing technology. Patients who underwent classic endocardial electroanatomical mapping served as controls (EAM group). Results: A total of 228 patients were included in the study (143 women, age 50 ± 17 years): 149 in the 3D-MODEL group and 79 in the EAM group. The acute complete elimination of clinical VAs was achieved for 133 (89%) of patients in the 3D-MODEL group vs. 65 (82%) in the EAM group (p = 0.14). The procedural time was significantly shorter in the 3D-MODEL group compared to the EAM group (38 ± 14 min vs. 80 ± 39 min, p < 0.001). A significant difference was also observed in the radiofrequency time between the 3D-MODEL and EAM groups (251 ± 176 s vs. 503 ± 425 s, p < 0.001). No significant difference in fluoroscopy time was found between the groups (284 ± 167 s vs. 260 ± 327 s, p = 0.49). Two cases of cardiac tamponade occurred, both in patients from the EAM group. During follow-up, lasting 14 ± 10 months, 87% of patients in the 3D-MODEL group and 75% in the EAM group remained arrhythmia-free (p = 0.45). Conclusions: The use of universal RVOT 3D modeling is a feasible, safe, and effective alternative to classic electroanatomical mapping in the ablation of idiopathic RVOT-VAs. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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14 pages, 2495 KB  
Article
Specific Premature Ventricular Complex Characteristics in Women: Insights from a Patient Cohort
by Ștefan Ailoaei, Laurențiu Șorodoc, Carina Ureche, Nicolae Sîtari, Alexandr Ceasovschih, Mihaela Grecu, Radu Andy Sascău and Cristian Stătescu
J. Cardiovasc. Dev. Dis. 2025, 12(5), 181; https://doi.org/10.3390/jcdd12050181 - 13 May 2025
Viewed by 462
Abstract
Background: Premature ventricular complexes (PVCs) are common arrhythmias that can range from benign to clinically significant. While PVCs have been extensively studied in the general population, gender-specific differences in their characteristics, prevalence, and clinical impact remain underexplored. This study aims to investigate the [...] Read more.
Background: Premature ventricular complexes (PVCs) are common arrhythmias that can range from benign to clinically significant. While PVCs have been extensively studied in the general population, gender-specific differences in their characteristics, prevalence, and clinical impact remain underexplored. This study aims to investigate the unique features of PVCs in women and their potential implications for diagnosis and management. Methods: We analyzed a cohort of female patients diagnosed with PVCs, assessing their electrocardiographic patterns, symptomatology, and clinical outcomes. Data were collected from medical records, including Holter monitoring, electrocardiograms (ECGs), and echocardiographic findings. The study also evaluated the association between PVC burden and underlying cardiac conditions. Results: This study analyzed 161 patients (59 females, 91 males) with PVCs, revealing significant sex-based differences. Males were older, had higher BMI, and smoked more, while females experienced more presyncope. ECGs showed greater QRS fragmentation in males. TTE and CMR found males had larger ventricles, lower EF, and more myocardial fibrosis (LGE: 59.34% vs. 37.93%). Patients with LGE were older and had worse clinical outcomes, including higher ICD implantation and hospitalization rates. Despite these structural differences, treatment efficacy was similar across groups. Conclusion: This study highlights key differences in PVC characteristics among women, underscoring the need for gender-specific approaches in clinical evaluation and management. Recognizing these distinctions may aid in early diagnosis, reduce unnecessary interventions, and improve patient outcomes. Further research is warranted to explore the long-term implications of PVCs in women and optimize therapeutic strategies. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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11 pages, 3100 KB  
Article
A Hybrid Minimally Invasive Atrial Fibrillation Ablation Procedure Using Unilateral Thoracoscopy and Endocardial Pulsed Field Ablation: An Early Feasibility Study
by Ivan Eltsov, Luigi Pannone, Domenico Giovanni Della Rocca, Massimiliano Marini, Giacomo Talevi, Andrea Maria Paparella, Pasquale Vergara, Erwin Ströker, Juan Sieira, Gian-Battista Chierchia, Carlo de Asmundis and Mark La Meir
J. Cardiovasc. Dev. Dis. 2025, 12(4), 145; https://doi.org/10.3390/jcdd12040145 - 9 Apr 2025
Cited by 1 | Viewed by 712
Abstract
(1) Objective: To examine the efficiency and efficacy of using endovascular mapping and pulsed field ablation in the setting of a hybrid video-assisted thoracoscopic atrial fibrillation (AF) ablation procedure. (2) Methods: Eleven consecutive patients underwent hybrid video-assisted thoracoscopic epicardial ablation and left atrial [...] Read more.
(1) Objective: To examine the efficiency and efficacy of using endovascular mapping and pulsed field ablation in the setting of a hybrid video-assisted thoracoscopic atrial fibrillation (AF) ablation procedure. (2) Methods: Eleven consecutive patients underwent hybrid video-assisted thoracoscopic epicardial ablation and left atrial appendage exclusion followed by endocardial ablation using pulsed field ablation energy. The completeness of epicardial and endocardial lesion sets were assessed using 3D electro-anatomical mapping. (3) Results: Left atrial appendage (LAA) exclusion and durable pulmonary vein isolation (PVI) and posterior wall isolation (PWI) were achieved in all patients. The endovascular part of the necessary lesion set using PFA energy was successful in 100% of the patients. All patients remained in SR during the 12-month follow-up period. (4) Conclusions: Our study confirms the feasibility of using endovascular pulsed field ablation to complete previously performed epicardial lesion sets during the hybrid AF ablation procedures, without extending the procedure time or increasing the risk of complications. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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Review

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12 pages, 2146 KB  
Review
Hybrid Ablation in Atrial Fibrillation: Bridging Mechanistic Understanding and Clinical Practice
by Flavia Ravelli, Stefano Branzoli, Alessandro Cristoforetti, Silvia Quintarelli, Alessio Coser, Paolo Moggio, Mark La Meir, Carlo de Asmundis, Luigi Pannone, Francesco Onorati, Roberto Bonmassari and Massimiliano Marini
J. Cardiovasc. Dev. Dis. 2025, 12(8), 313; https://doi.org/10.3390/jcdd12080313 - 19 Aug 2025
Viewed by 293
Abstract
Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, poses a significant burden on global morbidity and healthcare expenditure. Although endocardial catheter ablation and surgical ablation are established therapeutic strategies, each exhibits inherent limitations in achieving comprehensive substrate modification. Hybrid ablation therapy, integrating [...] Read more.
Atrial fibrillation (AF), the most prevalent sustained cardiac arrhythmia, poses a significant burden on global morbidity and healthcare expenditure. Although endocardial catheter ablation and surgical ablation are established therapeutic strategies, each exhibits inherent limitations in achieving comprehensive substrate modification. Hybrid ablation therapy, integrating both endocardial and epicardial approaches, aims to overcome these limitations by enabling the more extensive and transmural targeting of arrhythmogenic foci and the complex atrial substrate. This review synthesizes the electrophysiological basis and mechanistic rationale underpinning hybrid AF ablation, highlighting its potential for an enhanced efficacy compared to isolated techniques. Furthermore, it introduces the emerging paradigm of three-dimensional ablation within this evolving field. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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Other

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11 pages, 5139 KB  
Case Report
Dilated Cardiomyopathy: A Novel BAG3 Mutation Associated with Aggressive Disease Progression and Ventricular Arrhythmias
by Paolo Pastori, Cristina Balla, Marta Rasia, Emilia Lo Jacono, Clelia Guerra, Roberta Schininà, Francesca Gualandi, Matteo Bertini and Giovanni Tortorella
J. Cardiovasc. Dev. Dis. 2025, 12(4), 121; https://doi.org/10.3390/jcdd12040121 - 28 Mar 2025
Viewed by 678
Abstract
We present the case of a 46-year-old man with a history of complex ventricular arrhythmias preceding the development of asymptomatic mild left ventricular dysfunction, who presented with acute-onset heart failure and was ultimately diagnosed with dilated cardiomyopathy. Genetic testing identified a novel, likely [...] Read more.
We present the case of a 46-year-old man with a history of complex ventricular arrhythmias preceding the development of asymptomatic mild left ventricular dysfunction, who presented with acute-onset heart failure and was ultimately diagnosed with dilated cardiomyopathy. Genetic testing identified a novel, likely pathogenic mutation in exon 4 of the BAG3 gene (NM_004281, c.1128del, (p.(Ser377AlafsTer47)), not previously reported in the literature. Given the presence of multiple clinical features indicative of a poor prognosis, he underwent prophylactic placement of a subcutaneous implantable cardioverter-defibrillator. The clinical presentation of this novel BAG3 mutation suggests that it may be associated with a significant arrhythmic phenotype. This case underscores the importance of close follow-up and genetic testing in patients presenting with mild left ventricular dysfunction and ventricular arrhythmias. Full article
(This article belongs to the Special Issue Modern Approach to Complex Arrhythmias, 2nd Edition)
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