Atrial Fibrillation: New Insights and Perspectives

Special Issue Editors


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Guest Editor
Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
Interests: electrocardiogram with concurrent imagingmagnetic resonance imagingatrial fibrillationcardiac arrhythmiaroc curve

E-Mail Website
Guest Editor
Cardiology Department, Centre Hospitalier Universitaire de Saint Etienne, Saint-Etienne, France
Interests: cardiology; electrophysiology; atrial fibrillation

Special Issue Information

Dear Colleagues,

Atrial fibrillation (AF) represents the most common sustained arrhythmia, associated with substantial mortality and morbidity, particularly in patients with heart failure (HF). The current standard of care, transcatheter pulmonary vein isolation (PVI) using thermal ablation techniques, has been proven to show symptom relief but also benefits in patients with HF or persistent AF. Despite these benefits, thermal ablation carries a risk of collateral tissue damage. In recent years, new insights in the causes of AFib evolution as well as in treatment efficacy have been found. For example, pulsed field ablation (PFA), a nonthermal technique based on irreversible electroporation, has emerged as a promising alternative to the conventional thermal ablation method. Accordingly, new advances in AF knowledge and treatment should be focused on in terms of the latest scientific data and releases.

Dr. Jean-Baptiste Guichard
Prof. Dr. Antoine Da Costa
Guest Editors

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Keywords

  • atrial fibrillation
  • electroporation
  • thermal ablation
  • pulmonary vein isolation
  • pulsed field ablation
  • Marshall alcoholization
  • clinical trials
  • dispersion
  • mapping

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Published Papers (1 paper)

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Research

15 pages, 2903 KiB  
Article
Electrophysiological Substrate and Pulmonary Vein Reconnection Patterns in Recurrent Atrial Fibrillation: Comparing Thermal Strategies in Patients Undergoing Redo Ablation
by Krisztian Istvan Kassa, Adwity Shakya, Zoltan Som, Csaba Foldesi and Attila Kardos
J. Cardiovasc. Dev. Dis. 2025, 12(8), 298; https://doi.org/10.3390/jcdd12080298 - 2 Aug 2025
Viewed by 379
Abstract
Background: The influence of the initial ablation modality on pulmonary vein (PV) reconnection and substrate characteristics in redo procedures for recurrent atrial fibrillation (AF) remains unclear. We assessed how different thermal strategies—ablation index (AI)-guided radiofrequency (RF) versus cryoballoon (CB) ablation—affect remapping findings during [...] Read more.
Background: The influence of the initial ablation modality on pulmonary vein (PV) reconnection and substrate characteristics in redo procedures for recurrent atrial fibrillation (AF) remains unclear. We assessed how different thermal strategies—ablation index (AI)-guided radiofrequency (RF) versus cryoballoon (CB) ablation—affect remapping findings during redo pulmonary vein isolation (PVI). Methods: We included patients undergoing redo ablation between 2015 and 2024 with high-density electroanatomic mapping. Initial PVI modalities were retrospectively classified as low-power, long-duration (LPLD) RF; high-power, short-duration (HPSD) RF; or second-/third-generation CB. Reconnection sites were mapped using multielectrode catheters. Redo PVI was performed using AI-guided RF. Segments showing PV reconnection were reisolated; if all PVs remained isolated and AF persisted, posterior wall isolation was performed. Results: Among 195 patients (LPLD: 63; HPSD: 30; CB: 102), complete PVI at redo was observed in 0% (LPLD), 23.3% (HPSD), and 10.1% (CB) (p < 0.01 for LPLD vs. HPSD). Reconnection patterns varied by technique; LPLD primarily affected the right carina, while HPSD and CB showed reconnections at the LSPV ridge. Organized atrial tachycardia was least frequent after CB (12.7%, p < 0.002). Conclusion: Initial ablation strategy significantly influences PV reconnection and post-PVI arrhythmia patterns, with implications for redo procedure planning. Full article
(This article belongs to the Special Issue Atrial Fibrillation: New Insights and Perspectives)
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