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Cardiac Electrophysiology: New Insights and Future Directions
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Cardiac Electrophysiology: New Insights and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 4933

Special Issue Editor

Dr. Michael Spartalis

E-Mail Website
Guest Editor
3rd Department of Cardiology, National and Kapodistrian University of Athens, 17674 Athens, Greece
Interests: cardiac electrophysiology; device therapy; atrial fibrillation; ventricular arrhythmias; sudden cardiac death; catheter ablation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Amidst the worldwide COVID-19 pandemic, significant progress has been made over the previous years regarding our comprehension of arrhythmia processes and diagnostics, as well as the development of novel therapeutics.

Our knowledge of the risk factors and processes of atrial arrhythmias, as well as the ability to anticipate and treat them, has been enhanced by the application of machine learning and artificial intelligence. Recent advancements in the field of atrial fibrillation ablation have introduced novel technology and techniques, such as pulsed field ablation. Recent randomized trials in atrial fibrillation ablation have provided valuable information regarding rhythm control and long-term results. Significant progress has been made in comprehending the management of inherited disorders, such as catecholaminergic polymorphic ventricular tachycardia. We have acquired understanding regarding the reappearance of ventricular arrhythmias in the context of different illnesses, such as myocarditis and inherited syndromes. Advanced computational methods can be used to forecast the occurrence of ventricular arrhythmias and accurately identify the location of the arrhythmias in order to assist with ablation procedures. Our comprehension of noninvasive radiotherapy has made additional progress.

We have enhanced our comprehension of the role of His bundle pacing and left bundle branch area pacing in order to uphold simultaneous ventricular activation. Significant progress has also been made in the field of defibrillators, cardiac resynchronization therapy, remote monitoring and infection prevention. Moreover, significant progress has been made in comprehending the paths and mechanisms responsible for the development of atrial and ventricular arrhythmias.

In the current Special Issue, we focus on the latest advancements, developments and discoveries in the domain of identifying and managing rhythm disturbances. Furthermore, manuscripts summarizing the current state of knowledge, original articles on arrhythmias related to specific diseases or disciplines, and those highlighting potential gaps in our understanding are also welcome.

Dr. Michael Spartalis
Guest Editor

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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • cardiac arrhythmias
  • atrial fibrillation
  • ventricular arrhythmias
  • remote monitoring
  • implantable cardioverter–defibrillators
  • cardiac resynchronization therapy
  • catheter ablation
  • channelopathies

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Published Papers (4 papers)

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Research

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9 pages, 1176 KiB  
Communication
Comparison of Oral Procainamide and Mexiletine Treatment of Recurrent and Refractory Ventricular Tachyarrhythmias
by Mauro Toniolo, Daniele Muser, Giacomo Mugnai, Luca Rebellato, Elisabetta Daleffe, Claudio Bilato and Massimo Imazio
J. Clin. Med. 2024, 13(20), 6099; https://doi.org/10.3390/jcm13206099 - 13 Oct 2024
Cited by 1 | Viewed by 986
Abstract
Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and [...] Read more.
Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias when the standard therapy strategy failed. Methods: All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in two cardiology divisions between January 2010 and January 2020 were enrolled. Patients were divided into group A (oral procainamide) and group B (mexiletine) and the two groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All events that occurred during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when a ≥80% reduction of the sustained ventricular arrhythmias burden recorded by the ICD was achieved. Results: A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the VA burden. After multivariable adjustment, therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06–6.14, p = 0.03). Only three patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy compared with six patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p = 0.47). Conclusions: Compared to mexiletine, oral procainamide had a higher efficacy for the treatment of recurrent and refractory VAs, and showed a good profile of tolerability. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)
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23 pages, 762 KiB  
Article
Harmonizing Heartbeats: The Mosaic of Cardiac Resynchronization Therapy Responders—A Comprehensive Exploration of Diverse Criteria and Predictors
by Elke Boxhammer, Sophie Zauner, Johannes Kraus, Christian Dinges, Christiana Schernthaner, Franz Danmayr, Tobias Kolbitsch, Christina Granitz, Lukas J. Motloch, Matthias Hammerer, Michael Lichtenauer, Uta C. Hoppe and Bernhard Strohmer
J. Clin. Med. 2024, 13(16), 4938; https://doi.org/10.3390/jcm13164938 - 21 Aug 2024
Viewed by 1262
Abstract
Background: Heart failure (HF) remains a challenging healthcare issue necessitating innovative therapies like cardiac resynchronization–defibrillation therapy (CRT-D). However, the definition of a CRT-D response lacks uniformity, impeding effective clinical evaluation. This study explores diverse CRT-D responder definitions encompassing functional, echocardiographic and laboratory criteria. [...] Read more.
Background: Heart failure (HF) remains a challenging healthcare issue necessitating innovative therapies like cardiac resynchronization–defibrillation therapy (CRT-D). However, the definition of a CRT-D response lacks uniformity, impeding effective clinical evaluation. This study explores diverse CRT-D responder definitions encompassing functional, echocardiographic and laboratory criteria. Materials & Methods: A single-center study involving 132 CRT-D patients scrutinized responder criteria including NYHA stage, LVEF increase and proBNP decrease. Statistical analyses such as Kaplan–Meier curves and Cox hazard regression were employed to evaluate responder characteristics and survival outcomes. Results: Responder rates varied across criteria, revealing nuanced patient profiles. CRT-D responders defined by NYHA decrease, LVEF increase or proBNP decrease exhibit improved survival rates after 2 and 3 years (p < 0.050). Young age, absence of recent myocardial infarction and normal right ventricular echocardiographic parameters emerge as predictors for positive response. In part, drug-based HF therapy correlates with increased responder rates. Cox regression identified LVEF ≥ 5% and proBNP decrease ≥ 25% as independent predictors of extended survival. Conclusions: CRT-D responder definitions exhibit considerable variability, emphasizing the need for a nuanced patient-centered approach. Factors like right ventricular function, drug therapy, atrial fibrillation and renal function influence responses. This study enriches our understanding of CRT-D response and contributes to the foundation for personalized HF management. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)
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13 pages, 1537 KiB  
Article
Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation
by Márton Boga, Gábor Orbán, Péter Perge, Zoltán Salló, Edit Tanai, Arnold Béla Ferencz, Patrik Tóth, Ferenc Komlósi, István Osztheimer, Klaudia Vivien Nagy, Béla Merkely, László Gellér and Nándor Szegedi
J. Clin. Med. 2024, 13(7), 1960; https://doi.org/10.3390/jcm13071960 - 28 Mar 2024
Cited by 1 | Viewed by 1108
Abstract
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates [...] Read more.
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)
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Review

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11 pages, 2278 KiB  
Review
Cardioneuroablation in the Management of Vagally Mediated Bradyarrhythmias—A Comprehensive Review of Ongoing Randomized Controlled Trials
by Przemysław Skoczyński, Sebastian Stec, Anna Ratajska, Magdalena Zając, Bruno Hrymniak, Anna Kustroń, Agnieszka Andrejków, Edyta Stodółkiewicz-Nowarska, Janusz Śledź and Dariusz Jagielski
J. Clin. Med. 2025, 14(2), 592; https://doi.org/10.3390/jcm14020592 - 17 Jan 2025
Viewed by 973
Abstract
Cardioneuroablation is a rapidly developing procedure for the treatment of vagally mediated bradyarrhythmias. However, the lack of multicenter, randomized trials prevents it from being included in bradyarrhythmia treatment guidelines. So far, only one small, randomized study has been published assessing the effectiveness of [...] Read more.
Cardioneuroablation is a rapidly developing procedure for the treatment of vagally mediated bradyarrhythmias. However, the lack of multicenter, randomized trials prevents it from being included in bradyarrhythmia treatment guidelines. So far, only one small, randomized study has been published assessing the effectiveness of this method in the treatment of reflex syncope. This is a brief review of ongoing randomized trials evaluating the effectiveness and safety of cardioneuroablation for the treatment of functional bradyarrhythmias. Full article
(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)
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