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Atrial Fibrillation and Heart Failure: Diagnostic and Therapeutic Challenges and Breakthroughs

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

Deadline for manuscript submissions: 20 July 2026 | Viewed by 3363

Special Issue Editors

Dr. Silvius Alexandru Pescariu

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Guest Editor
1. Department VI—Cardiology, “Victor Babeș” University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
2. Research Centre of the Institute of Cardiovascular Diseases, G. Adam Str. no 13A, Timisoara, Romania
Interests: atrial fibrillation; heart failure; pacemakers; cardiac electrophysiology; ischemia; mitral valve
Dr. Felix Bratosin

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Guest Editor
Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Interests: gut microbiome; infectious diseases; antimicrobial resistance; respiratory infections; opportunistic infections
Special Issues, Collections and Topics in MDPI journals
Dr. Cristian Mornos

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Guest Editor
Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, Timisoara, Romania
Interests: heart failure; ischemic coronary disease; advanced echocardiography; cardiac imaging; myocardial dysfunction; clinical significance of basic science; innovative diagnostic tools
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As Guest Editors, we welcome submissions for this Special Issue exploring atrial fibrillation and heart failure. This Special Issue explores the complex, bidirectional relationship between atrial fibrillation (AF) and heart failure (HF). These are some of the most common and most complex pathologies, with extremely high relevance in research, especially within the clinical setting. With both conditions contributing synergistically to increased morbidity and mortality, this Special Issue highlights current diagnostic dilemmas, mechanistic insights, and therapeutic strategies. Emphasis is placed on clinical approaches, imaging techniques, risk stratification tools, and integrated care models. Contributors may present cutting-edge research, including pharmacologic and interventional innovations, aiming to optimize clinical outcomes as well as improve the quality of life. By addressing both shared and distinct clinical pathophysiological pathways, this collection offers a vast and comprehensive perspective on some of cardiology’s most clinical pressing burdens.

Dr. Silvius Alexandru Pescariu
Dr. Felix Bratosin
Dr. Cristian Mornos
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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

  • atrial fibrillation
  • heart failure
  • cardiac electrophysiology
  • ventricular remodelling
  • rhythm control
  • catheter abla-tion
  • neurohormonal activation
  • biomarkers
  • ischemia
  • integrated cardiovascular care

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Published Papers (2 papers)

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Research

15 pages, 580 KB  
Article
Chronic Low-Grade Inflammation: A Possible Link Between COVID-19 and New-Onset Atrial Fibrillation
by Ciprian Ilie Roșca, Daniel Florin Lighezan, Daniel-Dumitru Nișulescu, Nilima Rajpal Kundnani, Romina Georgiana Bita, Ariana Violeta Nicoras, Christian Banciu and Andreea Munteanu
J. Clin. Med. 2026, 15(5), 1750; https://doi.org/10.3390/jcm15051750 - 25 Feb 2026
Viewed by 2530
Abstract
Background: Persistent inflammation and endothelial dysfunction have been proposed as key mechanisms of post-COVID cardiovascular sequelae and may contribute to atrial fibrillation (AF). We examined whether inflammatory/prothrombotic biomarkers and endothelial function differ between post-COVID patients and controls, and whether baseline inflammation/endothelial dysfunction relates [...] Read more.
Background: Persistent inflammation and endothelial dysfunction have been proposed as key mechanisms of post-COVID cardiovascular sequelae and may contribute to atrial fibrillation (AF). We examined whether inflammatory/prothrombotic biomarkers and endothelial function differ between post-COVID patients and controls, and whether baseline inflammation/endothelial dysfunction relates to AF burden at 12 months. Methods: In this single-center, retrospective observational study, 198 outpatients were enrolled: 99 post-COVID patients evaluated 3–6 months after documented SARS-CoV-2 infection (Group 1) and 99 age- and sex-matched controls without prior COVID-19 (Group 2). At baseline (t0), clinical characteristics, inflammatory/prothrombotic biomarkers, brachial artery flow-mediated dilation (FMD), and 24 h Holter ECG were assessed in both groups. Univariable linear regression tested associations between baseline variables and FMD in Group 1. At 12 months (t1), 24 h Holter ECG was repeated in both groups. Quartile analyses were performed according to baseline neutrophil-to-lymphocyte ratio (NLR) to explore AF distribution across inflammatory strata. Results: At baseline, post-COVID patients had higher inflammatory and prothrombotic markers than controls (ESR, CRP, fibrinogen, and D-dimer; all p < 0.0001) and markedly lower FMD (7.72 vs. 13.72; p < 0.0001). In Group 1, FMD was inversely associated with multiple inflammatory/prothrombotic markers (all p < 0.0001), with the strongest association for ESR (R2 = 0.6297). Holter-detected AF prevalence at baseline did not differ significantly between groups (25/99 [25.3%] vs. 18/99 [18.2%]). At 12 months, AF prevalence was numerically higher in the post-COVID group (32/99 [32.3%] vs. 21/99 [21.2%]); on two-sided testing, this difference was borderline (p = 0.047) and should be interpreted cautiously. Across increasing baseline NLR quartiles, AF prevalence increased stepwise in both groups (post-COVID: 2/25, 5/25, 10/24, 15/25; controls: 1/25, 3/25, 7/24, 10/25), consistent with the enrichment of AF in higher-inflammatory strata. Conclusions: Post-COVID patients exhibited a persistent inflammatory–prothrombotic profile and pronounced endothelial dysfunction at baseline. At 12 months, AF burden was numerically higher post-COVID, and AF clustered in strata characterized by higher baseline NLR and lower FMD, consistent with an inflammation–endothelial dysfunction axis associated with subsequent AF burden. Prospective studies with standardized rhythm monitoring and comprehensive multivariable adjustment are warranted. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure: Diagnostic and Therapeutic Challenges and Breakthroughs)
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14 pages, 403 KB  
Article
Mitral Valve Abnormalities as Predictors of Procedural Success in Alcohol Septal Ablation: A Pilot Study
by Raluca Coifan, Monica Mircea, Alexandru Silvius Pescariu, Oana Voinescu, Bogdan Enache, Laurentiu Pascalau, Mihai-Andrei Lazăr, Ionut Golet, Adrian Sturza, Constantin Tudor Luca, Adina Ionac and Cristian Mornos
J. Clin. Med. 2026, 15(3), 1031; https://doi.org/10.3390/jcm15031031 - 28 Jan 2026
Viewed by 294
Abstract
Background/Objectives: Alcohol septal ablation (ASA) is an established interventional therapy for patients with obstructive hypertrophic cardiomyopathy (OHCM) who remain symptomatic despite optimal medical treatment. Nevertheless, 10–20% of patients fail to achieve a satisfactory hemodynamic or clinical response, highlighting the need for improved [...] Read more.
Background/Objectives: Alcohol septal ablation (ASA) is an established interventional therapy for patients with obstructive hypertrophic cardiomyopathy (OHCM) who remain symptomatic despite optimal medical treatment. Nevertheless, 10–20% of patients fail to achieve a satisfactory hemodynamic or clinical response, highlighting the need for improved patient selection. Given that mitral valve (MV) morphology plays a central role in left ventricular outflow tract (LVOT) obstruction, we aimed to evaluate the impact of MV anatomical parameters on ASA outcomes. Methods: We retrospectively analyzed 38 OHCM patients who underwent ASA and had complete echocardiographic data before and at 6-month follow-up. Patients were stratified into responders (n = 32, defined as >50% reduction in LVOT pressure gradient and/or residual LVOT gradient < 50 mmHg) and non-responders (n = 6, <50% reduction or persistent gradient ≥ 50 mmHg), consistent with criteria used in previous ASA outcome studies. MV parameters—including redundant anterior mitral leaflet (AML) length, posterior mitral leaflet (PML) projection, and anterior displacement of the coaptation point (AML/PML projection ratio)—were compared between groups. Results: Non-responders demonstrated significantly greater AML redundancy (13.16 ± 1.72 vs. 9.96 ± 1.99 mm, p < 0.001), larger PML projection (18.5 ± 3.78 vs. 13.65 ± 3.8 mm, p = 0.006), and lower AML/PML projection ratio (0.80 ± 0.15 vs. 1.34 ± 0.45, p = 0.007). These parameters were associated with reduced post-procedural LVOT gradient reduction in univariate logistic regression (p = 0.01, p = 0.027, p = 0.015, respectively). Multivariate modeling was not pursued due to collinearity among MV parameters and the limited number of non-responder events, which precluded robust adjustment. Conclusions: Mitral valve morphological features—particularly redundant AML, greater PML projection, and anterior displacement of the coaptation point—were associated with suboptimal ASA outcomes in univariate analysis. These data emphasize the need for comprehensive MV imaging in pre-procedural assessment. Integrating MV morphology into current selection algorithms may refine ASA patient selection and improve long-term success rates. Full article
(This article belongs to the Special Issue Atrial Fibrillation and Heart Failure: Diagnostic and Therapeutic Challenges and Breakthroughs)
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