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Current Practice and Future Perspectives in Ablation of Atrial Fibrillation
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Current Practice and Future Perspectives in Ablation of Atrial Fibrillation

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

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 18500

Special Issue Editor

Prof. Dr. Sebastien Knecht

E-Mail Website
Guest Editor
AZ Sint Jan Ziekenhuis, Brugge, Belgium
Interests: atrial fibrillation; catheter ablation; technology; pulmonary vein isolation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Atrial Fibrillation (AF) is the most common cardiac arrhythmia and is responsible for increased stroke risk, heart failure and all-cause mortality. Catheter ablation of AF has emerged as the most efficacious treatment to maintain sinus rhythm and has to be considered in symptomatic patients, certainly after AF recurrence despite antiarrhythmic medication. Results of catheter ablation have dramatically improved in the last few years, in line with technological evolution and better understanding and judgement of the lesions performed during the procedure. This is particularly the case for Pulmonary Vein Isolation, which remains the gold standard for any AF procedure and which has been shown to be much more efficient and durable than before. This also seems to be the case for ablation outside PV isolation, which is sometimes necessary to potentially improve the outcome of some patients presenting with persistent AF or left sided flutters.

This special issue will discuss the different aspects of the actual results and expectations from AF ablation and the potential improvements for the future.

Prof. Dr. Sebastien Knecht
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.

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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
  • Pulmonary Vein Isolation
  • Atrial tachycardia
  • Technology

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Published Papers (5 papers)

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Review

10 pages, 246 KiB  
Review
Impact of Catheter Ablation for Atrial Fibrillation on Quality of Life
by Ursula Rohrer, Martin Manninger, Andreas Zirlik and Daniel Scherr
J. Clin. Med. 2022, 11(15), 4541; https://doi.org/10.3390/jcm11154541 - 4 Aug 2022
Cited by 4 | Viewed by 1564
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults. It is a complex arrhythmia leading to increased morbidity and mortality requiring thorough assessment and classification to guide therapy and to assess whether to pursue rate or rhythm control therapy. To obtain [...] Read more.
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults. It is a complex arrhythmia leading to increased morbidity and mortality requiring thorough assessment and classification to guide therapy and to assess whether to pursue rate or rhythm control therapy. To obtain rhythm control, several strategies are available with different advantages and disadvantages concerning success rate and safety. Apart from antiarrhythmic drugs, catheter ablation is a well-established invasive therapy to treat atrial fibrillation. As quality of life is a very important factor to pursue rhythm control, several studies investigated on the specific impact of catheter ablation on quality of life. Catheter ablation shows a beneficial effect on quality of life in paroxysmal and persistent atrial fibrillation independent of the timepoint and strategy of catheter ablation. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation)
17 pages, 2714 KiB  
Review
Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation
by John L. Fitzgerald, Melissa E. Middeldorp, Celine Gallagher and Prashanthan Sanders
J. Clin. Med. 2022, 11(9), 2660; https://doi.org/10.3390/jcm11092660 - 9 May 2022
Cited by 10 | Viewed by 4884
Abstract
Management of atrial fibrillation (AF) requires a comprehensive approach due to the limited success of medical or procedural approaches in isolation. Multiple modifiable risk factors contribute to the development and progression of the underlying substrate, with a heightened risk of progression evident with [...] Read more.
Management of atrial fibrillation (AF) requires a comprehensive approach due to the limited success of medical or procedural approaches in isolation. Multiple modifiable risk factors contribute to the development and progression of the underlying substrate, with a heightened risk of progression evident with inadequate risk factor management. With increased mortality, stroke, heart failure and healthcare utilisation linked to AF, international guidelines now strongly support risk factor modification as a critical pillar of AF care due to evidence demonstrating the efficacy of this approach. Effective lifestyle management is key to arrest and reverse the progression of AF, in addition to increasing the likelihood of freedom from arrhythmia following catheter ablation. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation)
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16 pages, 1381 KiB  
Review
Identifying Atrial Fibrillation Mechanisms for Personalized Medicine
by Brototo Deb, Prasanth Ganesan, Ruibin Feng and Sanjiv M. Narayan
J. Clin. Med. 2021, 10(23), 5679; https://doi.org/10.3390/jcm10235679 - 1 Dec 2021
Cited by 8 | Viewed by 3815
Abstract
Atrial fibrillation (AF) is a major cause of heart failure and stroke. The early maintenance of sinus rhythm has been shown to reduce major cardiovascular endpoints, yet is difficult to achieve. For instance, it is unclear how discoveries at the genetic and cellular [...] Read more.
Atrial fibrillation (AF) is a major cause of heart failure and stroke. The early maintenance of sinus rhythm has been shown to reduce major cardiovascular endpoints, yet is difficult to achieve. For instance, it is unclear how discoveries at the genetic and cellular level can be used to tailor pharmacotherapy. For non-pharmacologic therapy, pulmonary vein isolation (PVI) remains the cornerstone of rhythm control, yet has suboptimal success. Improving these therapies will likely require a multifaceted approach that personalizes therapy based on mechanisms measured in individuals across biological scales. We review AF mechanisms from cell-to-organ-to-patient from this perspective of personalized medicine, linking them to potential clinical indices and biomarkers, and discuss how these data could influence therapy. We conclude by describing approaches to improve ablation, including the emergence of several mapping systems that are in use today. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation)
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15 pages, 1025 KiB  
Review
Review of the 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation—What Has Changed and How Does This Affect Daily Practice
by Johanna B. Tonko and Matthew J. Wright
J. Clin. Med. 2021, 10(17), 3922; https://doi.org/10.3390/jcm10173922 - 30 Aug 2021
Cited by 7 | Viewed by 4950
Abstract
The high prevalence of atrial fibrillation (AF) in the overall population and its association with substantial morbidity, increased mortality and health care cost has instigated significant basic and clinical research efforts over recent years. The publication of multiple new high-quality randomized multi-center trials [...] Read more.
The high prevalence of atrial fibrillation (AF) in the overall population and its association with substantial morbidity, increased mortality and health care cost has instigated significant basic and clinical research efforts over recent years. The publication of multiple new high-quality randomized multi-center trials in the area of AF management and the rapidly evolving technological progress in terms of diagnostic possibilities and catheter ablation in recent years demanded a revision of the previous ESC AF Guidelines from 2016. The 2020 guidelines provide up-to-date, evidence-based guidance for the management of AF. One of the most important innovations is the presentation of a new concept for structural characterization of AF (the “4S AF scheme”) replacing the traditional classification based on its temporal pattern alone (paroxysmal-persistent-permanent). The 4S-AF-scheme highlights the importance of systematic assessment of stroke risk, severity of symptoms, total AF burden and underlying substrate as the foundation for effective and individualized AF treatment for each and every patient. Further novelties relate to the presentation of an easy and intuitive management pathway (“ABC pathway”) and strengthening the recommendations for early rhythm control, in particular the role of first line catheter ablation in heart failure. Another core component of the guidelines is the focus on patient involvement to achieve optimal outcomes. Patient education, shared decision making and incorporation of patient values and patient reported outcome of treatment interventions as well as integrated care by a multidisciplinary team all have a central role in the proposed management pathway for AF. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation)
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9 pages, 601 KiB  
Review
Atrial Fibrillation Ablation in Heart Failure Patients
by Michael Derndorfer, Shaojie Chen and Helmut Pürerfellner
J. Clin. Med. 2021, 10(16), 3512; https://doi.org/10.3390/jcm10163512 - 10 Aug 2021
Cited by 2 | Viewed by 2201
Abstract
Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one [...] Read more.
Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome. Full article
(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation)
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