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Medicina
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New Advances in Atrial Fibrillation
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New Advances in Atrial Fibrillation

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 October 2022) | Viewed by 12553

Special Issue Editors

Dr. Muhammet Ali Aydin

E-Mail Website
Guest Editor
Heart Centre Bremen, Kardiologisch-Angiologische Praxis, 28211 Bremen, Germany
Interests: atrial fibrillation; structural heart disease; aortic valve diseases; device therapy
Dr. Simon Pecha

E-Mail Website
Guest Editor
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
Interests: atrial fibrillation; heart surgery; device therapy

Special Issue Information

Dear Colleagues,

Atrial fibrillation is the most frequent arrhythmia with rising incidences with age. Ten percent of the older population beyond the age of 70 years is supposed to present or suffer from atrial fibrillation. However, the clinical presentation of atrial fibrillation is unpredictable, with a huge spectrum from asymptomatic to severe ill patients. It remains unclear why some patients feel a strong sense of suffering and others do not, even if the general conditions and ECG presentation are completely identical.

It is still a 20-year-old study, the AFFIRM study, that sets the guardrails in the treatment of AF and divides patients into two simple categories: patients receiving rate-controlling treatment and patients receiving rhythm-maintaining treatment. Of course, atrial fibrillation is both a disease in its own right and a symptom that can occur in many, perhaps all, common cardiac conditions.

Is it conceivable that it is time to tailor the therapy to the needs and the underlying diseases. Does atrial fibrillation need to be assessed and treated differently in aortic stenosis than in hypertrophic obstructive cardiomyopathy or ischemic cardiomyopathy?

Still, the pathology of atrial fibrillation remains to be elucidated. We know since the revolutionary work of Prof. Michel Haïssaguerre that ectopic cells in the pulmonary vein are crucial for the initiation of atrial fibrillation. But what about other mechanisms whose significance we know only insufficiently? What is the pathomechanism of atrial fibrillation, for example, in structural heart disease such as aortic stenosis or in ischemic heart disease? What role does micronecrosis, inflammation, or simple "overstretching stimuli" play in triggering and maintaining atrial fibrillation? Perhaps it is a mix of all that: ectopic cells, fibrosis, infection, stretch, and hormonal parameters.

Of course, as we all know, the life expectancy is identical for both frequency control and rhythm control. We need to be more concerned about quality of life and possible sequelae, sometimes with devastating consequences for the individual patient.

Instead of a binary therapy decision, it is time to develop an individual, tailor-made strategy for each atrial fibrillation patient, which takes all accompanying circumstances into account.

The aim of this Special Issue is to shed light on new aspects of the pathomechanism, various manifestations, and the challenges of clinical daily practice of atrial fibrillation.

Dr. Muhammet Ali Aydin
Dr. Simon Pecha
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 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. Medicina 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 2200 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
  • structural heart disease
  • interventional rhythm therapy

Published Papers (6 papers)

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9 pages, 1303 KiB  
Article
E/e’ Ratio Predicts the Atrial Pacing-Induced Left Atrial Pressure Response in Patients with Preserved Ejection Fraction
by Seung-Young Roh, Dae-In Lee, Kwang-No Lee, Jinhee Ahn, Yong-Soo Baek, Dong-Hyeok Kim, Jaemin Shim, Jong-Il Choi and Young-Hoon Kim
Medicina 2023, 59(2), 210; https://doi.org/10.3390/medicina59020210 - 21 Jan 2023
Cited by 1 | Viewed by 1498
Abstract
Background and Objectives: Left atrial hypertension is one of the pathophysiologies of heart failure with preserved ejection fraction. We hypothesized that left atrial pressure response (LAPR) to incremental pacing is higher in patients with atrial fibrillation (AF) and can predict left ventricular diastolic [...] Read more.
Background and Objectives: Left atrial hypertension is one of the pathophysiologies of heart failure with preserved ejection fraction. We hypothesized that left atrial pressure response (LAPR) to incremental pacing is higher in patients with atrial fibrillation (AF) and can predict left ventricular diastolic dysfunction. Materials and Methods: Patients requiring left atrial access as a part of a therapeutic procedure for AF (n = 204, AF group) or supraventricular tachycardia (n = 34, control group) were analyzed (male n = 183, 54 ± 12 years old). LAPR was measured during incremental pacing. Results: Baseline left atrial pressure and LAPR at all pacing rates were not different between the AF and control groups. They were higher in patients with a high E/e’ (≥ 8) than in those with a low E/e’ (<8). LAPR at a pacing interval of 400 ms and E/e’ were positively correlated (r = 0.373, p < 0.001). Body mass index and a high E/e’ were independent predictors of pacing-induced left atrial hypertension. Conclusions: LAPR to incremental pacing was constant regardless of AF. The non-invasive echocardiographic marker E/e’ reflected pacing-induced left atrial hypertension. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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9 pages, 2684 KiB  
Article
A Simplified Approach to Pulmonary Vein Visualization during Cryoballoon Ablation of Atrial Fibrillation
by Omar Anwar, Da-Un Chung, Melanie A. Gunawardene, Christiane Jungen, Jens Hartmann, Christian Meyer, Nele Gessler, Stephan Willems, Samer Hakmi and Christian Eickholt
Medicina 2022, 58(12), 1700; https://doi.org/10.3390/medicina58121700 - 22 Nov 2022
Viewed by 1389
Abstract
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: [...] Read more.
Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p < 0.0001; LA angiography: 297.9 ± 4.62 vs. PV-Angiography: 348.9 ± 11.03; p < 0.001, respectively) per vein were slightly but significantly higher in the PV angiography group. We observed no difference in late AF recurrence (24.7% LA angiography vs. 21.3% PV angiography; p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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10 pages, 1165 KiB  
Article
Atrial Fibrillation and Transvenous Lead Extraction—A Comprehensive Subgroup Analysis of the GermAn Laser Lead Extraction RegistrY (GALLERY)
by Da-Un Chung, Simon Pecha, Heiko Burger, Omar Anwar, Christian Eickholt, Herbert Nägele, Hermann Reichenspurner, Nele Gessler, Stephan Willems, Christian Butter and Samer Hakmi
Medicina 2022, 58(11), 1685; https://doi.org/10.3390/medicina58111685 - 21 Nov 2022
Cited by 1 | Viewed by 1658
Abstract
Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the [...] Read more.
Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the procedural outcome and risk-factors of patients with atrial fibrillation (AF) undergoing TLE. Methods: We performed a subgroup analysis of all AF patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for all-cause mortality were assessed. Results: A total number of 510 patients with AF were identified with a mean age of 74.0 ± 10.3 years. Systemic infection (38.4%) was the leading cause for TLE, followed by local infection (37.5%) and lead dysfunction (20.4%). Most of the patients (45.9%) presented with pacemaker systems to be extracted. The total number of leads was 1181 with a 2.3 ± 0.96 leads/patient. Clinical procedural success was achieved in 97.1%. Occurrence of major complications was 1.8% with a procedure-related mortality of 1.0%. All-cause mortality was high with 5.9% and septic shock being the most common cause. Systemic device infection (OR: 49.73; 95% CI: 6.56–377.09, p < 0.001), chronic kidney disease (CKD; OR: 2.67; 95% CI: 1.01–7.03, p = 0.048) and a body mass index < 21 kg/m2 (OR: 6.6; 95% CI: 1.68–25.87, p = 0.007) were identified as independent predictors for all-cause mortality. Conclusions: TLE in AF patients is effective and safe, but in patients with systemic infection the mortality due to septic shock is high. Systemic infection, CKD and body mass index <21 kg/m2 are risk factors for death in patient with AF undergoing TLE. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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7 pages, 451 KiB  
Article
Complete Left-Atrial Lesion Set versus Pulmonary Vein Isolation Only in Patients with Paroxysmal AF Undergoing CABG or AVR
by Yalin Yildirim, Johannes Petersen, Ali Aydin, Yousuf Alassar, Hermann Reichenspurner and Simon Pecha
Medicina 2022, 58(11), 1607; https://doi.org/10.3390/medicina58111607 - 7 Nov 2022
Cited by 6 | Viewed by 1557
Abstract
Background and Objectives: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in [...] Read more.
Background and Objectives: In patients with paroxysmal atrial fibrillation (AF) undergoing CABG or aortic valve surgery, many surgeons are not willing to open the left atrium to perform a complete left-sided Cox-Maze lesion set. Pulmonary vein isolation (PVI) is often favored in those patients. We investigated the outcome of patients with isolated pulmonary vein isolation compared to those receiving an extended left atrial (LA) lesion set. Materials and Methods: Between 2003 and 2016, 817 patients received concomitant surgical AF ablation in our institution. A total of 268 patients with paroxysmal AF were treated by surgical ablation concomitant to AVR or CABG. Of those, 86 patients underwent a complete left-sided lesion set, while 182 patients were treated with an isolated pulmonary vein isolation. The primary endpoint was freedom from atrial fibrillation at 12 months’ follow-up. Results: There were no statistically significant differences regarding baseline characteristics. No major ablation-related complications were observed in any of the groups. In the PVI group, three patients (1.6%) had an intraoperative stroke, while two (2.3%) patients experienced a stroke in the LA ablation group (p = 0.98). In-hospital mortality was 3.4% in the PVI group, and 2.8% in the extended LA group (p = 0.33). Freedom from AF at 12 months’ follow-up was 76% in the extended LA ablation group and 70% in the PVI group, showing no statistically significant difference (p = 0.32). Conclusion: Surgical AF ablation concomitant to CABG or AVR in patients with paroxysmal AF is safe and effective. There was no statistically significant difference between the compared lesion sets in terms of freedom from AF, survival or stroke rate after 12 months. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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8 pages, 3133 KiB  
Case Report
HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing
by Peter-Stephan Wolff, Anna Winnicka, Adam Ciesielski, Malte Unkell, Grzegorz Zawadzki, Agnieszka Sławuta and Jacek Gajek
Medicina 2022, 58(12), 1828; https://doi.org/10.3390/medicina58121828 - 12 Dec 2022
Cited by 4 | Viewed by 1876
Abstract
Background and Objectives: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. [...] Read more.
Background and Objectives: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. Materials and Methods: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. Results: In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. Conclusion: Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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5 pages, 427 KiB  
Brief Report
The Prevalence of Iron Deficiency in Atrial Fibrillation: Low Hanging Fruit?
by Bachar Alabdullah, David Ferreira, Erin Bourke, Harish Kamalanathan, Ibrahim Elashri, Kushal Porwal, Michael J. Tiller, Payal H. Gadre, Sarah Jones and Michael McGee
Medicina 2022, 58(10), 1492; https://doi.org/10.3390/medicina58101492 - 19 Oct 2022
Viewed by 3997
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. The relationship between AF and iron deficiency is poorly understood. Materials and Methods: We conducted an observational study investigating the prevalence of iron deficiency in those with AF. [...] Read more.
Background and Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. The relationship between AF and iron deficiency is poorly understood. Materials and Methods: We conducted an observational study investigating the prevalence of iron deficiency in those with AF. Iron deficiency was defined by the American College of Cardiology (ACC) criteria for iron deficiency in heart failure. Results: Of 134 eligible subjects, 81 (60.4%) met the ACC definition of iron deficiency in heart failure. Those who were iron deficient were more likely to be female (OR 1.876, p = 0.005), have a history of diabetes mellitus (OR 3.085, p = 0.001) a history of stroke (OR 3.147, p = 0.016), and have higher CHA2DS2-VASc (p ≤ 0.0001) and Charlson Comorbidity Index scores (CCI) (p = 0.007). Conclusions: The prevalence of iron deficiency in those with AF appears high and warrants evaluation in a prospective study. Full article
(This article belongs to the Special Issue New Advances in Atrial Fibrillation)
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