{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:59:20Z","timestamp":1761663560686,"version":"build-2065373602"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although immediate recurrence of atrial fibrillation (IRAF) after cardioversion has been proposed as a surrogate for atrial substrate vulnerability, its broad definition may insufficiently discriminate patients at highest risk of postablation recurrence. We introduced the concept of ultra\u2010early recurrence of AF (URAF)\u2014defined as recurrence within 10\u2009s after direct current cardioversion (CV) under deep sedation\u2014as a novel marker of advanced remodeling in persistent atrial fibrillation (AF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether URAF independently predicts late recurrence following pulmonary vein isolation (PVI) in patients with persistent or long\u2010standing persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 104 patients undergoing first\u2010time PVI for persistent AF. Among 93 patients who underwent external CV, URAF, and IRAF were defined as AF recurrence within 10 and 90\u2009s, respectively. Recurrence of atrial arrhythmias was assessed at 12\u2009m postablation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      URAF was observed in 10\/104 patients (9.6%) and was associated with higher 12\u2010m recurrence compared with URAF\u2010negative patients (50% vs. 18%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), whereas IRAF (20\/104, 19.2%) showed no significant difference (30% vs. 19%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.28). On multivariable logistic regression, URAF (Odds Ratio (OR): 4.8; 95% Confidence Interval (CI): 1.16\u201319.98;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029) and long\u2010standing AF (OR: 5.5; 95% CI: 1.70\u201317.78;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) emerged as independent predictors of recurrence. Kaplan\u2013Meier analysis showed worse recurrence\u2010free survival for URAF (log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02; HR 4.5, 95% CI 1.18\u201317.41).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>URAF may represent a promising intra\u2010procedural marker associated with post\u2010ablation recurrence in persistent AF, but prospective validation in larger cohorts is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70212","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T04:15:32Z","timestamp":1760760932000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultra\u2010Early Recurrence of Atrial Fibrillation After Direct Cardioversion Predicts Late Recurrence After Ablation for Persistent Atrial Fibrillation"],"prefix":"10.1002","volume":"41","author":[{"given":"Hiroto","family":"Sugiyama","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"},{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5101-6926","authenticated-orcid":false,"given":"Yoshimi","family":"Onishi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"},{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Onuki","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"},{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8048-4890","authenticated-orcid":false,"given":"Shuhei","family":"Arai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Yoshikawa","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Mase","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuya","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9433-3484","authenticated-orcid":false,"given":"Masaaki","family":"Kurata","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshitaka","family":"Iso","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4735-5816","authenticated-orcid":false,"given":"Taku","family":"Asano","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University Fujigaoka Hospital  Yokohama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiro","family":"Shinke","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Showa Medical University  Tokyo 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