{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:40Z","timestamp":1792812700766,"version":"4.5.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:00:00Z","timestamp":1608163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007497","name":"Biosense Webster","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1 : 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF\/atrial tachycardia (AT) at 3\u2009years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n\u2009=\u2009128, AAD, n\u2009=\u2009127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3\u2009years of follow-up. For the primary endpoint, the Kaplan\u2013Meier estimate of the rate of persistent AF\/AT at 3\u2009years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6\u20139.4%)] than with AAD therapy [17.5% (95% CI, 10.7\u201327.9%); one-sided P\u2009=\u20090.0009]. Patients \u226565\u2009years were \u223c4 times more likely to progress to persistent AF\/AT than patients &amp;lt;65\u2009years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88\u201317.00); P\u2009=\u20090.0727]. Primary adverse events were reported for eight patients in the RF ablation group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euaa298","type":"journal-article","created":{"date-parts":[[2020,9,28]],"date-time":"2020-09-28T11:22:00Z","timestamp":1601292120000},"page":"362-369a","source":"Crossref","is-referenced-by-count":215,"title":["Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST)"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2649-3870","authenticated-orcid":false,"given":"Karl-Heinz","family":"Kuck","sequence":"first","affiliation":[{"name":"Department of Cardiology, Asklepios Klinik St. Georg, LANS Cardio, Stephansplatz 5, 20354 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2334-1663","authenticated-orcid":false,"given":"Dmitry S","family":"Lebedev","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Centre, St. Petersburg, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6553-9141","authenticated-orcid":false,"given":"Evgeny N","family":"Mikhaylov","sequence":"additional","affiliation":[{"name":"Almazov National Medical Research Centre, St. Petersburg, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Romanov","sequence":"additional","affiliation":[{"name":"E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e1szl\u00f3","family":"Gell\u00e9r","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskars","family":"Kal\u0113js","sequence":"additional","affiliation":[{"name":"P. Stradins Clinical University Hospital, Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Neumann","sequence":"additional","affiliation":[{"name":"Kerckhoff Klinik, Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3788-3997","authenticated-orcid":false,"given":"Karapet","family":"Davtyan","sequence":"additional","affiliation":[{"name":"National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Keun","family":"On","sequence":"additional","affiliation":[{"name":"Arrhythmia Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Popov","sequence":"additional","affiliation":[{"name":"Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7113-2084","authenticated-orcid":false,"given":"Maria Grazia","family":"Bongiorni","sequence":"additional","affiliation":[{"name":"Second Division of Cardiology, University Hospital, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-7745","authenticated-orcid":false,"given":"Michael","family":"Schl\u00fcter","sequence":"additional","affiliation":[{"name":"Asklepios Proresearch, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asklepios Klinik St. Georg, LANS Cardio, Stephansplatz 5, 20354 Hamburg, Germany"},{"name":"Almazov National Medical Research Centre, St. Petersburg, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifan","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asklepios Klinik St. Georg, LANS Cardio, Stephansplatz 5, 20354 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"2021042811443854000_euaa298-B1","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1161\/CIRCEP.112.970749","article-title":"Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real-life global survey evaluating patients with atrial fibrillation international registry","volume":"5","author":"Chiang","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021042811443854000_euaa298-B2","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1093\/eurheartj\/ehw007","article-title":"The 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